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Some of the latest Biden-camp excuses coming up seem plainly and on their face delusional. I'm paying close attention to who is saying what, using what words, to see their degree of participation in this farce. The obvious logical implications of these claims are, well, obvious.
Exhibit 0: Biden himself talked about his debate the next day. He said:
Are we supposed to be impressed about telling right from wrong? That he knows how to do the job he's been in for four years? These are not reasons to be elected President again, they are basic pre-requisites. For that matter, "speaking smoothly" and "walking" might actually be core requirements as well.
Exhibit 1: He traveled too much before the debate. He did go on some global travel, but then spent 11 days at Camp David afterward preparing and recovering. But who on earth takes a whole week and a half to recover and is still at the point where he, as he himself said at a recent fundraiser, almost fell asleep on stage? Even on its face, that's worrying. This is not an excuse, it is a condemnation.
Exhibit 2: Biden struggles after 4 p.m.. Staffers say that he really does everything between 10 and 4. Six useful hours is, on its very face, a very worryingly short amount of time to not "make verbal mistakes and become tired". The debate was at 9pm local time. But the job of President isn't really seen as a part-time gig! If I said to you, "yeah my grandpa has six good hours, but after that he gets tired and makes a lot of mistakes" I wouldn't go "great, let's put him in charge of the country for four years and hope that that window of time doesn't shrink too much". This is not an excuse, it is a condemnation.
Exhibit 3: It was "preparation overload". Okay, fine, some candidates self-destruct for no reason on the debate stage, or lean too hard on canned phrases (Marco Rubio I'm looking at you). But usually this is limited to a few occurrences. Biden was consistently off all night and responded to comments Trump was expected to make, but did not yet make, on at least four separate occasions. If a candidate takes 11 days to prepare for one 90 minute stretch and still blows it, surely that says something about the candidate? That's like saying "I did poorly on the test because I studied too much". Like, it happens, but not to this extent. This is not an excuse, it is a condemnation.
Exhibit 4: It's hard to debate when the other person lies a lot, says Nancy Pelosi and others (though, credit due, just today she said whether it was a condition or episode is a fair and legitimate question). But a candidate lying in the debate should make your job easier, not harder, because even if the moderators don't fact-check, what's to stop you from doing so? Biden did at least once or twice, or tried to, so clearly it can work. Sure, you don't have notes per the rules, but surely if there are 20 false statements (per NYT's count) you can pick out at least a few with your week+ of prep. On its face, this is not a good excuse.
Exhibit 5: A columnist claiming replacing him would be undemocratic. Yes, he got votes in the primaries. However everyone knows that the party endorsed and supported him before other challengers even got going, which makes this argument eerily similar to the obvious horseradish of saying Iran is democratic because people vote (ignoring how candidates are selected). Furthermore, there's evidence the Biden team has withheld information and exposure to Biden on purpose, and as at least one media outlet likes to remind us, "democracy dies in darkness".
Sidenote, related: Here for example, you get stories about the insularity of his team recently. Corporate wants you to find the different between this picture:
...and this picture:
Pam: They're the same picture.
Okay, well to be fair, one is an intelligence briefing (Trump) about core national security issues and the other (Biden) seems to be more domestic political briefings (I think, from context), so the level of severity is actually quite different but... I'm still struck by the similarity.
tl;dr: We all know a debate is not the same thing as actual governing. But just like how excuses tell you hints about the character of the individual, I think the excuses given by the people around Biden give you hints about Biden, too. Good on the press for calling them like they are: excuses.
I'm going to be contrarian and say I thought Biden's debate performance was horrifying but I think it's still fine to run him if voters were like me and not like normal people.
I realize he looks terrible but is the President not being in peak fitness actually that important? Biden doesn't strike me as insane, or malevolent, or like he's so completely out of it that he'll launch nukes because he mistook the big red button for the toilet handle.
I'm probably too cynical but I think the President's job is probably a lot like a doctor's job in a hospital: the nurses all know more or less what the patient needs but they need the MD to make decisions. Sure you'd like a brilliant doctor like House for the truly difficult problems but any doctor that just did what the nurses told him to would probably make for an okay hospital. Biden probably spends his days picking from a set of reasonable proposals offered by his handlers. If he makes too many batshit decisions in a row too often he'll eventually get replaced.
I also don't think Trump has any edge on the mental side that would make up for the fact that he's him. Also his edge isn't great anyway, he's also incoherent, except he presents with speed freak energy. I wouldn't expect his judgment to be any better and he could just as likely start sundowning any day now as well.
