​The United States has 19 aircraft carriers including 12 large-deck aircraft carriers and seven smaller carriers.  These are the lynchpin of the United States maritime policing system which was originally designed during World War II and operated ever since to project force to protect material supply lines, markets, and client states.  But the lumbering behemoth aircraft carriers and associated ships necessary to protect them are sitting ducks in a new era of drone swarms and hypersonic missiles.  A logical answer would be to retire these artifacts of a past war age and put the savings toward modern systems, but the United States military is doubling down and developing directed-energy weapons including lasers to protect them.

​Large-deck, nuclear-powered aircraft carriers have over four acres of deck space, enough to support a carrier air wing of 75 or more aircraft, and are staffed by about 5,000 personnel.  These nuclear-powered carriers have unlimited range, requiring refueling only once during their 50-year service lives.  A carrier strike group includes two destroyers, a submarine, one cruiser, and one supply ship. 

Each carrier deploys 70 aircraft of various models for different purposes with massive operating costs – the new F35 model, for instance, costs $115 million initially and over $40k per hour to operate.  One estimate concluded it costs $6.5 million per day to operate a carrier strike group, a figure which includes paying for 6,700 sailors plus operating and capital costs.

Aircraft carriers under construction today may still be in the active fleet in 2050.  That longevity, the gigantic operating costs, and the ambiguity of future threats in a period of rapid technological change make carrier construction and operation critical to consider now, not later.

​There are several factors at play here that keep military strategies from evolving.  One is the huge capital investment on aircraft carriers and associated equipment and the resultant organizational inertia to considering retirement of these artifacts of an aging military strategy.  Rethinking current strategy and streamlining might eliminate those platforms along with the sinecures and associated bureaucracies and so entrenched personnel advocate to protect their organizations. 

​The Navy responds to comments about the vulnerability of aircraft carriers by saying they are mobile and so less vulnerable than land bases but that comparison reveals the embedded psychology of competition with other branches of the military.  The fact is any military platform has vulnerabilities.  Aircraft carrier groups look like sitting ducks and merely saying they offer advantages to land bases does not change that fact.

​The Navy has habitually viewed manned aircraft and cruise missiles as the principal danger to its carriers but weaponry is evolving and modern threats are cheap, small-scale, and lethal.  Responding to a swarm of several hundred cheap drones is costly and virtually impossible.  But the bigger issue is hypersonic missiles, operating at a speed of Mach 5 and above, flying in indirect, darting motions, and so almost impossible to intercept with conventional weaponry.

The Navy is moving forward quickly to place directed-energy weapons into service as a major part of its air defense capabilities.  They represent these weapons can reduce or eliminate the threat of multiple drones strikes and hypersonic weapons.  Not surprisingly these representations counter the criticism of the vulnerabilities of these military antiques and keep the huge flotilla and attendant support enterprises employed.

Getting into the dross about technologies and discussion about specific platforms often obscures strategic examination of the purposes and outcomes.  Directed-energy and laser weapon systems may be an upgrade to traditional ballistics (missiles and bullets), but they do have limitations and are an imperfect solution.  Directed-energy weapons on Navy ships would be limited to about one mile.  The energy can be adjusted for any atmospheric distortions on the way to its target.  Normal ballistic considerations such as wind and gravity are not a factor. 

​Each shot of traditional weapons costs thousands or millions of dollars plus they are limited by supply.  Directed-energy weapons require weighty upfront cost and reconstruction of existing ships to support them – including ways to generate and distribute the required electrical power.  Advocates say the upfront cost is offset by the fact that the energy source, be it fuel oil or a nuclear reactor, is already paid for and the upfront cost would be countered by lower life-cycle costs.

These weapons, however, are ineffective during some weather conditions and as a result, are an ineffective defensive measure – the enemy could simply attack when it is raining.

An examination of the Department of Defense 2020 Defense Appropriations bill shows research and procurement of directed-energy weapons throughout all branches of the military.  Implementation of this weaponry could be very useful in some circumstances and could ultimately be an effective tool in missile defense. 

