Author: A.T.

But first: “A lawyer, a spy, a mob boss, and a money launderer walk into a bar. The bartender says: you guys must be here to talk about adoption.” — Dr. A on Twitter

And whom do you believe — Eric Trump in 2013 (“We don’t rely on American banks. We have all the funding we need out of Russia.”) or Eric Trump denying he ever said that?

And why did Deutsche Bank loan him all that money?  Was there a Russian connection?

Why was the Vice Chair of a famous Russian money-laundering bank in Cyprus chosen to be our Secretary of Commerce?

And why was a guy Trump had not previously known — paid $10 million a year to help Putin — chosen to head Trump’s campaign?  Whose idea was that?

And why was the guy chosen to run — and gut — the State Department the only one of those being considered whom Putin awarded the Order of Friendship?

And why did Trump’s Attorney General lie about his contact with Russians?

And why did his National Security Advisor lie about his contact with Russians?

And why did his son Donald lie about his contact with Russians?

And why did son-in-law Jared attempt to set up a back-channel connection with the Russians that US intelligence would be unable to detect?

And why did Jared omit his Russia contacts from from his SF-86 disclosure form?  (And why does he still have security clearance?)

And why does Trump seem so happy whenever he’s with the Russians, inviting them and their photographer, but no American photographer, into the Oval Office; switching seats to seek out Putin for an hour’s chat at the G20 dinner?

And why does Trump still not accept the intelligence community’s assessment that Russia worked to influence our election?

When Trump fires Sessions to install someone to fire Mueller, he will explain that all this nothing-burger stuff is detracting from his (unparalleled) ability to get us all GREAT health care at a tiny fraction of the cost . . . make America safe again by getting Mexico to build a beautiful wall . . . and boost our economy by negotiating great trade deals.

Which brings us to . . .

John Mauldin’s report on the trade war that Trump is teeing up.  (By pulling out of the TPP, Trump’s already ceded American leadership in the Pacific to China.)

. . . Candidate Trump talked about renegotiating trade agreements to help American workers. I support that goal. The problem is that President Trump seems intent on starting a trade war that will hurt those same workers. We are on a very dangerous course. Worse, if a report I saw last week is accurate, that course is already locked in.

. . . This is what Axios reported June 30, based on the input of anonymous Trump-administration sources:

Read the whole letter, but the gist of the Axios report was that “One official estimated the sentiment in the room as 22 against [imposing 20% steel tariffs] and 3 in favor — but since one of the three is named Donald Trump, it was case closed.”

Apparently, our president has created a National Trade Council and put a discredited economics professor at its helm — someone who understands trade in the same way Trump’s EPA chief “understands” climate change or Trump himself “understands” health care — which is why we all now have GREAT health care at not just a fraction of the price (which would have been amazing) but at a “tiny” fraction of the price.  It was so easy!

Make no mistake: Putin is winning.

As I wrote earlier this month . . .

My fantasy — and it is only that — is that some crisis a month or three down the road triggers a lawsuit that can only be decided by the Supreme Court.  And that that Court, though captured by the right, somehow finds the fundamental patriotism and fairness to say something like this:

Seventeen years ago this Court faced a national crisis and — in a ruling it went out of its way to brand as non-precedential — made a tough and widely criticized call that, in effect, gave George W. Bush the Presidency and, as it happened, the opportunity to appoint two of us to this body.

Last year, the Senate made the unprecedented decision not to allow the President to fill a vacancy on this Court, on the grounds that the will of the people as expressed in 2008 and 2012 did not give him that authority — the Senate needed to see how the people leaned in 2016.  As we now know, the people — not the Electoral College, the people — leaned toward the Democratic candidate.

Today we face a new crisis.  In developments that have been building all year, it has become clear that the 2016 election results were interfered with by a massive Putin-directed thumb on the electoral scale — a thumb the existence of which the Trump team long denied knowledge of but of which we now know they were well aware.  In that context, we have been called upon to overturn the 2016 result as tainted, and to order a workable mechanism by which the country can move forward and regain its footing.

We hereby direct former presidents Obama and Bush, acting in concert, to recommend to this Court, in the shortest time possible, an interim president and vice president to serve out the remainder of this presidential term — or a shorter term if a majority of the House and Senate shall call for an earlier election.

