Whither Healthcare?

“Now, I have to tell you, it’s an unbelievably complex subject. Nobody knew health care could be so complicated.”  — President Donald Trump 27 February 2017

And you know what?  He is correct.

As the Senate debates and votes on Trumpcare to repeal and replace Obamacare over the coming days, much will be written and talked about regarding its impact and efficacy.  Some will think it is great and others will think it a travesty.  It all depends on what the goal for the program might be and how one thinks that goal should be attained.  Is Trumpcare, or the American Health Care Act (AHCA) (as it is called in the House of Representatives while the Senate Bill is called the Better Care Reconciliation Act of 2017) designed to help Americans and keep them healthy or is it an attempt to do the bare minimum while saving the government, and ultimately tax payers, money?  One’s view of Trumpcare also depends on whether or not Obamacare, or the Affordable Care Act (ACA), is working for you.

Put more succinctly, is healthcare in the greatest country on earth a right or a privilege?  Should it be open to a free market — those that can afford to pay do, those that can’t need to earn more money — or something that every citizen deserves?  If you happen to think that healthcare is a privilege, you get what you pay for, then you may as well stop reading here because you basically think that the government should have nothing to do with healthcare.  If you think that access to healthcare should be a right, then read on. Be forewarned however, that this is, as the president says, complex. Politicians of every stripe also parse and obfuscate elements of healthcare to their own advantage. It can be difficult to determine where the truth lies — especially since many times two people can both be technically correct while interpreting the meaning in totally different ways.  As I like to say, it is the difference between what things are and what things mean.

Here is the crux of the problem.  The United States does not suffer from poor medical care.  People come from all over the world to have their health problems resolved here in the U.S. — if they can afford it. That is the problem.  It is not the quality of care, but rather having access to good care and being able to afford it. Access and affordability are the reason we need insurance plans which is what both Trumpcare and Obamacare are really about.

The U.S. does not really have a health system.  It has a series of health systems depending on whether the individual is on Medicaid or Medicare (the dreaded by conservatives single payer system), or on the VA or Tricare (military) system (basically socialized medicine), or gets insurance through an employer (where most people get their insurance), or buys it on the open market (usually very expensive).

A pervasive goal in the U.S. should be that no one goes bankrupt due to an unexpected illness or injury. Likewise no one should have to forgo medical treatment because they cannot afford it.  Both happen in the U.S., although by most accounts, Obamacare went a long way in reducing the numbers of people in either situation.

So let’s design a system that helps people get care without using their every last dollar.  Let’s assume we want a system where no one can be turned down — or charged unattainable amounts of money — for a pre-existing condition.  This seems to be one area that most politicians can agree upon and one of the most popular aspects of Obamacare.  How to do that?  It does not take a genius to see that maybe I won’t buy any insurance until I get sick or injured and I will save a lot of money in the meantime.  That leaves only those with pre-existing conditions on the insurance rolls — a situation which will either leave the premiums so high as to be unaffordable, or leave the insurance companies holding the bag and going bankrupt.  To even out the costs and make them more affordable to all, we would then require everyone to have insurance — the dreaded mandate. However, it may not be fair or even affordable for everyone to buy insurance, especially for people that do not receive insurance through their employer, so if we are going to require it, then we should come up with a system to help people pay for it — the other debated aspect, subsidies. Those three elements are the basis for every proposed health care plan concocted by politicians.  If you play around with one of the three, it impacts the other two.  It becomes a very complicated game.  How one plays the game depends on my opening statement — what is the goal for the plan?

On top of that throw in hot button issues such as who can do what (Planned Parenthood anyone?), whether in our proposed system we “punish” young healthy citizens by making them subsidize the old “sick” citizens, should the government have the power to tell people that they “have” to have insurance, and who pays for all this, the wealthy or the poor who are most likely to benefit from a plan like this.  It does indeed get complicated in a hurry, and also very emotional for a lot of people.