​The crux of the debate however is missing from most boys-with-toys discussions:

• Aircraft carrier strike groups are expensive, outmoded, and vulnerable to attack.  Should the United States reconsider the current military configuration and provide more cost-effective solutions for a new age?
• Are these asymmetric threats such as drone swarms and hypersonic missiles defendable with any technology?
• Hypersonic missiles are the biggest threat to the current nuclear balance of power and a first-strike weapon.  Should the United States initiate an international treaty to stop research and production?

​A generic Navy argument for aircraft carriers is presented at https://www.lexingtoninstitute.org/wp-content/uploads/aircraft-carrier-invulnerability.pdf.  Information on aircraft carrier staffing is available at https://fas.org/irp/doddir/navy/rfs/part04.htm.  The 2020 United States Defense Appropriations bill is available at https://www.congress.gov/bill/116th-congress/house-bill/2968/text. 

Corporate media may be aligned on one side of the fence or the other, but they all made money throwing snowballs at the ‘other side’ during the Trump debacle.  Now the Trump regime is falling into the land of implausible conspiracy theory, Infotainment, also known as Hate, Inc. will be looking for content to keep the audience captive, and sell advertising to the precious age 25 to 54 age demographic.

What most people think of as 'the news' is Infotainment – culturally-aligned programming designed to pander to specific sects of the popular audience.  Such masquerade reinforces and does not challenge, further distancing people from one another in political tribes, and obscuring discussion about the real issues pertinent to the welfare of the vast majority of Americans.

Before the 2016 election, Andrew Lack, then the head of NBC News, was concerned MSNBC’s revenue would take a 30 percent hit if Hillary Clinton was elected.  But the reality TV show that was the Trump Presidency appeared and with it the fortunes of Infotainment soared.  It has indeed been a profitable time for cable news, as well as a record-breaking year for political books.

Cable news ratings detonated in October 2020 as Fox News, CNN, and MSNBC all saw record numbers for the month.  Fox News had the highest-rated month in cable news history, according to Nielsen Media Research.  All three of the major cable news networks also saw substantial growth when compared to the same month last year.  As discussed in a previous investigation, however, placing too much emphasis on Fox News success stories is mistaken, as CNN and MSNBC appeal to similar tribal audiences

​Fox News was up 83 percent year-over-year in total viewers and 139 percent in the key 25-54 demographic that advertisers covet most in prime time.  CNN saw a 98 percent increase in total viewers when compared to October 2019, and a 116 percent jump in the demographic, while MSNBC was up 38 percent in total viewers and 45 percent in the younger category.

​The Trump Presidency will limp off as the biggest loser in election history with the resounding national repudiation of a 6-million vote deficit and so the Trump brand will be ever-tarnished.  The current Donald Trump industrial complex efforts are best viewed as the monetization of resentment politics.  The Trump contingent will likely spin away into entropic discussions on fringe media on limited platforms such as OAN and Newsmax.  While the world of conspiracy theory will always exist, witness Holocaust Denial, such nonsense will at best be whispered discussion in polite society.  The Trump following appears to be withdrawing to the aforementioned echo chambers but they will almost certainly remain isolated and without much voice or influence in the larger discussion.

​Fox News, perhaps better viewed as the official White House network, will evolve from the smarmy call-ins by President Trump to an amen chorus of sycophantic fawning adoration and reinforcement.  That is now gone.  The new governance will be by traditional neo-liberal governance with a divided legislative branch stalling substantive social reform and be vanilla pudding after the past four years.  Fox News will be hard-pressed to find villains enough to maintain an audience in what appears to be the most boring Presidency in the modern era, only rivaled historically by Calvin Coolidge.  

​Women of color such as the ‘Squad,’ Alexandria Ocasio Cortez, and the hard-to-revile Kamala Harris are difficult to use as the necessary grist for hate media although they have some limited appeal.  But where is the meat?