Or something like that.  And Barack and George, very different people but both sane patriots, would perhaps recommend to the Court Joe Biden and Mitt Romney; the Court would approve; and most of the nation — not having attained anything like great health care at a tiny fraction of the cost — nor remotely to have tired of “winning so much they got tired of winning” — would breathe a huge sigh of relief.  As would the world.

Or they could just give it to Hillary, who did get more votes despite it all.  But Putin/Trump have been so effective at getting people to misperceive her (she is wonderful and would have made a great president), it could fail to give the same sense of closure.

Here’s the trailer for a documentary on the different “shades” of gender identity.  (I’m the old, square one.)

Commented one audience member on IMDB after seeing Between the Shades‘ debut at a film festival last month: “I am a straight man, and I went to see it with a straight woman. We both stood-up and cheered as the credits rolled at the end, loving each and every participant, fully embracing the individuality of us all, and the deft hand of the filmmakers. We were definitely entertained and elevated.”

How the world has changed.

At least a good chunk of it.

But these two minutes show how much harder it is for non-conforming people to live in places like Turkey and Russia and Uganda.  (They might have included Texas — for example and example — though Texans now enjoy certain federal protections that the Republican Party was unsuccessful in blocking.)

And here are seven minutes with a law student from New Jersey — atheist dad, Catholic Mom — and their attempts to deal with his sexuality.  Hard not to like this guy.

From Between the Shades:

“No matter how different people are, everybody wants to be loved.”

“If you meet someone and fall in love with them, why would you let anything stop you from love? And that’s really what it comes down to.”

Love is love.  No?

Have a great weekend!

Our Republican friends prevented us from creating millions of good new jobs revitalizing our crumbling infrastructure — lest a strong economy improve Obama’s chances at reelection, and because the plan included a surcharge on income above $1 million a year to pay for it.

Similarly, they’ve worked hard to impede, and now destroy, the Affordable Care Act, because it imposes an extra 3.8% tax on dividends and capital gains above a certain level — an extra $3.8 million in tax for every $100 million you earn.  The billionaires most influential in the Republican Party hate that tax, even though the combined rate (23.8%) is still lower than it was after Ronald Reagan’s eight years (28%).

(Democrats have wealthy supporters, too, but many of them are Patriotic Millionaires, either explicitly or in spirit.)

Rather than accept Medicaid expansion, that would have helped so many of their constituents, many Republican governors actually eschewed that federal aid.  And rather than work to improve the ACA — by allowing Uncle Sam to negotiate prescription drug prices, and adding yet a further 2%, say on investment income above $1 million (still below Reagan’s top rate) — they are hell-bent on its demise.

Republican Game-Playing Is Responsible for Three-Quarters of 2018 Obamacare Rate Increases.

It looks like health insurance rates will go up a lot next year, but not because medical inflation is high or because insurers aren’t making money under Obamacare. Mostly it’s because insurers are nervous about whether they’re going to lose the CSR subsidies that are part of Obamacare. President Trump has deliberately chosen to keep this dangling, so insurers have to raise their rate requests in case he decides to stop paying it. Insurers are also nervous about the individual mandate, which helps bring young, healthy customers into the insurance pool. Republicans have been talking about officially forbidding the IRS from enforcing it, and if that happens rates will have to go up too.

Charles Gaba has gone through the rate requests of 20 states, and he figures that these two things account for about 71 percent of the size of the rate hikes that have been requested so far. In other words, if insurers in your state are asking for a 20 percent increase, 6 percent of that is from normal causes and 14 percent is from deliberate Republican efforts to destabilize the individual market.

California’s exchanges are well run, and the state is fully committed to Obamacare. The state insurance commissioner has asked insurers to submit two rate requests for 2018, one with and one without uncertainty over CSR and the mandate, and these rate requests are set to be unveiled on Monday. It’s going to be an important bellwether.

WHEELTUG ENTHUSIASTS: Narration has been added to the Paris Airshow video.

Well, a very small step.

But Parvez Sharma’s book, A Sinner In Mecca: A Gay Muslim’s Hajj of Defiance, will be released next month, and if enough of us pre-order it, we will help initiate the virtuous cycle that makes books successful.  Success begets success.

You don’t even have to read it!  Give it to your local library if it doesn’t interest you.  (“Putting his own life at risk, the author takes us on a surprising and compelling journey through the front lines of his much-contested faith.” — Reza Aslan, author of the #1 New York Times best-seller Zealot.)