In evaluating a planned system, lots of politicians focus on premiums and deductibles — and not always together.  It is possible to devise a plan with very low premiums, lower than Obamacare, but does it cover everything?  Does it have a high deductible?  Does it have annual or lifetime caps? What pre-existing conditions are covered?  Those and other details mute any discussion about premiums.  To coin a phrase, we cannot compare apples with oranges.  Premiums are certainly relevant when discussing the cost of a particular plan, but it is not sufficient to get a true picture of the impact or value of that plan.

To muddy the issue, the president makes unfounded claims about Obamacare.  He says “it is dead.” Except it isn’t.  But the president and the Republican leadership are trying hard to kill it, partly to force through Trumpcare.  Insurance exchanges are drying up and companies are pulling out because of the biggest fear they have — uncertainty.  The Congress has yet to decide if they will provide the money for the aforementioned subsidies to help people afford the mandated insurance.  And they have announced that they will not enforce the mandate.  Two of the legs of our three-legged plan are being distorted, that means the third leg is terribly out of balance which makes it appear the system is not working.  If insurance companies don’t think they are going to get paid — or that they will be left holding the bag for high cost pre-existing conditions which they are required to cover — then there are two choices.  They can raise premiums or leave the market.  Most experts assert that without the uncertainty coming from the White House and Capital Hill, the health insurance system in the U.S. would be stable and hold down costs for most (most — not all) Americans seeking health care.  Many people now have insurance that would not otherwise have it.  The result is “wellness checks” and other preventive health measures now sought out by people that did not seek it before.  Therefore they are healthier and the over all expenditures for larger, more catastrophic care comes down because they are less necessary.  Like it or not, the states that expanded Medicare under Obamacare generally have more small hospitals and clinics serving the poor or rural areas of their states because those hospitals have a known source of income for the care they provide.  Many of those small hospitals and clinics closed in states that did not expand Medicare and there is significant concern over the reduction of those Medicare funds under Trumpcare.  In mostly rural states such as Alaska and Maine, even their Republican Senators are concerned and may vote against the proposed Senate bill.  Senators Murkowski and Collins both realize what the proposed reductions in Medicare mean to their states and are worried, as are others.

Whatever your own views on healthcare in the U.S. take a good hard look at any plan floated to solve the problem.  I am no expert on this subject.  Not at all.  I recognize that we do not have a bottomless purse to pay increasing costs for social programs.  I get it.  Personally, I think we leave a lot of possible solutions (such as a single payer system which prevails in many modern nations, such as Canada) on the table because of emotional political arguments rather than a factual airing of the pros and cons to different solutions.

It boils down to one’s personal views.  Do you get what you pay for and if you can’t pay you don’t get it? Or should the greatest nation on earth also provide the best healthcare available to its citizens?  If so, how is it paid for?  There are no easy answers, but I think we are making it harder on ourselves than needed.  Democrats and Republicans state that they both have the same goal — to make healthcare available to our citizens and at a cost that is sustainable.  If that is the case, then everything else is politics.

To me, we have a system for providing affordable care through an insurance program called the ACA — Obamacare.  No one thinks that system is perfect.  Democrats affirm that they are willing to work with Republicans to fix what needs to be fixed.  Republicans shout that Democrats are obstructionists while jamming through a bill that even most Republicans did not get a chance to look at.

You can look it up, you don’t have to take my word for it, but in putting together Obamacare the Democrats took nearly a year, held countless hearings, folded Republican amendments into the final bill, and tried to put together a bipartisan bill.  Politics interfered at the end of that process and one could argue that Democrats jammed it through at the end.  But contrary to what you now hear, it was not a secret process and it wasn’t a slap dash final product.  I am not sure what the rush is in the Republican held Congress at this point.  This is major legislation that will impact many Americans and a large chunk of our economy. There is no need to play hurry up ball at this point.  Every piece of legislation has some perverse and unintended consequences.  Obamacare has some.  Trumpcare certainly will if it has not been properly vetted and reviewed.  It is too important to just slam through, whether or not you support the fundamental political and social theories behind it.

This process is not in the best interests of our country.  I hope that cooler heads prevail and that everyone takes a step back.  Take a deep breath.  Let’s regroup and come forward with a bipartisan approach to helping every citizen find effective and affordable healthcare.

I’m not holding my breath.


