Loose Lips Sink Ships: The Difference Between Leakers, Whistleblowers, and Plain Old Criminals

The Twitter POTUS has filled his Administration with amateurs and old political hands with no direct loyalty to him. A combination of slip ups by the inexperienced and deliberate revelations by shocked professionals has produced a deluge of leaked information, the likes of which the Press has never seen. They, and we, have been delighted by the Trump White House’s informational unseaworthiness. However, since Donald Trump exposed an Israeli asset by sharing intelligence with the Russians, we have seen a slight shift in the public discussion of leaks. The Press has simultaneously glorified leakers of Trumpian misdeeds as patriots and condemned Trump himself  as a danger to international security for “leaking” intelligence to Russia. In the last week someone in the Trump Administration has also leaked information about the Manchester bombing of an Ariana Grande concert to the FBI, causing the United Kingdom to suspend intelligence sharing for 24 hours. The question is, has the Press been hypocritical in its treatment of leaks? The answer is no. The problem here is that we are using the same word – “leaks” – for a few different types of information dumps. There are three types of leaks going on here: personal leaks that irritate Donald Trump, leaks revealing government lawbreaking, and leaks revealing top secret information unrelated to government misconduct. Here are the differences, and why they are important.

Palace intrigue, or will Sean Spicer get fired this week?

Gossip, or “palace intrigue,” about what Trump is planning, thinking, or saying is what most people really mean when they say the Trump Administration has more “leaks” than past Presidencies, and they are the primary source of Trump’s fury. Here are some examples: in April Vanity Fair told us that Kellyanne Conway didn’t really have a defined job, and might be on her way out; we also heard that there is a behind-the-scenes war going on between Jared Kushner and Steve Bannon, and that Steve Bannon might get canned; now it seems that poor, abused Sean Spicer might be about to get the boot (after all, we’ve heard Trump didn’t like that Spicey was being played by a woman on Saturday Night Live).

The only person harmed by these revelations is Donald Trump, but he has very little ability to stop them, because the relevant information is not privileged or classified and the Supreme Court has made it almost impossible for a public figure, especially a politician, to sue the Press for defamation.  These leaks are completely harmless to the institutional stability of the United States, and they are source of gleeful schadenfreude to those of us who dislike Trump. However, the public discussion has failed to distinguish between these relatively harmless inside baseball reports and the types of information dumps that implicate the Press’s official role in our constitutional Republic.

Whistleblowing, or I don’t think we’re supposed to be bombing Cambodia

Whistleblowers are “leakers” who reveal information that is classified but alerts the public to some kind of government misconduct of which it is unaware. Accurately and responsibly reporting information provided by whistleblowers is the highest calling of the Press. New York Times v. United States, more commonly known as the Pentagon Papers case, made clear that the First Amendment allows the Press to print classified information it receives, so although it is illegal for a whistleblower to distribute the information to the Press, it is not illegal for the Press to distribute it to the people. Famous examples include Daniel Ellsberg, who leaked the Pentagon Papers, Mark Felt a.k.a. Deep Throat, who leaked aspects of the Watergate investigation, and Edward Snowden, who leaked information about the NSA’s surveillance of American citizens (he also belongs in the third category, though more on that later).

The hallmark of a true whistleblower is the revelation of an abuse of government power either against American citizens, or by one branch of government against the other. For instance, Daniel Ellsberg leaked the Pentagon papers because they proved not only that the Johnson Administration lied to the American people about whether Vietnam was winnable, but that Johnson lied to Congress, proving, to Ellsberg, the necessity of Congressional war powers.  Edward Snowden revealed that the NSA was collecting vast troves of data on American citizens without a warrant.  Mark Felt kept the Washington Post apprised of the progress of the Watergate investigation at the FBI, and was a huge part of Nixon’s eventual downfall. Imagine what would have happened if there had been no revelations to the public about Nixon’s dirty tricks, and he had been treated like a normal President? Do you think his henchmen would have flipped? I doubt it. It is the interaction of whistleblowers like Felt and Ellsberg with a Free Press that keeps our government as honest as we can make it.

Dirty leaking criminals, or guess who tapped Angela Merkel’s cell phone?

All leaks of classified information are crimes; when those leaks compromise the function of the US Government and our international relations, they can be catastrophically damaging, and the perpetrators should be treated accordingly.  It’s hard to discuss this issue without wading into the Edward Snowden controversy, so here I go: he’s not a hero, but he could have been, and he serves as a great illustration of the difference between whistleblowers and plain old criminals. There are about ten major revelations from Snowden. Two of them, alerting us to the collection of telephone metadata and PRISM, were legitimate blows of the whistle. Well done, Ed. The other eight (revealing the tapping of Angela Merkel’s phone, proprietary NSA technology, and spying by the British GCHQ in London) did not reveal government misconduct, they just told our adversaries how we operate and our friends that we can’t be trusted with information. These revelations perform no essential constitutional function; they are therefore inexcusable. The recent leak of information about the Manchester bombing falls into this category. There was no government misconduct there – the leaker was just delivering a scoop, and impeded a major counterterrorism action being undertaken by our closest ally. Trump’s revelation of information gained from an Israeli spy was hugely controversial for the same reason – he compromised an asset of a close ally for no reason.

Don’t let Trump lump leaks together

Going forward, it’s important to distinguish which type of leak is being discussed by the Trump Administration and in the Press. Does this leak involve classified information? If not, no one’s committing a crime, they’re just making Trump’s life difficult. If classified information or the contents of a criminal investigation are involved, is this information essential for an informed public to interact with government? All of the leaks and testimony about Trump’s involvement with Russia are important because the public needs to make electoral decisions with the full picture – it needs to approach Trump’s decisions vis a vis Russia with the proper context. However, if leaks of government information don’t serve the public, it’s important to support any Administration, even Trump’s, in rooting out the perpetrators. There is a difference between careful, deliberate revelations taken for the public good, and plain old loose lips. Loose lips can get people killed, and when there is no public good in the balance, deliberate revelations of classified information from allies is a serious crime, the prosecution of which we should all support.