It’s the story of his film by the same name.  (“Brilliant . . . rare . . . takes aim at Wahhabi Islam” — Vice. “A rebuke of Saudi Arabia” — Yahoo News.  “A swirling, fascinating travelogue and a stirring celebration of devotion.” — New York Times Critics Pick.  “Revelatory.” — Washington Post.)

Islam can go two ways, as most of us can: peace and love and light . . . or, if sufficiently misled, desperate, or disrespected, something inhuman and horrifying.  Kind of like me: most of the time, a teddy bear . . . but make me crazy enough, as the local FedEx did recently, over nothing (which was part of what made me crazy!), and Dr. Jekyll becomes Mr. Hyde. May you never see my dark side.

Parvez is on the side of sweetness and light.  And gives heart, and spiritual support, to those who would modernize the faith and condemn barbaric Wahhabism.

So let’s see if we can get his book picked up here and around the world.  Click.

MILLENNIALS SAVING FOR RETIREMENT

My pal Bob Pozen wrote this piece for The Hill on the savings habits of millennials — those aged 20 and 36. They’re saving at a pretty good clip, which is great — but more for rainy days and nice vacations rather than for retirement. One structural reason is that half aren’t offered a retirement plan at work. Sure, they could open an IRA on their own (a Roth! read all about it!), but most don’t. Bob urges Congress to adopt the Automatic IRA, which would require employers with over 20 employees not offering a plan of their own to hook up their payroll systems to an IRA provider (Fidelity, Vanguard, whomever) and send regular IRA contributions from their employees paychecks — unless they opted out.

Smart.

Need a break from the negative?  Watch this TED Talk:

Inventor Manu Prakash turns everyday materials into powerful scientific devices, from paper microscopes to a clever new mosquito tracker. From the TED Fellows stage, he demos Paperfuge, a hand-powered centrifuge inspired by a spinning toy that costs 20 cents to make and can do the work of a $1,000 machine, no electricity required.

Or watch Mozart with a sense of humor.  (Thanks, Mel!)

Our petulant, vulgar, narcissistic president lies uncontrollably* and has dramatically diminished our standing in the world . . . but that’s okay, because we’re about to get “great health care at a tiny fraction of the cost.”

He and his team are deeply in bed with our principle adversary of the past 70 years . . . but that’s okay because Russia’s no longer communist. (Now it’s a journalist-murdering oligarchy run by a kleptocrat who hopes to — and is impressively succeeding at — destabilizing our democracy.) 

And because everybody’s getting the aforementioned health care. (“It’s going to be so easy.“)

He carries Tic Tacs wherever he goes, kept a book of Hitler’s speeches by his bedside, mocks the disabled, is on his third wife, and is everything Jesus deplored — but that’s okay, because — well, truthfully, I can’t imagine why it’s okay.  Yet it is, with 82% of self-identified Republicans. 

Oh.  And did I mention that he knows nothing about the complex issues that confront mankind? 

But plans to solve them by giving huge tax cuts to the uber-wealthy?

If you don’t think that will work, join MoveOn’s Resistance Summer.  Or the DNC’s Resistance Summer.  (Great minds think alike.)  Or find your own way to resist.  We need to fix this.

*Even FOX is beginning to call out the lies.  Watch.  Or the truncated clip.

I saved this for a Friday so you have the whole weekend to watch Bernie addressing a high school class 2003.  It’s an hour.

Steve:  “I wish I had seen it before the 2016 primaries.  I wish millions of us had seen it.  Hillary might still have been our candidate, but some of the candidates who lost winnable elections might have run better campaigns, and we would have won big instead of losing big. Progress, not disaster. . . . I’d love to see him make a high school video again in 2018.  I’d love to see progressives in every state do it, in majority white working class school districts as well as in big cities, and in community college classrooms and college classrooms too. . . . I think such videos are  powerful because they’re about our kids as they near voting age. We all love them, we all want what’s best for them, and we all know they are our future.  We all love our country, and, in the end,  most of us want to get along   If more such videos were made, many would go viral, mainstream media would cover them, and mainstream media narratives would change.  After all, on most issues, progressive positions have majority support, and the mainstream media — journalists, editors, and even publishers and owners — know this.  Many of us know it.   If more of us acted on what we know,  cynicism would decline.  Democrats would nominate more progressives, turnout would rise, small donations would more often beat big ones, and more and more Democrats and independents, at every level, would win.  Maybe we’d take back the Congress next year, and a lot of state governments too, and undo some of the harm Trump and the GOP has caused.  We’d win the presidency and the Congress in 2020.  After that, if we stayed together and didn’t overreach, we’d win again and again. Little by little our country would heal.  We’d enter a new era. And if enough of us still believe in American democracy  we can enter it soon.”