A Soup Sandwich

With increasing frequency, nearly daily, we as a nation wake up to yet another incredible self-created crisis in the Trump Administration.  People that care that our nation’s leader is becoming something of a punch line around the world debate whether President Trump’s actions, statements, and yes, tweets are part of a larger plan or simply the reflection of a man with little to no intellectual curiosity, the attention span of a young child, and who is in way over his head.  I am increasingly falling into the latter category.

In my day the military term for his administration would be that it is a soup sandwich.  The term means exactly what the imagery suggests, something so confused and messy that it cannot be salvaged.

The litany of recent events are well-known.  Whether it is his casual revelations to the Russians of highly critical intelligence, his thinly veiled threats to former FBI Director Comey, his stated reason for firing Mr. Comey because of the “Russian thing”, or the possibility that he tried to stop the FBI investigation of the Russian meddling and specifically Lt General Michael Flynn’s possible involvement with the Russians, his actions have shown a president and an administration that have lost their way.  Put more bluntly, look in the dictionary for “soup sandwich” and you will see a picture of the president.

Note again that all of the crises that the White House staff have dealt with thus far are all self-created by the president.  This does not bode well for handling the inevitable national security crisis or domestic tragedy on the horizon that will test our ability as a nation to deal with all that comes our way.

Most legal scholars and Constitutional law experts point out that nothing that we know about thus far concerning the president’s actions is illegal.  Unethical and/or immoral, perhaps, but not illegal.  This is very troubling.  As Dana Milbank ably points out in a recent opinion piece, just because it is legal, does not mean that it is right.  Or as we used to say, just because you can do something, it doesn’t mean that it is a good idea.  The basic point is that President Trump knows no boundaries, has no self-control and therefore has the ability to do great damage to our nation, whether deliberate or out of ignorance.  As Mr. Milbank points out in his troubling piece, the president is within his rights — legally — to do all of the things that we know about.  But the assumption for all modern presidents is that a president would not do all of those things without the proper justifications and explanations.  In crafting the Constitution, the Founding Fathers assumed that the chief executive would be virtuous , guided by honor, and exhibit self-restraint.  Scholars point out that the Constitution gives many powers to the president, specifically and inherently.  The checks and balances that we rely upon cannot stop the president from wreaking havoc in the short-term.  Although the ultimate power rests with the Congress — impeachment — and the courts — ruling certain presidential actions unconstitutional — it takes time and political capital to bring those counter balancing powers to bear. In the meantime, significant and even irreparable damage can be done to our nation.  With President Trump we have a chief executive that seems to be lacking the knowledge to understand the limits and responsibilities of the presidency combined with unchecked impulsivity that can easily lead to damaging actions and decisions.

Look at President Trump’s background.  His success as a businessman by most accounts was not so much because of his personal knowledge and ability.  It was more about branding.  He sold the Trump Brand to investors and let others actually build the real property.  Recently, few of his Trump buildings were actually Trump projects, he merely sold his name and promotional abilities for use by those doing the work.  He became famous due to his time as a television reality star.  Even today he talks about “ratings” for press conferences and speeches.  The pop psychoanalysis could go on and on, but in every instance, it appears that his personality is ill-suited to lead the greatest nation on earth.  To me, for example, he related the very highly classified information to the Russian Foreign Minister (information that will probably result in lives lost, and certainly the loss of an important avenue of intelligence) not because he wanted to help the Russians. I think he did it because he was showing off and wanted to impress his visitors.  Remember this is the guy that in the midst of the ceremony “celebrating” the House passing Trumpcare, stopped his speech to turn around and ask “How am I doing? Am I doing OK? Hey, I’m president. I’m president. Can you believe it?” Well, no, I can’t believe it.  But it is true.

I hear the “I word” — impeachment — bandied about a lot recently.  From what we know now, we are not there yet.  I also worry that under the current divisive political atmosphere in our country that an impeachment act and subsequent trial would be very bad for our nation.  We might not recover from that trauma for many years.  Therefore any impeachment proceedings must be based on clear violations of the law, should there be any.