Cancer Treatment In Germany: What Happens When The Government Doesn’t Want You To Die

A note from Pie Face: I am admittedly and unreservedly biased toward the German system of universal healthcare. You can read more about it here, but in sum it is a mixture of state regulated nonprofit health insurance organizations, or “social” care, and private insurers.  Healthcare providers are mostly private. German healthcare is cheap, fast (faster than here, usually) and of excellent quality. Maple Pie describes below what it’s like to navigate the German system as a cancer patient, including pre- and post- operative care.

By Maple Pie

I have two insurance policies for medical and dental care. The “obligatory” one is from a public health insurance company of my choice and gives me standard universal coverage for an income-based monthly fee. The optional one is from a private health insurance company, a so-called supplementary policy which covers me for semi-private stationary hospital treatment, i.e. a two-bed room and treatment by the head doctor or his authorised substitute. I can have a one-bed room if I pay the extra cost from my own pocket.

When a standard screening for bowel cancer turned up positive, my family doctor gave me an acute referral for a proctologist. The enteroscopy, given under sedation, confirmed there was a malignant tumour that needed to be removed in a hospital. The necessary referrals in hand, I went home and laid down for the rest of the afternoon while my husband phoned around for advice. It turned out an acquaintance was Head Visceral Surgeon and a Professor at a nearby University Teaching Hospital!

I was in hospital for further diagnostic work within about 10 days. The results were discussed in a conference of doctors from all relevant disciplines, which set up the roadmap for further treatment. A port was set just below my right shoulder to allow chemotherapy with a pump system (a very gentle method), a tumour marker was set and radiation appointments arranged.

A referral from a local oncologist entitled me to out-patient treatment in the hospital’s Oncology and Nuclear Medicine Departments. Regular blood work, medication,  chemo, radiology and regular feedback from doctors were all taken care of in the hospital and registered in my “Therapy Pass”. A good prognosis , co-ordinated treatment, regular feedback and the luck to have read Randy Pausch’s “The Last Lecture” before my cancer was discovered provided me with a positive attitude.

The Operation took place 3 months after the original diagnosis. After 24 hours in intensive care I was back in my room. A specialist  arrived to check the pain killer machine and a physiotherapist came with first exercises, e.g. how to get into a sitting position or to roll out of bed.

By the time I was released a good week later I had been set up with an ostomy therapist to help me handle my colostomy pouch independently and the hospital social worker had booked me for a post operative care measure in Bayrisch Gmein, a spa near Bad Reichenhall.  This is a three-week rehab sponsored by a private cancer treatment initiative and must be begun within 14 days after hospital release. Without going into detail, it was fantastic; an individually tailored and co-ordinated programme for medication, diet, physio- and psychotherapy, further colostomy pouch training,  and informative seminars on, for example, further relevant treatment and how to manage the paperwork involved. Free time was spent in the legendary spa, Bad Reichenhall, to which we had access.

Three months after the first operation the colostomy could be reversed.  I had access to the proctology department and my ostomy therapist took care of the paperwork necessary to set me up with necessary hygiene and medical aids. The public health care policies cover the cost of pouches, lingerie protectors, etc. up to a certain level. Patients pay a small per cent of the cost of such articles and must cover “extras” themselves.

Every three months after the colostomy reversal I have been called into the Oncology Department for regular blood checks and occasional CTs, enteroscopies, chest X-rays, etc.  The results are discussed with the oncologist who manages my case. This year I have graduated to a six-month rhythm.  Throughout the treatment my family doctor and I have received relevant documentation of tests and medical reports for our records. All in all, my treatment has been competent and comprehensive, and I am more than satisfied with the results.

After The Monuments: Coming To Terms With History And Hate

Yesterday the last of the much-maligned Confederate statues was removed from Lee Circle in New Orleans, ending a two year battle over how to deal with the city’s – and the South’s – veneration of its “Lost Cause.” Watching a city I love in the throes of an uncharacteristic battle between hateful white supremacists and aggrieved activists has brought home to me the degree to which America has failed to wrestle with a defining fact of its history: while it lost the argument about the supremacy of the federal government, the Confederacy won the Civil War. Terrorist actions all over the South and the cost of enforcing Union policies soured northerners’ taste for the Reconstruction that would have ended white supremacy. After that, Southerners got sharecropping, which was scarcely better or freer than slavery, and Jim Crow. They spread their propaganda all over the country with Birth of a Nation, which lionized the KKK. They argued for “states’ rights” so often the rest of the country forgot or ignored that it is a euphemism for white supremacist oligarchy. Even northern textbooks taught that the Civil War wasn’t really about slavery. And when black southerners migrated north in search of a freer life, they faced less obvious but still permanent racial restrictions. For over a hundred years our history has been written by unacknowledged Confederate victors. I think the movement to erase Confederate monuments from the public square is the expression of an unaddressed need for what the Germans call Vergangenheitsbewältigung, or processing and coming to terms with history. We can’t process our history by wiping the public square clean of the evidence of American apartheid. We have to use it.