​It is also hard to imagine much for Anderson Cooper to scold or Rachel Maddow to rail against.  We may have arrived at the dawn of the Steve Kornacki era – the chart throb of the 2020 election – as a new Walter Cronkite or Dan Rather figure leading us in a daily,  if mundane, read-through of the news.

And one cannot forget the master of hate media, Rush Limbaugh, a legendary disinformation source jacking up his millions of followers daily, finally going to the grave and taking his rictus of masturbatory right-wing propaganda with him.   Sean Hannity and Mark Levin are out there in the wings but they seem unable to foster the same hateful connection with a fading white male audience as the liver-lipped Limbaugh.  We can similarly expect the era of hate radio to fade with the long-promised demise of the master of the genre.

Stephen Colbert will find it difficult to stay relevant so audiences may move back to the sillier Jimmy Fallon, from politics back to entertainment.  Bill Maher has an isolated audience on HBO and his snarky comments on society may continue to exist but without as much fuel without the indelicate excesses of the Trump circus.  Seth Meyers will have to take a long look for things to take a closer look at. 

Perhaps fabled stalking horses Kim Jong Un and Vladimir Putin or Nicholas Maduro can step in to provide some thrills and chills.  We always have the prospect of genocide in Africa.  The Middle East has been a  source of great fun and adventure in the past and test driving some new weapon systems in another war of liberation is not out of the question.

​So what will we do without the daily running sore of the Trump Administration?

​Information about NBC’s concern about a Clinton Presidency was obtained at https://www.nytimes.com/2020/11/01/business/media/ben-smith-election.html.  Data on cable news ratings were provided by https://thehill.com/homenews/media/523045-cable-news-october-ratings-explode-as-fox-news-hits-historic-highs.  

​Expenditures on healthcare consume more of the United States economy than other developed nations with much poorer results.  In some cases, results are inversely correlated with costs expended per capita.  The why’s of that are complex but remain unexamined by corporate media.  This investigation presents the facts and poses questions for later studies.

Three cohort countries were selected for comparison:

• United Kingdom
• Sweden
• Canada

All are developed nations, have similar medical technologies, have analogous age demographics and occupational exposure to health hazards, and provide comparable delivery systems.  The other three countries, as in almost all developed countries, provide economic delivery through socialized medical systems, a factor which is significant in this discussion, among other economic factors.

For this investigation health indicators were selected for analysis:

• Infant mortality
• Maternal mortality
• % Mortality from CVD, Cancer, Diabetes between Ages of 30 and 70
• Life Expectancy at birth

​These health indicators are commonly-referenced indices of health for nations.  The raw data for this investigation was provided by the World Bank.  These indices are a sample, but almost all the significant health indicators show the same trends and relationships as presented in this study.  The most recent year data was published was 2017, but other credible primary sources indicate the trendlines only have accentuated since that time.

​The United States far outstrips the cohort in percent of Gross Domestic Product devoted to health care – 17% for the United States and an average of 10.7% for the other three, a variance of about 6.7%.  In 2000 the United States rate was 12.5% vs an average of the cohort of 7.2%, for a variance of about 5.3%.  The United States expenditures as a percent GDP have been increasing over time, but more important is the immense size of the GDP of the United States vs. population.  

​In 2017, the United States spent about $10.2k per capita against an average of $4.8k for the other countries – an astounding comparison.  That value has continued to increase in the study period, inflation-adjusted values considered, doubling the United States value of $4.9k in 2000.  The cohort countries have also had similar percentage increases – from an average of about $2k in 2000 to the previously referenced $4.9k average in 2017.

With this incredible increase in real dollars devoted to medical care, logic would indicate health indicators are improving, and the United States is leading the world in public health.  Unfortunately, that is not the case.  In all the examined indicators the United States not only trails the rest of the cohort but trails badly.

​Infant mortality is a common statistic to evaluate public health; it is the number of infant deaths per 1,000 live births.  The chart above shows the values by year and while all the countries in the study show a similar rate of decline over time, the United States at 5.6 had about 2.3 infant deaths per 1,000 more than the average of the cohort group at about 3.3. 