☞ I love the sentiment, and we should for sure try — though it’s not clear to me that thoughtful videos do have the power to go viral.  Bernie’s high school Q&A has scored barely 200,000 hits.  This one has scored nearly 3 billion.

Whichever candidate you favored in 2016 — even Trump — I think Bernie’s video may resonate with you.

I was neutral.  Though I privately believed Hillary would likely have made more progress, as president, toward the goals both she and Bernie shared — which was almost all of them — I’d have done all I could to vault Bernie into the Oval Office, had he won the primary.

Ellie: “If the Democrats, especially the DNC, had run a clean game, Bernie would have crushed Hillary.  I will never forgive them for that, and I blame them for all the horrors that have followed, as Bernie would have crushed Trump also.”

☞ The DNC had nothing to do with the READY FOR HILLARY movement that gave her a 2-year head start — we sure didn’t prevent Bernie from doing the same.  A two-year head start, with millions of dollars and millions of names is hard to overcome.  As is a sense of inevitability, which as the primaries began was widespread.

When the nascent field was Clinton, Webb, O’Malley, Sanders, and Chaffee, I think most democrats were mainly focused on holding the White House and — thrillingly, to some — electing the first woman president (who, by the way, was the most qualified nominee of ANY gender ever to run for the office, even including Bernie).

So the DNC chair at the outset of the process wanted to do everything appropriately — and sought input from all her predecessors — but was not focused on helping Chaffee or Webb or O’Malley or Sanders tear down our all-but-inevitable candidate or use up Democratic resources that could be used to hold the White House and perhaps take back Congress,  I think these things were in her mind.

Most of the specific charges against the DNC on the Bernie/Hillary score are either just wrong or exaggerated.  I’ve run thru a few of them in months past.  For more on that, please take a look.

I’m not saying that, with the benefit of hindsight, every single decision was ideal.  But in the context of the time at which it was made — early on, when Hillary seemed inevitable; or at the end, after she had in fact sewn it up but Bernie kept going in hopes the superdelegates would override the popular vote — I think there was just much less to fault than many of my fellow Bernie fans believe.  (It is possible to be both a Hillary and a Bernie fan — I am living proof.)

One particularly sad example of that was revealed in the WikiLeaks, when the DNC CFO — a wonderful guy who had devoted 20 years to the cause, as solid and well-meaning as they come — was caught in a private email having suggested the press ask Bernie about his religious beliefs.  Terrible out of context (and not fantastic in context), but the context matters: Hillary had won (unless superdelegates chose to override the popular vote, which was simply not going to happen); yet Bernie was continuing to campaign and suck in tens of millions of tremendously-well-intentioned Democratic dollars that could serve only to weaken Hillary’s chances against the Republican, and weaken the sense of unity we’d need to win (which Bernie later worked admirably to promote).

In that context, charged with trying to build the DNC war chest so we could win, the CFO and others were frustrated.  So in a private email (that was, properly ignored), he tossed out a bad, idea.

I’m not justifying it, but it had zero impact on Bernie’s campaign — and cost him his career (and the DNC, a key team member with institutional memory no one else had).

Had he made that suggestion in the thick of things, when Bernie clearly had a chance, it would have an attempt to put a thumb on the scale.  But that’s not when it happened.  It happened when Bernie — who had lost — was, unintentionally, I’m sure — hurting our chances of holding the White House.

So timing and context matter.

Finally, Ellie asserts Bernie would have beaten Trump.  I sure as heck would have tried to help him. And it’s easy just to state that — how could anyone not beat Trump?  Yet the one talent Trump does seem to have, other than bankrupting businesses at no cost to himself, is destroying opponents.  And in attempting to distort Bernie’s terrific qualities and qualifications, he would likely have had even more support from the business community, who would have perceived him as more of a threat than Hillary.

I truly don’t know whether Bernie would have won, but I am skeptical of those who feel they DO know.