Destroying evidence doesn’t help the victims of a crime

Confederate monuments all over the Southern and border States are evidence and must be used to teach the true history of the United States. Both sides of the New Orleans monuments controversy are wrong. Leaving these monuments up as they were doesn’t preserve history, it celebrates mythology. However, tearing them down and hiding them away somewhere like Beauvoir (the home of Confederate President Jefferson Davis) does not erase the white supremacy they represent any more than bulldozing Dachau would have helped erase the impact of the Holocaust. Americans need to be taught about the truth of the Civil War and its aftermath. We need to understand that it had many facets; it was a war about slavery, but it was also a war about whether states could challenge federal power. I would argue that the South functionally won the first question, while the North won the second – and unforgivably waited 100 years to enforce it in favor of black Americans, benefiting economically from Southern practices all the while. We need to understand the nuance that comes with all human history – that Confederates were not universally bad, and that some important ones evolved on the issue of civil rights. Most importantly, we all need to understand the length of scope of the oppression black Americans suffered after the war that was supposed to liberate them. The only way to do that is to use the evidence at hand – statues erected decades after the civil war to Confederate leaders and white supremacist terrorists – to prove that the American history we have been taught is upside down.

These monuments tell an important story about the reality of post-civil war America

The existence of all four monuments taken down by the City of New Orleans proves that the regime in charge 130 years ago revered and celebrated the Confederacy and its cause. Two of them also represent specific lessons about the good and the bad in New Orleans after the Civil War. This first important monument is to the Battle of Liberty Place, an insurrection by white supremacists against the Reconstruction government of New Orleans. This monument was nothing more and nothing less than a homage to racist terrorists who wanted to re-take the city in order to oppress a hefty percentage of its citizens. The fact that it stood, prominently displayed, in the middle of a modern American city until 1989 (and still stood tucked in a corner until 2017) says pretty much all you need to know about the degree to which the South’s commitment to white supremacy (and the North’s quiet enabling of it) has dominated American history. That monument needs to be displayed prominently in an educational context in a public place in the City of New Orleans to teach this history to future generations.

So does the monument to Pierre Gustave Toutant-Beauregard, the man who fired the first shots of the Civil War. He wasn’t just a Confederate General, he was also a prominent advocate for the civil rights of freedmen after his side was “defeated.” He was the most prominent advocate of the New Orleans Unification movement, which saw local Democratic lawmakers and business leaders unite with local wealthy pre-war free people of color to propose equal representation in government for both races and integration of the schools, among other things. It represents New Orleans’s unique pre-war racial dynamics, and an attempt by one of the most prominent Confederates to accept defeat and move on. Beauregard’s change of heart demonstrates that individual opinions varied, and the City of New Orleans has a history at odds with the glorification of Liberty Place. It is certainly an injustice that we have failed for so long to acknowledge the true legacy of the Confederacy. However, it would be foolish and dangerous to overcompensate by pretending that everyone in the Confederacy or in the history of the South should be dismissed as wholly malevolent for participation in white supremacy. Among other things, painting the entire history of every white southerner as purely evil will simply provoke resistance to the message, even in sympathetic people. Coming to terms with history means coming to terms with the whole of history, not creating a new anti-Southern mythology to replace the old pro-Southern mythology. Fortunately, other states and countries have had creative solutions to this problem.

Education, Truth, and Reconciliation

I think possibly the best way to use the Confederate statues removed this month is to create something like Memento Park in Budapest.  The Hungarian government understandably removed a great many public statues after the fall of Communism. They represented Russian ideological control of the country and all of the wrongs done by the Hungarian regime against its people. So the government created a curated presentation of those statues designed to educate future generations about their oppressive past. Can you imagine a similar exhibit in City Park in New Orleans? I can. I think it would be a powerful start to the reconciliation this country sorely needs right now, which can only come from processing the whole truth of our history.

That sort of reconciliation through truth has been going on in Maryland, and I think they have the right idea. In front of the Maryland State House stands a statue of Chief Justice Roger B. Taney, a Marylander who wrote the infamous Dred Scott decision, and who opposed Abraham Lincoln’s emancipationist policies until his death in 1864.  This year, the descendants of Taney and Scott met at the statue and Taney’s descendant apologized to the Scott family. The Scott family asked that the State “Add to [the statue], don’t take from it,” suggesting it would be educational to add a statue of Scott and explanation of the court case to the statue of Taney. There is also a movement for the addition of a statue of Frederick Douglass, another Marylander with a profound impact on the Civil War. These ideas will use and value history, rather than attempting to erase an ugly past or hide it away on a plantation. If there is one thing the New Orleans battle over Confederate monuments has taught us, it is this: failing to come to terms with the history of American apartheid and the people who participated in it – the good, the bad, and the ugly – will only create two polarized mythologies and contribute to the schism in our national life.

Why The Special Counsel Ain’t Special Enough To Stop Trump

This week the US and the world received a well-deserved bit of relief from the scandal-plagued disaster that is the Trump Presidency: Deputy Attorney General Rod Rosenstein has appointed former FBI Director Robert Mueller as the Justice Department’s Special Counsel for the investigation into the Trump Campaign’s ties to Russia. This is undeniably welcome news; the furor ensuing from Donald Trump’s decision to fire FBI Director James Comey has revealed that Attorney General Jeff Sessions has no intention of respecting his promised recusal from matters relating to the Russia investigation. Appointing a Special Counsel to investigate the Trump-Russia connection effectively prevents Sessions from polluting or controlling the information and decisionmaking within the investigation. However, the Special Counsel is an internal position governing a specific investigation within the Justice Department. He is still controlled by the Executive Branch, which can fire him and control his access to resources.

Right now, the Republican Party, whose leaders have stood behind Trump’s every provably false tweet, have no claim to objectivity or, frankly, integrity. They also control two of the three branches of government. Any effective investigation must be taken out of their hands.  That leaves us with two types of independent investigators that have been used before: independent counsels and independent commissions. In order to figure out which solution fits the problem, we have to ask ourselves: what is the most critical outcome of this investigation? Is it criminal prosecution, proven beyond a reasonable doubt, or is it a full and fair assessment of all the evidence from all sources, in a form presentable to the American People (and usable by Congress for impeachment)? I think it is the latter, and the only way to properly hold Trump accountable and restore the integrity of our Republic is for Congress to get a veto-proof majority together and form an independent commission to investigate Trump’s connections to Russia.