​There are other factors in play in this statistic as there are huge disparities in the United States in income, with an incredible amount of the population living in poverty.  Low-income results in poor nutrition, less access to medical care, less prenatal medicine, and so results in higher infant mortality.

​The rate of increase of maternal mortality, the number of women who die per 100,000 live births, is depicted in the above chart.  In 2000, that number was 13, but by 2017 it had increased to 19, while the cohort average dropped from 8.7 to 7.  The increase is attributable to a complex and interrelated group of economic factors, poor public health management infrastructure, and inefficient delivery of medical care.

​The chart above presents the percent of 30-year-old people who would die before their 70th birthday of cardiovascular disease, cancer, diabetes, or chronic respiratory disease assuming s/he would experience current mortality rates at every age and s/he would not die from any other cause of death (e.g., injuries or HIV/AIDS).  A cursory evaluation of the slopes of the curves tell the tale here once again – the United States rate of decline has flattened and compares unfavorably with the cohort.  In the United States in 2017, at 12%, that value was 5% higher than the average of the cohort, which was 7%.  That variance was about 4.3% in 2000.

​Life expectancy at birth is the average number of years that a newborn is expected to live if current mortality rates continue to apply.  The United States trails the cohort.  In 2017, the life expectancy of the United States was about 78.5 for all sexes compared to the average of the cohort at almost 82.  The trend of decline in absolute values is particularly troubling and indicative of systemic societal, economic, and medical care issues.  The average of the cohort was almost 3.4 years higher in 2017, an increase from the value of 2.2 years higher in the year 2000.

The trends in public health in the United States are not good, especially considering this study data included only data through 2017.  The recent bungled response to COVID will accelerate the decline relative to the cohort, which is representative of other developed nations.

​Certain questions arise from this investigation:

• Industrial medicine should not be excused from this discussion.  Philosophy about means and methods and delivery of medical care are central to these public health problems.
• How does the United States reverse the economic circumstances that contribute to the poor state of health?
• Health policy reform initiatives would be a more efficient use of money than the current system.  Why isn’t that a high priority in the political discussion?
• An empirical examination of the costs of a profit-driven delivery system of industrial medicine in the United States would inform public discussion of socialized medicine.  Why is that data not readily available and discussed?
• Major industry lobbying forces love tribal divides as those divisions allow opportunities to defer regulation, lower regulatory scrutiny, reduce enforcement, and eliminate market controls.  How does our society remove these tribal divides and so get to an intelligent discussion of public health?

​If the United States and China were married one would say the relationship is ‘complicated.’ China is the largest United States trading partner, the biggest source of imports, and the third-largest export market. China is also the largest foreign holder of U.S. Treasury securities, which help fund the federal debt and keep United States interest rates low.  A ‘divorce’ from this problematic relationship is impossible.

In 1978 China initiated major economic reforms allowing the formation of rural private businesses, opening its economy to foreign trade and investment, relaxing state control over pricing, and incredible government spending to increase industrial production and improve the education of its workforce.   

​China’s GDP growth averaged 9.5% through 2018 making it the fastest sustained expansion by a major economy in history.  Such growth has doubled its GDP every eight years and raised 800 million people out of poverty. Most economic models conclude China will overtake the United States in GDP by 2030.

China’s success was based on a mixed economy that incorporates limited capitalism within a command economy. In a command economy production, investment, prices, and incomes are determined centrally by a government.

​United States corporate interests and corporate media like to sneer at centrally planned economies but such planning and direction have been highly successful in certain times in United States history; the incredible industrial production to support the allied war effort during World War II, the Marshall Plan to rebuild Europe after the war, military production during World War I, and the sustained military-industrial weapons development, production, and implementation during the American Empire being specific examples.

​A comparison of the growth rates between China and the United States leads to intriguing conclusions.   