Anyway, that’s my two cents.  Watch the video.  We’re all on the same team, wanting much the same things, as Steve says.  We need to come together whenever possible.  If we do, we may right the ship after all.

Happy Bastille Day.  Vive la France.

Halo Top — imagine: eating an entire pint of ice cream without guilt.

And we’re not joking. While Halo Top is low-calorie, high-protein, and low-sugar, we use only the best, all-natural ingredients to craft our ice cream so that it tastes just like regular ice cream. We know it sounds too good to be true, so don’t just take our word for it — dig in and see for yourself just how good healthy ice cream can be!

The peanut butter (320 calories in the entire pint) is insane.  The vanilla bean (240) shouts for a pint of blueberries as its complement.  Has there ever been a better summer than this?  (Ice cream-wise?)

Here’s their story.  And here’s what happened when a guy ate nothing but Halo Top for 10 days (spoiler alert: he lost 10 pounds).  I wouldn’t go that far.  But a pint a night?

Meanwhile, the summer, non-ice-cream-wise, continues to deteriorate, as our truly dangerous president dumps 70 years of earned world leadership down the drain — at a time when the world needs all the steady leadership it can get.

Monday I quoted the Australian journalist whose two-minute assessment has gone viral.  (More from that clip: “Trump has pressed fast forward on the decline of the United States as a global leader.”  At the G20 “He managed to isolate his nation, to confuse and alienate his allies, and to diminish America.  He will cede that power to China and Russia — two authoritarians states that will forge a very different set of rules for the 21st Century.  Some will cheer the decline of America. But I think we’ll miss it when it’s gone.  And that’s the biggest threat to the values of the West which he claims to hold so dear.”)

Really worth the two minutes — and forwarding to friends who voted for Trump expecting “great health care for everybody at a tiny fraction of the cost” — which he said would be easy.

Then again, he also said he would “absolutely” release his tax returns if he ran for president, that he saw thousands of Muslims cheering as the Twin Towers fell, that his investigators in Hawaii had found amazing stuff about Obama’s true birthplace, that he had won the presidency by a wider margin than anyone since Reagan — and that he carries Tic Tacs everywhere he goes.

This man cannot be our president.

Pence is apparently gearing up (read it here). Just what we need — a medieval theocrat.

My fantasy — and it is only that — is that some crisis a month or three down the road triggers a lawsuit that can only be decided by the Supreme Court.  And that that Court, though captured by the right, somehow finds the fundamental patriotism and fairness to say something like this”

“Seventeen years ago this Court faced a national crisis and — in a ruling it went out of its way to brand as non-precedential — made a tough and widely criticized call that, in effect, gave George W. Bush the Presidency and, as it happened, the opportunity to appoint two of us to this body.  Last year, the Senate made the unprecedented decision not to allow the President to fill a vacancy on this Court, on the grounds that the will of the people as expressed in 2008 and 2012 did not give him that authority — the Senate needed to see how the people leaned in 2016.  As we now know, the people — not the Electoral College, the people — leaned toward the Democratic candidate.  Today we face a new crisis.  In developments that have been building all year, it has become clear that the 2016 election results were interfered with by a massive Putin-directed thumb on the electoral scale — a thumb the existence of which the Trump team long denied knowledge of but that we now know they were well aware.  In that context, we have been called upon to overturn the 2016 result as tainted, and to order a workable mechanism by which the country can move forward and regain its footing.  We hereby direct former presidents Obama and Bush, acting in concert, to recommend to this Court, in the shortest time possible, an interim president and vice president to serve out the remainder of this presidential term — or a shorter term if a majority of the House and Senate shall call for an earlier election.”

Or something like that.  And Barack and George, very different people but both sane patriots, would perhaps recommend to the Court Joe Biden and Mitt Romney; the Court would approve; and most of the nation — not having attained anything like great health care at a tiny fraction of the cost — nor remotely to have tired of “winning so much you’ll get tired of winning” — would breathe a huge sigh of relief.  As would the world.

Or they could just give it to Hillary, who did get more votes despite it all; but Putin/Trump have been so effective at getting people to misperceive her (she is wonderful and would have made a great president), it could fail to give the same sense of closure.

I’m now going to have a full pint of Halo Top chocolate ice cream (280 calories).

What Congress should really be working on.