Independent Prosecutions have been nasty, brutish and very, very, long

After Richard Nixon stepped down as a result of the Watergate scandal, Congress passed the Ethics in Government Act, which authorized either Congress or the Attorney General to create a special prosecutor (later an Independent Counsel) to investigate the misdeeds of elected officials. The results of that law were mixed – Congress allowed it to expire in 1999 for a reason. The Independent Counsel was overseen by a three-judge panel of the United States Court of Appeals for the DC Circuit, but in reality, he had expansive power, and that power was frequently abused. As David Frum ably explained in The Atlantic, a prosecutor is exclusively tasked with finding crimes to prosecute. As with most prosecutors, Independent Counsels tended to go after any crime they could find, even if it was only tangentially related to the matter they were appointed to investigate. Possibly the best example is Kenneth Starr, the Independent Counsel under Bill Clinton, who managed to turn the investigation of an inept real estate deal into an impeachment over a semen-stained dress. The Counsels who investigated Presidents, Starr and Lawrence Walsh, who investigated Reagan’s involvement in the Iran-Contra affair, each took seven years to conclude, and neither found prosecutable Presidential misconduct. The difference between crime-finding and truth-seeking is significant, and it is unlikely that an Independent Counsel would give Congress, the American public, and the world the assurance we need that the American President, the most powerful man on earth, is not wholly compromised. While the FBI Investigation into Trump’s Russia connections is critical, a prosecutor is not the right person to gather the whole picture and present it to the American people.

Everyone can trust an Independent Commission of politically disinterested experts

An Independent Commission created by Congress is a group of appointees from outside government who engage in fact-finding about a clearly defined subject. No branch of government oversees the content of the investigation (although Congress, as always, has the power of the purse). At the end of the investigation, the Commission produces a report laying out all of their findings. A good example of this is the 9/11 Commission. Because Independent Commissions are tasked only with fact-finding, they would be able to draw inferences and report intelligence and other information on Russian activities that might never be usable in a court of law. A 9/11 Commission for Trump-Russia could provide ample evidence for Congress to start the political process of impeachment, which is distinct from the criminal process of indictment and prosecution. No prosecutor can do that. Moreover, an Independent Commission includes individuals from different ideological viewpoints who do not have skin in the political game. The 9/11 Commission was credible because it was bipartisan and because no one on the Commission was seeking reelection. We need that kind of credibility right now, and there really are no downsides, unless you are Donald Trump or his associates, and you have something to hide.

Congress has to stand up to Donald’s Trump card

The only problem with an Independent Commission (or, for that matter, a new Independent Counsel authorization act) is that Donald Trump has to sign the authorizing legislation into law. I don’t think anyone doubts that Trump, if given the chance, is going to veto any legislation authorizing anyone to investigate him. We know he does not care about optics; the man fired his FBI Director and then told the international news media that he did so because he didn’t like being investigated. However, the Constitution gives the first branch of government the right to override a petulant President’s veto. It is time for the Republican Party to rediscover its moral fiber. Trump, as odious as he is, is not the best evidence that our Republic is in danger. The cowardice of Congress is our real problem. Each branch of government is given rights and duties under the Constitution. Congress does not just have the right to act as a check on the President, it has the duty to do so. The Republican Congress is trying to avoid the truth about what it has inflicted on this country, and that abrogation of duty has the power to unbalance our government permanently. Congress needs to grow up and appoint some truth-seekers. As Justice Louis Brandeis once wrote about the value of publicity,  “Sunlight is said to be the best of disinfectants.”


Red Tape And Regulations: Is There A Benefit To Bureaucracy?

Who needs a bunch of interfering bureaucrats? We do. From unwieldy Medicare administration to environmental regulations, both states and individuals have their reasons to bemoan the cumbersome federal bureaucracy. A lot of this criticism comes from the right wing of the political spectrum. Republicans usually complain about federal interference with states’ rights and individual autonomy, but a new reason for the Republican Party to fear the federal bureaucracy has begun to emerge over the first 120 days of this train wreck of a Presidency. The career civil service does not like to have its work disrespected and impeded, and Donald Trump is doing his best to withhold the personnel and resources federal agencies need to carry out their respective missions. He has already infuriated the National Park Service and the EPA, and now, by firing James Comey, he has alienated the second most powerful element of the domestic bureaucracy (the first being the IRS): the men and women of the FBI. This raises an interesting question when the leadership of two of our three branches of government appear determined to dismantle it: could the monolithic, unchanging, much maligned nature of the career federal bureaucracy be the institution that saves us from authoritarianism?

Trump can starve executive agencies, but bureaucrats will still execute their missions

It is no secret that Trump has done his best to impede federal agencies by depriving them of politically appointed staff.  For the 530 positions that require political appointments, he has only put forth 37 nominees. However, in using this tactic, he is really compromising his own agenda, not the daily functions of the Executive. Critical agency positions do not simply go unfilled in the absence of a nominee – they are filled by career bureaucrats unassociated with political parties (for instance, the current Acting Director of the FBI is married to a Democratic operative). Consequently, career civil servants have been preventing Trump’s Cabinet nominees from destroying their respective Departments. Fortunately for us, those bureaucrats have the law on their side.