• Between 1980 and 2019 the rate of growth in China exceeded the rate of growth of the United States every year. 
• The military interventions required to maintain the American Empire plus unrestrained capitalism combined to produce cyclical downturns:
  • The contraction of the United States economy in the early 1980s was caused by the Reagan Administration’s intention to shake out inflation by setting historically high-interest rates.
  • The 1992 recession was the result of the George H. W. Bush Administration's invasion of Kuwait in the first Gulf War.
  • The 2002 retraction was precipitated by the George W. Bush Administration’s invasions in the Middle East in response to 9/11.
  • The 2008 Great Recession was precipitated by the housing market credit speculation collapse caused by financial deregulation initiated by the Clinton Administration and administered by the George W. Bush Administration.
  • Although the data is not complete, the United States will certainly incur a huge historic reversal due to its government’s bungled management of the COVID pandemic.
• While China had some dips in rates of growth there never was negative GDP during this time.
• The United States economy appears to be unable to exceed a 3% rate of growth during the past 10-year period.

The People's Bank of China, the nation's central bank, manages the yuan to dollar value in part to ensure exports to the United States will be a little cheaper than those produced in the United States, providing a base of export revenue.  This has substantial benefits for United States consumers; for instance, the cost of clothing in the United States, even without an inflation adjustment, is less than it was 20 years ago.  This also has destroyed the United States manufacturing base causing economic upheaval and associated civil unrest.

​The Chinese government's spending has been a significant driver of its growth. The strategy has worked, but China’s present debt-to-GDP ratio is one of the highest in the world and its domestic consumer demand is low.  These factors are now considerably slowing growth, but China realizes it must reform its economy.  President Xi Jinping authorized the “Made in China 2025” plan to continue economic growth. The plan emphasizes growth in technology, aircraft engines, and electric automobiles. China has become a world leader in solar technology and is cutting back on the export of steel and coal.

​The more problematic issue for the United States is the stagnant economy despite historically low-interest rates and incredible deficit spending over the past four years.  The solutions are murky and a topic for another investigation, but the questions remain:

• Would strategic government direction of the United States economy jumpstart the economy from its current malaise?
• The current tax structure encourages harvesting and hoarding of wealth suppressing investment and growth.  Reform of the tax code is necessary to improve economic conditions.
• Economic retractions in the United States are related to a lack of regulation of financial markets combined with foreign intervention.  It’s time to reconsider the cost/benefit and the associated moral and ethical issues of military actions.  Rational regulation of financial markets should also be in the national discussion.
• The current United States defense expenditures are a drag on growth and should be reconsidered.
• The current corporate ‘shareholder value’ philosophy suppresses investment and long-term growth in favor of short-term gains may need serious consideration.
• The economic reversals due to unrestrained capitalism destroy middle-class wealth in the United States.  This invites populist demand for change and civil unrest and this condition will not change until the fundamental economic welfare of the population improves.  This warrants serious discussion and strategic preparation as they appear predictable or at least inevitable.

​The Congressional Research Service provided an excellent summary of the history of the Chinese economy at https://fas.org/sgp/crs/row/RL33534.pdf.  Raw data on GDP was provided by https://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG.  An interesting treatise on the Chinese economy was presented at https://www.scmp.com/economy/china-economy/article/3099951/china-overtake-us-worlds-top-economy-2032-despite-washington.  

Testosterone augmentation for men is the province of pop-up clinics with billboard advertisements advertising a return to virility and youth to an increasingly older and overweight population of American men.  Testosterone supplementation in many cases also offers a cure for Type-2 diabetes and associated maladies.

In Type-2 diabetes, cells develop resistance to insulin raising blood sugar causing the pancreas gland to make more insulin.  Eventually, the pancreas can’t keep up and the person’s blood sugar continues to rise, leading to prediabetes and Type-2 diabetes.   The incidence of Type-2 diabetes is in most part caused by the huge levels of consumption of sugars in cheap industrial foods and the conditioning of Americans to consume such surrogates for food.

​About 10% (34 million) of Americans have diabetes and somewhere close to 95% of them have Type-2 diabetes.  Type-2 diabetes causes attendant diseases including cardiovascular disease, peripheral neuropathy, stroke, infections leading to amputations, chronic renal failure, and blindness.  Another 88 million Americans have blood sugar levels high enough to qualify as prediabetic and likely will be diagnosed at some point in their lives with Type-2 diabetes.  Not only is this a huge public health problem it also represents an enormous future cost in medical care required by the diseased population.