From the Wall Street Journal:

The Smart-Medicine Solution to the Health-Care Crisis
Our health-care system won’t be fixed by insurance reform. To contain costs and improve results, we need to move aggressively to adopt the tools of information-age medicine

By Eric Topol

. . . No matter how the debate in Washington plays out in the weeks ahead, we will still be stuck with astronomical and ever-rising health-care costs. The U.S. now spends well over $10,000 per capita on health care each year. . . .

. . . Our health-care system is uniquely inefficient and wasteful. The more than $3 trillion that we spend each year yields relatively poor health outcomes, compared with other developed countries that spend far less. . . .  more than 1 in 4 patients harmed while in the hospital; more than 12 million serious diagnosis errors each year; a positive response rate of just 25% for patients on the top 10 prescription medications in gross sales.

. . . Radical new possibilities in medical care are not some far-off fantasy. Last week in my clinic I saw a 59-year-old man with hypertension, high cholesterol and intermittent atrial fibrillation (a heart rhythm disturbance). Before our visit, he had sent me a screenshot graph of over 100 blood pressure readings that he had taken in recent weeks with his smartphone-connected wristband. He had noticed some spikes in his evening blood pressure, and we had already changed the dose and timing of his medication; the spikes were now nicely controlled. Having lost 15 pounds in the past four months, he had also been pleased to see that he was having far fewer atrial fibrillation episodes—which he knew from the credit-card-size electrocardiogram sensor attached to his smartphone.

In my three decades as a doctor, I have never seen such an acceleration of new technology, both hardware and software, across every dimension of medical practice. . . .

Smart medicine offers a way out, enabling doctors to develop a precise, high-definition understanding of each person in their care. The key tools are cheaper sensors, simpler and more routine imaging, and regular use of now widely available genetic analysis. . . .

One obvious practical effect of these developments will be to replace hospital stays with remote monitoring in the patient’s home. The Food and Drug Administration has already approved wearable sensors that can continuously monitor all vital signs: blood pressure, heart rate and rhythm, body temperature, breathing rate and oxygen concentration in the blood. The cost to do this for weeks would be a tiny fraction of the cost for a day in the hospital. Patients will be able to avoid serious hospital-acquired infections and get to sleep in their own beds, surrounded by family.

We do more than 125 million ultrasound scans a year in the U.S., at an average charge of well over $800 — that’s $100 billion. But we now have ultrasound probes that connect with a smartphone and provide exquisite resolution comparable to hospital lab machines. It is possible to examine any part of the body (except the brain) simply by connecting the probe to the base of a smartphone and putting a little gel on the probe’s tip. When I first got a smartphone ultrasound probe last year, I did a head-to-toe “medical selfie,” imaging everything from my sinuses and thyroid to my heart, lungs, liver, gallbladder, aorta and left foot.

That experience came in handy when I recently developed pain in my flank. Seeing my very dilated kidney on my smartphone screen helped to confirm the diagnosis that I had a kidney stone. The CT scan later ordered by my doctor showed a nearly identical image, but the charge for that was $2,200. If this single tool was used in a typical office visit, a large proportion of expensive and unnecessary formal scans could be avoided.

Smart medicine can also bring some sanity to how we handle medical screening, which today results in an epidemic of misdiagnoses and unnecessary procedures and treatments. The leading culprits are routine tests for breast and prostate cancer for individuals at low risk for these diseases. Because the tests have such extraordinarily high rates of false positives, they result all too often in biopsies, radiation and surgery for people in no medical danger.

It would not be hard to use screening tests in a more discriminating way, for the much smaller population that really should worry about certain serious health problems. Genome sequencing for an individual — identifying all three billion base pairs in a person’s genetic makeup — can now be done for about $1,000, and we know a great deal about which genes predispose someone to conditions such as cancer and heart disease. . . .

Routine use of individual genetic information could also allow us to prescribe drugs more effectively, avoiding the waste, in clinical time and in money, caused by medications that misfire. . . .

Smart medicine can also transform the doctor-patient relationship. Most medical services today are still provided in the traditional outpatient setting of a doctor’s office. It takes an average of 3.4 weeks to get a primary care appointment in the U.S., and there’s little time allotted for each visit. Most doctors provide a minimum of eye-to-eye contact as they busily record the session on a keyboard.