Unless and until Congress rescinds the laws each department is designed to execute – the National Environmental Protection Act and Clean Water Act, for instance – career civil servants will continue to carry out the daily functions of the Executive Branch. Even after Trump has installed his saboteurs, their ability to destroy their agencies will be limited in the long term; many of the authorizing statutes, especially environmental laws, authorize citizens to sue to force executive agencies to carry out their missions and enforce Congress’s mandate.  So if, for instance, the new EPA destroyer-in-chief rescinds anti-pollution regulations, and pollution grows demonstrably worse, any affected citizen can sue to reverse that decision. It seems unlikely, given the profusion of leaks in Trump’s first 100 days, that career bureaucrats responsible for the day to day running of the Executive Branch will obey any instruction to disregard court decisions or betray their agencies’ missions. Just look at Sally Yates. Why would they destroy the agencies to which they have devoted their careers if they have the law on their side?

The FBI is the worst agency to alienate because it is semi-independent and has the authority to destroy Trump

It also seems that Trump has infuriated many career FBI agents and administrators by firing James Comey disrespectfully and on a transparently pretextual basis. No reasonable person believes Trump fired Comey because his mistreatment of Hillary Clinton proved incompetence. Acting FBI Director Andrew McCabe contradicted Trump’s assertion that Comey was incompetent under oath before the Senate. Subsequently, Trump revealed that he was going to fire Comey no matter what, because of Comey’s insistence on investigating Trump’s Russia connections. Suddenly, a profusion of leaks flowed out of the FBI. Trump clearly has not considered the potential consequences of his actions; knowledge is power, so any individual FBI agent working on the Russia investigation has power over Trump, if that agent is willing to talk to the Press. The benefit of a large bureaucracy like the FBI is that even if Trump goes after big names, the relatively anonymous cogs will continue pursuing the task at hand – in this case, the unmasking of Donald Trump. I’m not saying the FBI or any other bureaucratic organization is a permanent bulwark against Trumpism. However, the highly regulated, protocol-driven, red tape riddled nature of a complex bureaucracy can slow the progress of Trump’s agenda until, hopefully, we can elect functional leaders to the Legislative Branch.

Trump has taken on a behemoth he cannot control

Until this week, Trump has been focused on undermining agencies like the EPA, the National Park Service, and the Department of Education, and the employees of those agencies have ensured the Press is well informed of the changes he wants to impose. Now he has taken on a bureaucracy that can truly harm him. As much as Trump and Jeff Sessions appear inclined to co-opt the federal law enforcement apparatus for political retaliation and drug prosecutions, the FBI’s investigation into Trump’s Russia connections is relatively protected from their interference because of Sessions’s recusal. Deputy Attorney General Rod Rosenstein oversees that investigation, and for all that Trump tried to pin the Comey firing on him, he is a well respected and ethical former US Attorney under both the Bush and Obama Administrations. It seems unlikely he will deliberately sabotage this particular investigation. The FBI investigation, infuriatingly slow and full of bureaucratic rules though it is, will labor on. Bureaucrats in the FBI and elsewhere are a force for continuity; simply by following byzantine agency protocols and imposing the red tape we all despise, they slow the rate of change. They can, if they are willing, curb the excesses of a President determined to undermine America’s institutions.

It’s The Sun Wot Won It… the topsy-turvy world of American media – and why it’s dangerous

By Mince Pie

In this week of dramatic developments on both sides of the Atlantic, I write from 35,000 feet above the Indian Ocean, having made a last minute trip home to London. A week surrounded by tea, queueing and the British media offered up much food for thought.

The UK is in the grips of election fever (or rather election malaise). After 3 major votes (Scottish Independence, General Election, Brexit) in two years, the British people will head to the polls again on June 8th after Prime Minster Theresa May called a surprise “snap” election.

In that context, in a supposed world of 24 hour news, fake news and social media hysteria one would expect wall-to-wall election coverage with vehement opinions flying all over the place. And yet, the British seem oddly calm and level headed about all this and the invective of American politics seems strangely absent. So I started to wonder why that might be.

One could chalk this up to natural British diffidence and refusal to get too excited about anything in case it “starts to rain later.” I don’t think that’s it though. I have been a resident of Australia for the last three years and have seen the same thing there.

I think the comparative equanimity of British and Australian voters comes not from the absence of political invective in media but from who is supplying that invective. In the USA, the TV channels are fundamentally biased towards either left or right. The TV companies that soak up the majority of news viewing were founded with agendas in mind: MSNBC, Fox etc. Sure if you want unbiased news coverage on TV you can find it (on CBS for example) but the big audiences are with the commercial behemoths. In general, my experience of the US is that if you want a level headed approach to news reporting and news commentary you have to pick up a newspaper.

In Europe and in Australasia, this situation is completely reversed. Small countries (in either geography or population) that have national broadcasters (the BBC, the ABC, TF1, ZDF etc) have embedded the concept of the neutral TV news report. In the UK, the BBC is duty bound by its governance to report both sides of an argument (in fact it often gets in trouble with conservatives for “sympathizing with the bad guys” because of it). Even the majority of the commercial channels get their news coverage from one source – Independent Television News (ITN) – which has a long history of outstanding independent news reporting and investigation. Monopoly rules prohibit agenda setting moguls like Rupert Murdoch from owning 100% of the news coverage of their own channels. Sky News (part owned by Murdoch’s right wing News International) has a rightward, populist tilt but he can’t push it too far. Certainly not as far as he’s pushed Fox in the USA.

The print media on the other hand is entirely different. From the holier-than-thou lefty liberalism of the Guardian to the right wing invective of the Daily Mail, the British press is a whole smorgasbord of vibrant political opinions of all stripes. The press are famous for claiming responsibility for shifting elections, particularly close ones. The support of the key tabloids is still, even in the declining age of print, seen as crucial to any would-be-leader’s chance of success.

So, why does having an even handed TV news underpinned by biased newsprint produce a more stable political culture than the other way around? Why do the Brits and Aussies manage to keep a lid on the invective when Americans do not?