Change in the prevalence of Type-2 diabetes would require significant alterations to lifestyle, food consumption, food distribution particularly to areas not served by real food, and education.  None of these would be easy, and to implement all in concert seems hopeless given the state of public health in the United States.  The United States leads the world in percentage of Gross Domestic Product expended for medical care but trails the developed world in important health indicators – a topic for another investigation.

Type-2 diabetes is associated with the consumption of ersatz industrial food laden with manmade sugars distributed through massive marketing, production, distribution, and sales networks that have displaced more nutritious alternatives.  Obesity is the biggest risk factor for Type-2 diabetes as it accounts for almost 85% of the overall risk and the current global spread of the disease.  Poor people eat cheap food, and so the prevalence of Type-2 diabetes is inordinately distributed to the people in the United States who are least-served by its massive industrial-medicine delivery system.

​Per standard industrial-medicine practice, the current treatments are initially oral prescriptions of prescribed pharmaceuticals. These drug regimens are imperfect because they fail to maintain stable glucose levels, and result in associated hypoglycemia, weight gain, and bone loss. Over time, these drugs tend to lose their efficacy and so a person who is diagnosed with Type-2 diabetes continues down an almost-inevitable road to insulin injection.

In a recent meta-analysis, the National Institutes of Health (NIH) concluded there is strong epidemiologic evidence for testosterone deficiency as an important risk factor of Type-2 diabetes in men and that high levels of free testosterone were significantly associated with decreased risk. Numerous long-term studies, also published by the NIH, and other reviews and meta-analyses, have provided evidence to support the association between testosterone deficiency and increased cardiovascular and all-cause mortality, although evidence for a pathogenic link is lacking.

​Testosterone decreases insulin resistance: normalizing blood sugar levels and mitigating (in men with low testosterone levels), if not eliminating, the problem.  There is no strong evidence testosterone supplementation causes an excess risk of health problems provided there is adequate medical surveillance such as monitoring to maintain proper hormonal levels.

Testosterone supplementation is mostly delivered through clinics advertising reversal of aging, improved virility, and weight loss.  As in all industrial medicine delivery systems, this is market-driven and the science follows.  Actual numbers are hard to find, but it appears American men are spending over $2 billion a year in testosterone replacement therapy.  One may reasonably infer these services are mainly acquired mostly by affluent white men and the men who could most benefit by testosterone supplementation do not have access to such treatment.

Although conspiracy theorists would postulate a link between ‘big pharma’ and suppression of testosterone supplementation to make money such foolishness is dismissed immediately.  Industrial medicine education does not instruct physicians in alternative management of disease and general and so it is the lack of knowledge and understanding of the practice that limits the management of Type-2 diabetes with testosterone supplementation.  Smoking cessation, weight reduction, reduction of sugars and industrial food, and exercise have also been shown to improve insulin sensitivity and should be used to mitigate the disease.

Although the science is sound, the current practice for Type-2 diabetes does not feature testosterone supplementation.  A search of the American Diabetes Association’s website does uncover some brief information on testosterone, but that information includes no discussion of the use of testosterone supplementation to treat Type-2 diabetes.  The Mayo Clinic Type-2 diabetes page is silent on testosterone.

​Testosterone supplementation in many cases could help mitigate Type-2 diabetes but it is only one aspect of managing the problem and improving public health.  The United States would benefit by a thorough discussion of the disease: future costs for health care could be substantially reduced and the welfare of millions of Americans could be improved.

​Evaluations of studies of testosterone and insulin resistance is offered at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793809/.  A second intriguing discussion is available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6305869/.  Information on testosterone sales can be found at https://www.drugwatch.com/testosterone/.  The American Diabetes Association discussion of testosterone can be found at https://diabetes.org/resources/men/low-testosterone.  The Mayo Clinic discussion of recommended treatments is presented at https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199.