The frustrations and inefficiencies of this system are obvious — and unnecessary. In the era of telemedicine consults, there is no reason to wait weeks for an appointment. For the same copay as an office visit, connection with a doctor can occur instantly or within minutes. With increasing use of patient-generated data from sensors and physical exam hardware that connects with a smartphone, the video chats of today will soon be enriched by extensive data transfer. . . .

. . . In a paper last year in the Journal of the American Medical Association, authors Andrew Beam and Isaac Kohane, specialists in biomedical informatics, calculated that advances in artificial intelligence now make it possible for computers to read as many as 260 million medical scans in a day, at a cost of $1,000. The advances in diagnostic power would be enormous, to say nothing of the cost savings. . . .

Fortunately, serious ventures in smart medicine are well along. . . .

But more could certainly be done to move us toward better health outcomes at lower costs. Perhaps some enterprising member of Congress will propose a Frugal Health Care Innovation Act, providing government incentives for technology, research and implementation. Such public support for electric cars has rapidly changed the face of the whole auto industry. American medicine today is no less antiquated than the Detroit of a generation ago, and it needs to find its way into the present century.

---

Dr. Topol is a cardiologist and professor of molecular medicine at the Scripps Research Institute in San Diego and the author of The Patient Will See You Now: The Future of Medicine Is in Your Hands. He consults for Illumina and Apple on some of the issues discussed here, sits on the board of directors of Dexcom and is a co-founder of YouBase.

First — magic!  (How do they DO this?)

But now, what could be true magic:  How to Make Congress Bipartisan, by National Review executive editor, Reihan Salam, and FairVote executive director, Rob Richie, in the New York Times.

You already know the bad news — a completely dysfunctional, polarized legislature.

 . . . The good news is that there is a way out: replacing our winner-take-all elections with a form of proportional representation where every voter matters in every election. It comes in the form of the Fair Representation Act, a bill introduced recently by Representative Don Beyer, a Democrat from Virginia, that is centered on two key changes.

Step 1 is to elect House members with ranked-choice voting in primary and general elections, a system proven in a dozen cities and adopted in Maine for congressional elections. Voters are able to rank candidates in order of choice, and their votes go to second choices if their first choice is in last place and loses.

Step 2 is to establish congressional districts with multiple representatives. Smaller states with fewer than six seats would elect all seats statewide. In bigger states, independent commissions would draw districts designed to elect up to five seats based on traditional criteria like keeping counties intact. Multi-winner districts were used in some House elections as recently as the 1960s and remain common in local and state elections.

What would transform politics would be combining [the two]. . . .

Consider Connecticut, where Democrats in 2016 easily won all five congressional seats, and Oklahoma, where Republicans won all five seats by landslide. Under the Fair Representation Act, House candidates would run statewide in both states. Voters would rank the candidates on their ballots. In the first round of counting, any candidate with one-sixth of the vote plus one would win a seat, while the last place candidate would be eliminated and her votes redistributed among the remaining candidates. This process would continue until all five seats were filled. The complex math of the process is in service of a simple principle: ensuring that a majority group elects the most seats, but not more than its fair share.

The result: Republicans would likely win two seats in Connecticut, and Democrats a seat or two in Oklahoma. And the same result would be replicated across the nation: A computer projection of how the law would work showed that in all states with at least three House seats, there would be no single-party districts.

That means there would be rural Democrats and urban Republicans. Members of both major parties would share districts, with new incentives to collaborate on legislation addressing their shared constituents’ needs. Candidates would be forced to reflect a greater mix of views and voters would have real choices, including third party and independent candidates. A more representative and functional Congress would regain legitimacy.

Congress not only has the power to act to reform its elections, but the obligation. In the past, it mandated single-winner congressional districts to avoid partisans manipulating outcomes with at-large elections, but that approach has led to today’s polarized politics. It’s time for a better standard.

Spread the word.  And could we please get rid of the Electoral College?  Here’s how we get that done: The National Popular Vote Interstate Compact.  Spread that word, too.

Because as Thomas Jefferson put it in 1816 (later inscribed on the Southeast Wall of his Memorial): “I am not an advocate for frequent changes in laws and constitutions. But laws and institutions must go hand in hand with the progress of the human mind. As that becomes more developed, more enlightened, as new discoveries are made, new truths discovered and manners and opinions change, with the change of circumstances, institutions must advance also to keep pace with the times. We might as well require a man to wear still the coat which fitted him when a boy as civilized society to remain ever under the regimen of their barbarous ancestors.