The obvious answer is that print is much smaller. 5m people will watch the BBC TV news in an evening. Another 2m will be watching an ITN production on another channel. At the height of its powers the Daily Mail will sell only a third as many copies as that. The quality press (the right wing Telegraph, the centrist but establishment Times and the lefty Guardian) will come up with around a million readers a day between them. This creates a natural foundation of people who get either all or at least part of their news coverage from more even handed sources. That doesn’t happen in the US. The only people getting unskewed news coverage are the readers of certain print publications (The New York Times for example) or viewers of venerable TV channels like CBS.

Print also encourages thought through its format. Long form content that uses only one of the senses (sight) is a relative rarity in the digital age. Whilst sensationalist headlines sell newspapers, they don’t get far without the content underneath them. TV news isn’t like that. A big headline, a few talking points and on to the next story with no pause for thought provocation or analysis is the staple of lots of commercial TV news operations.

A vibrant mix of news is good – it showcases new thinking, new ideas and ensures minority opinion is heard. Bias is good as long as it is balanced by a healthy source of objectivity. The British, French and Australians have a news culture where TV is even handed and print is politically skewed. The USA is the other way around – and its news culture is all the more divisive and dangerous for it.

Trump Fires Comey: It’s About The Subpoenas, Stupid

May 9 started as an ordinarily confusing and disorganized day at the Trump White House. When asked whether the White House has confidence in Comey, Sean Spicer hedged and said he needed to ask the President. A few hours later, James Comey learned that he had been fired as FBI Director when the news media reported it. At some point in the day, he received a certifiably bizarre letter from Donald Trump, sayingI greatly appreciate you informing me, on three separate occasions, that I am not under investigation” and then firing him.  Earlier this hour, CNN reported that grand jury subpoenas had been issued to associates of former National Security Adviser Michael Flynn, saying it had learned of the subpoenas hours before Comey was fired. I think the chaotic, characteristically ill-executed firing of James Comey was a consequence of the progress of the Flynn prosecution, and the media’s awareness of it.

This is NOT about Hillary’s e-mails

I’m not one for excessive conjecture, but it doesn’t take an avid conspiracy theorist to conclude that Trump’s excuse for firing Comey is a pretext. Trump’s ostensible reason, as outlined in a very competent analysis by Deputy Attorney General Rod Rosenstein, is that Comey deserved to be fired because he mishandled the conduct of his investigation into Hillary Clinton’s e-mails, largely by discussing the investigation publicly and opining on whether she was prosecutable, which is not the FBI’s job (all true). However, given that the President and the Attorney General were fully supportive of this action until this morning reveals this justification as only the thinnest of pretexts.

Some say this termination has something to do with Comey’s mischaracterization of Huma Abedin’s use of e-mail on her home computer, and his subsequent “correction” of his misstatement. That explanation makes little to no sense. Comey’s initial statement supported Trump’s narrative. His need to walk it back, or at least to soften it, has been a constant theme in the Trump Administration. I think the explanation is a whole lot simpler than that.

It’s a pathetically transparent attempt to CYA

Donald Trump and his associates have been acting as if they are hiding something since the day they took office. Michael Flynn, Jeff Sessions, and Jared Kushner have all been caught in significant lies about ties to foreign powers, particularly Russia. It cannot be a coincidence that, on the day we discover a grand jury has been convened to consider the alleged criminal activities of Michael Flynn, Trump uses a very public termination letter to the man investigating Flynn to assert that Trump himself has never been under investigation. I don’t think we’ll know the full story anytime soon, but I don’t think we need to look far to figure out why an impulsive, reactionary, ignorant President decided to fire the nation’s Top Cop the day the country found out one of the architects of his campaign is in the early stages of a criminal prosecution.

The Day France Refused To Surrender

It is a great day for France, Europe, and western democracy; it is a terrible day for Anglo-American surrender jokes. Today Emmanuel Macron, a capitalist, pro-EU, pro-UN liberal, won the French Presidential election in what appears to be a landslide victory. The French people rejected Marine Le Pen’s nativist campaign in favor of the post-war values and institutions that have given us peace in the West for over 70 years. This is partially a testament to the virtue and reasoned choices of French voters, but it is also the result of Macron’s active defense against the Russian interference that helped convince Britons to leave the EU and Americans to elect Donald Trump. In our era, tyrannical regimes are not using tanks to threaten us; they are using cyber warfare and disinformation campaigns. Tyrants finally have a means to exploit the biggest weakness of democracies – that government leadership is determined by ordinary people who can make extraordinarily bad decisions if you scare them enough. In this war all democracies are equally vulnerable, and it was Britons and Americans, unprotected by the English Channel and Atlantic Ocean, who surrendered without much of a fight and, in America’s case, elected a collaborator. In a volte-face from 1940, it was the French (and the Dutch) who fought back.

The French rejected anti-refugee fearmongering and Russian interference

The French electorate resisted two of the driving forces that brought us Brexit and Donald Trump: fear of Islamic immigration and Russian propaganda. Marine Le Pen’s campaign included anti-Muslim and anti-refugee rhetoric similar to the Trump and Brexit campaigns, but her loss indicates that these narratives were not determinative for a majority of the electorate. France’s successful rejection of anti-refugee rhetoric is notable in light of the fact that it was France, not Britain or the US, who has suffered multiple significant terrorist attacks directed by the Islamic State. While the Pulse nightclub shooting in Orlando was a significant event, it was one of many “lone wolf” operations undertaken by a disturbed young man. While terrible, it was not an attack by an organized terror network. It is particularly impressive that France elected a pro-EU candidate, given the fodder the nativist right had at its disposal.