It'd be sweet if they ran a Biden that was 20 years younger, but I still think he's better than Trump.
I recall a QC from a little back which asserted that nurses and NPs really don’t compete.
Medical education is insane, and it both teaches skills and filters for intelligent, diligent, neurotic individuals. It’s tempting to suggest that the metis of nursing experience can outweigh a fancy education, and I’m sure it happens on the margin, but I wouldn’t bet on it.
Which is kind of a moot point, because I really doubt political office works like a hospital. When a hospital needs to plan its COVID strategy, or negotiate jurisdiction with a neighboring ER, or secure funding, it doesn’t send the most senior doctor. It has dedicated administrators.
Biden surely has access to the most competent team his establishment can provide. I agree that they can probably handle the vast majority of normal government tasks. Better than Trump, judging by the giant holes in his cabinet! But that’s not necessarily enough.
For crises and for strategy, I think I’d rather have the average American than either Biden or Trump.
How many hospital procedures does the distinction between NP & Doctor make a meaningful difference, though? I'm sure there's shortfalls but is it a matter where 98% is functionally identical treatment? Plus frankly what % of the remainder cases where there'd be a meaningful differentiation represent productive uses of resources versus using pure ingenuity and the light of god to get the 85 year old to 87 years old.
Procedures? Nearly all of them, although if for no other reason than the fact that midlevels don't do most types of procedures. This being for a variety of reasons including the fact that they don't get training in this area (or much training at all - NPs can be online degrees).
The best case data presented by the NP lobby will argue that MDs and NPs have the same outcomes, when MDs are handling complicated cases and NPs are handling basic ones. More balanced analysis is pretty lopsided.
The differences are stark. For instance a Child Psychiatrist has 23,000 hours of clinical training. An equivalent NP has 600. And the formers hours are predominantly work, with the NPs being shadowing. And if that Child Psychiatrist wants to switch to Emergency Medicine they'd need an additional 15,000 hours of training. The NP would need zero.
I understand that there are a lot of different procedures, but surely there has to be some sort of pareto principle involved in which the top 30 or so procedures cover 90% of the hospitalizations. I do agree that NPs will get the most basic cases, but what % of cases actually is that?
Is there that huge a difference between 23,000 hours of Child Psychiatry and 600? I work in a well-paid niche role and generally if somebody's got the right disposition towards it I'd be comfortable of allowing most fresh grads on the tools after about 50 hours of shadowing.
The word procedure in a medical context refers to physical tasks that must be performed on the patient, such as surgeries. PAs/NPs are allowed to do a very small subset of these, which makes sense because they don't have things like formal Anatomy Lab or years of supervised practice doing hysterectomies etc.
I'm guessing you don't want to get wrapped up in semantics on that though, so NPs, or my friend John who works in IT can handle the most basic admissions, but what we train for in medicine (and what you pay for in the hospital) is for correctly identifying if the patient is basic (which midlevels suck at) and for when a basic admission suddenly turns not (uncommon but not rare).
Midlevels typically extend the nursing model of "the blood pressure is high, we should fix it, let's use this medication" pattern recognition. The physician model emphasizes understanding the underlying physiological reason for the rise in blood pressure, and identifying a pharmacologic agent that addresses that physiologic response in a way that does not interfere with any other medication or pathology the patient has. "How" not "what." I know what emphasis I'd prefer if I was in the hospital and for my family. This may seem like a harsh characterization (although if you look at training material you'll see legitimate emphasis on "the nursing model") but this is also where that time gap comes into play. Doctors barely get all their learning in and that is with 7-12 years of 60-80+ hour weeks.
Most people don't realize what goes on in medicine because the majority of their interaction is an outpatient visit with the doctor rolling in and asking a few unsatisfactory questions before making some vague pronouncement and then leaving, and if they have a family member in the field it's a nurse who is high on her own supply.
Like with pilots and flight attendants most of the training and activity is invisible to you, but it's absolutely critically important for when things go wrong.
For the hours stuff think of it as more like a combat sport than normal on the train training. Who you putting your money on in a fight? The person with 600 hours of training or 23,000 hours, especially given the fact that the people with significant native talent go into one field preferentially over the other? This isn't something like a role where you have to learn how to use one machine that does the same thing every time, its something where you need experience blocking all kinds of attacks from all kinds of body types which takes year to build up.
Also keep in mind stuff like the fact that it takes years of practice to respond appropriately when someone starts actively dying in front of you, something which happens rarely in most types of finished practice, all the time in MD training, and not really at all in NP training. You need that in your tool belt.
I'll stop here.
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