It is also promising that the Macron campaign seems to have resisted the cyberattacks from Russian hackers. Macron has taken a bullish position against Russian propaganda; in late April he revoked RT’s press credentials in retaliation for Russian hacks, and in recognition of the fact that it constituted an organ of Vladimir Putin’s propaganda machine. In the final hours of his campaign, hackers dumped a load of documents they had obtained from a “massive” hack. It turns out that the Macron campaign had prepared for this eventuality.  As the Daily Beast reported yesterday, the campaign deliberately planted fake passwords and documents to bamboozle hackers, and ensure that when any document dump came along, it could respond with certainty that some documents were fake. The French government also asked French media outlets to stay away from the document dump for the one day preceding the election. These are calculated controls designed to promote reasoned decisions by French voters and prevent hackers from acquiring an outsized influence. Ultimately, both French voters and French political structures found ways to resist the forces that compromised the British and American electoral systems.

Give the French their due – we’re the cheeseburger eating surrender monkeys

Yes, my friends, after 77 years it is time to surrender our jokes about the surrender of 1940. I don’t know what we’re going to do with all those dropped rifles, never used, but we no longer have the right to taunt anyone for cowardice. This time, at a moment when democracy was threatened, it was Britain and America who, demoralized and rudderless, fell victim to the fearmongering of antidemocratic forces from within and without. This time, France stood up and stemmed the tide of hate in defense of our common values. And we shouldn’t be surprised, despite the many, many digs we have thrown their way since 1940. As Winston Churchill once said, “all my life I have been grateful for the contribution France has made to the culture and glory of Europe, and above all for the sense of personal liberty and the rights of man which has radiated from the soul of France….Show me a moment when I swerved from this conception, and you will show me a moment when I have been wrong.” Contre nous de la tyrannie, L’étendard sanglant est levé. From the center of the new Résistance we will be looking to France for inspiration and leadership. Well done, my friends, and Vive La France!

Birthin’ Babies On Single Payer: A British Mom On How Her Two Healthy Kids Arrived

A note from Pie Face: Pregnancy is a universal facet of any healthcare system, and so I have asked moms who gave birth in publicly funded systems to tell us about how they interacted with the systems, and whether they felt supported and prepared for the complicated and difficult medical process that is pregnancy and childbirth. Remember, this used to kill 1/3 of women, so it’s an important metric for the success of any healthcare system. Here’s one mom’s experience in Britain’s NHS.

By Rhubarb Pie

As a pregnant woman in the UK, my first point of contact with the NHS was an appointment with a midwife at my General Practitioner (GP) surgery. Considering I was only 6-8 weeks pregnant (think blue lines on a stick rather than cute scan picture), this was far more thorough that I expected. It covered birth options, weight and blood pressure checks, nutritional advice and any concerns or previous complications. I came away with a big folder of acronym-heavy maternity notes to keep with me in case of emergencies and take to subsequent appointments. Pregnancy is confirmed and dated based on an ultrasound scan at around 8-12 weeks, which I had at a local hospital. I also remember blood tests around this stage. Personally, I felt no pressure from my midwife in relation to screening options or my choice of where to give birth.

My two pregnancies were both straightforward until the later stages; I went along for appointments with my midwife every few weeks and to hospital for a routine scan at around 20 weeks, at which the sonographer checks for abnormalities. Barring the odd appointment delay, the system ran smoothly. I had my midwife’s mobile number and contact details for the hospital maternity assessment unit in case of any concerns.

Despite regular contact with midwives, I didn’t see a doctor at all during my first pregnancy until the day I went into labour. Maybe this hands-off approach is one of the reasons National Childbirth Trust (NCT) courses are popular in the UK among those who can afford them. I agree with the general consensus that these courses are good for peer support, but can see why they are criticised as too middle-class and for glorifying low-intervention birth. There are free NHS antenatal (prenatal) courses, but provision seems patchy and our local sessions were run on a weekday morning, so not great for working parents.

After a complicated birth first time round, my second pregnancy included an appointment with a hospital consultant: a frank, unhurried, informative conversation. Later in my second pregnancy, I became ill and had appointments with my GP and midwife. Looking back, I think better communication between these two could have reduced or avoided complications.

When it comes to the actual births, my tendency is to wax lyrical about the amazing NHS hospital staff involved. Possibly this says more about the nature of my experiences than the quality of care, but the fact is that in another place or another time, the outcomes for me and my children would have been very different. My first child arrived via emergency c-section, my second was born prematurely and spent three weeks in a neonatal intensive care unit.

Among the many positives (aside from two healthy children), I gave birth in a clean, comfortable, private room with the support of thoroughly professional midwives and doctors. I was discharged at a reasonable time and felt informed about and involved in decisions relating to our premature baby’s care. I’m not saying our hospital experience was without fault; an accidental double-dose of antibiotics for our newborn baby, staying two nights on a crowded ward after surgery and conflicting advice about breastfeeding could all be perceived as symptomatic of a system under strain.

My experience of postnatal care was mixed. The community midwife visited a few days after birth and I went to a local clinic for a postnatal check-up: all fine. However, subsequent home visits are made by a health visitor (a qualified nurse or midwife specialising in public health). These checks are intended to support parents and ensure the baby’s development is on track, but I’m not the only parent to find them a bit intrusive. Something I did find helpful was a free six-week postnatal course run by health visitors at my local NHS clinic, but this has since been scrapped (presumably due to funding cuts).

Contact with health services has been a regular feature of early parenthood – from getting prescriptions for antibiotics to treat mastitis to accessing support for mental health issues, infant vaccinations, getting coughs and colds checked out and minor surgery for trapped fingers. It’s not always easy to judge the seriousness of children’s health conditions – especially before they can talk – and I feel fortunate to have access to decent healthcare without having to worry about the costs.


Single Payer In The Era Of Austerity: An NHS Doctor Tells Us Why It’s Still Great

By Steak and Ale Pie

I work as doctor in one of the most monolithic healthcare systems there is.  The UK NHS is centrally funded from general taxation and is the third largest employer in the world.  Hospitals are mostly owned by the government and doctors and other healthcare workers in hospitals are effectively civil servants.  Family doctors on the other hand are effectively private contractors for the state.

The aim is to provide “cradle to grave” healthcare for all UK citizens and legal residents, free at the point of need.  The only charges are flat rate prescription charges which are waived if you are on a low income, under 18, or have a chronic condition like diabetes which means you will need a lot of repeat medications.  And of course the legalised extortion racket that is hospital parking charges.

That’s right, you can walk into an ER with a broken leg, get a kidney transplant or waste my time with your self-limiting viral illness and not pay a penny (or dime if you prefer).

Sometimes the quality of care provided is truly exceptional, and sometimes, well, less so. I’d like to talk about the good, the bad and the ugly.

The Good:

Particularly for acute problems, like heart attacks, the care you can get is truly world class.  If your coronary arteries give up on you after a lifetime of nicotine and saturated fat you can be on the slab getting angiography to unblock them in 20 minutes or less, with no questions about payment.  And this care is available to you whether or not you are a big shot banker in the City of London or something more socially useful like an alcoholic bum who sleeps in the park.

There is no co-pay (apart from – and I have no doubt you guys will find this hilarious – for dentistry), no lifetime limits, and you are not tied to your employer for healthcare.  You don’t have to save up in order to be able to pay to deliver a child, and you aren’t going to go bankrupt because you can’t pay for your chemo.

The NHS has exceptionally strong primary care.  NHS general practitioners (GPs) are a bit like the family doctors in the US.  They provide excellent general healthcare and manage most conditions. If you need to see a specialist like me it is they who refer.  This triage is hugely efficient and cuts down on unnecessary activity in the secondary care sector.  The upshot of this, and perceived downside for many, is that patients cannot see a specialist directly (more on that later).

One of the less tangible benefits, and one that I personally find satisfying, is that I have no pecuniary interest in my patient’s care. Have the scan or not, get the expensive treatment or not, have me do the procedure or not – it makes no financial difference to me.  This disinterest, in the purest sense of the word, means that people trust me to make the right decisions and offer them treatments that are best for them, and not my bank balance.

It is free.  Did I mention that it is free? Of course, if you fancy going to a private hospital with lovely carpets and better food but much worse care then you can get private health insurance.

The Bad:

It is free.  While that means anyone can access it, it also means that anyone can access it. Some people don’t always value what they don’t pay for and think it is perfectly ok not to attend booked appointments, or turn up to the ER at 2am on a Friday night with the same back pain that they have had for 25 years (to anyone thinking of doing this – I don’t think I am going to have any better ideas than the succession of doctors and reiki masters you have seen over the years, and someone is probably doing their best to die on me not very far from where you are sitting.  Stay at home!).

If your problem is not life-threatening, you will wait to see a specialist – longer than you and perhaps they would like.  As real terms funding has been going down (despite what the politicians would have you believe), that wait will get longer.

For some, the fact that GPs are effectively the gatekeepers to specialist care is a problem, and certainly one that patients can find frustrating.  Personally, I think the person with the medical degree and decades of experience is better placed than you to decide whether or not you need to see a gastroenterologist for that abdominal pain, but, you know, whatever.

Continuing in the vein of cost, some very expensive treatments, particularly newer cancer drugs (which it has to be said are in the main expensive with dubious survival benefits at present), are simply not available to NHS patients.   As funding cuts bite this is becoming increasingly problematic and it is currently the case that some high-cost cancer treatments that are standard of care in other countries are not offered to NHS patients.  NICE is a body which aims to promote cost and clinical effectiveness in the NHS and it is this organisation that decides whether or not treatments should be offered (the ins and outs and rights and wrongs of all this are a whole article in itself).  This is obviously highly controversial and some treatments are simply being rationed due to their high costs, for example the newer treatments for Hepatitis C.

The Ugly:

It all comes down to money at the end of the day.  We spend less as a percentage of GDP than other developed nations, and the fact that the NHS can provide care that is sometimes as good, sometimes worse, and sometimes better, but is definitely in the mix, when compared to these countries is a testament to the staff working within it.  But as costs rise and funding falls, there will be a reckoning.

Cuts in social care mean that often there is nowhere safe for patients to be discharged to, particularly the frail elderly.  They linger in hospital unnecessarily, waiting for care to be arranged while we all hope they don’t catch pneumonia and die. This happens on a distressingly regular basis.

Raising taxes to pay for the resources needed is, as ever, politically toxic.  While perhaps insurance-based “top-ups” could relieve things somewhat, they remain iniquitous and it is difficult to see how they will integrate with the NHS as it currently exists.  More worrying perhaps is that our political masters look not across the English Channel to our European neighbours for models of care but across the Atlantic to the catastrophe that is the US healthcare system.

In Closing:

So where does that leave us?  The NHS remains a towering achievement whose future is uncertain, but I am deeply proud to work for an institution that still aims to provide free healthcare for all as a fundamental right, and puts these ideals into practice every day.  Health policy is often made by people working in think tanks in their 30’s or 40’s who often have no direct experience of being unwell. As Susan Sontag so memorably put it, we have no idea what it is like in the “Kingdom of the Sick” until we are there.  The patients I see with serious illnesses, both chronic and acute, hugely value and appreciate the universal healthcare that they are provided. It is such a precious and important gift to be able to give – to relieve suffering, to cure diseases and sometimes even to save a life.  To be able to do so freely considering only a patient’s clinical need and not their financial situation is a wonderful privilege, and I cannot imagine it any other way.