The other proposal that floats around from time to time is that the 25th Amendment can be used to remove him from office.  This amendment pertains to the succession to the presidency should the president be unable to fulfill his duties.  The relevant section of the amendment in this case is Section Four which provides a procedure for the Vice President and such other “principal officers of the executive departments” (meaning the Cabinet) to declare the president unfit for duty.  Should the president contest that declaration, it goes to a two-thirds vote in both the House and the Senate.  This too would be a long drawn out procedure that could seriously divide our country should the president resist the take-over attempt.  It seems unlikely in any event that Vice-president Pence and the Trump appointed Cabinet would invoke this avenue of removal, barring some obvious and unassailable problem with the president.

Finally, President Trump could resign.  Many pundits and others think this is the most likely scenario for the current president to leave office.  President Trump himself said that 

“I loved my previous life. I had so many things going. This is more work than in my previous life. I thought it would be easier.  I like to work, so that’s not a problem, but this is actually more work and while I had very little privacy in my old life because, you know, I’ve been famous for a long time, I really, this is – this is much less privacy than I’ve ever seen before.”

None-the-less, I doubt very much that the president has any intention of resigning.  He likes the attention and being on the “inside” — people have to pay attention to him and he likes that.

Potentially compounding President Trump’s negative impact on the nation is the dilemma many of his top advisers are facing.  It is a classic scenario.  The president continually throws good, hard-working and upright people under the bus.  They go out and defend his actions in, I hope, good faith only to have him personally provide a completely different rationale for his actions.  This can only go on for so long before people start to ponder resigning.  This is the dilemma such good people face — resign and save my reputation and integrity or stay and try to change things because they could really be a lot worse if no one of significant knowledge and competence is left to try to hold him in check?

I fear that most people consider the recent events as “typical” Washington politics.  That’s too bad. This is not typical and it is not normal. And it isn’t “sour grapes” that the Democrats lost the presidency.

Many continue to state that as a nation we should give the guy a chance.  He’s only been in office about four months.  Give him time.  I tried.  Sorry, but I do not think that anything is going to cause President Trump to change.

For the Republican majority on Capital Hill I can only say, “Clean up on aisle seven.  Soup sandwich in progress.”  The Republican agenda depends on a functioning presidency.  The deal with the devil is almost gone as more and more of the president’s actions take away from the legislature’s ability to legislate.  Clean up the soup sandwich through comprehensive and bipartisan investigations.  Find out what actually happened, or did not happen, and get it into the public domain.  Use a little Clorox on the clean up of the soup sandwich.

If it turns out there is nothing there involving the Russians or other problems then so much the better. If there is something, hold all involved accountable.  The good news/bad news may be that there is nothing there. The good news is that people will not go to jail and the integrity of the system may be restored. The bad news is that we will still be left with a soup sandwich.

 


Incompetent or Dangerous?

Yesterday, President Donald J. Trump fired James B. Comey Jr., the Director of the Federal Bureau of Investigation (FBI).  This came in the midst of an ever-increasing FBI investigation into known Russian meddling in the 2016 presidential election and the increasing number of revelations of ties between the Trump campaign and the Russians.  Those are actually two different issues, which our president apparently cannot understand.

There is wide-spread consensus based on the truth and, you know, actual facts that the Russians interfered with the election.  Most likely they interfered because, as former Bush Administration Secretary of State Condoleezza Rice explained, Russian President Vladimir Putin is a pay-back kind of guy.  He hated Secretary of State Hillary Clinton, primarily because she called his election a sham, and sought the opportunity to work against her campaign.  According to Secretary Rice’s theory, he relished disrupting the election in and of itself, but to have Secretary Clinton as the recipient only made it sweeter.

Every American should be gravely concerned that a foreign power aggressively and with malice of forethought worked hard to disrupt the very foundation of our Republic.  Every American.  This is not a political issue.  Consequently both the Senate and the House of Representatives are conducting bi-partisan inquiries into what happened and how we can protect against it in the future.

However, President Trump seems to believe this is unnecessary.  If one pays only the mildest of attention to the news, you know that he is constantly calling the fact of the interference a “hoax” and the investigations “a waste of taxpayer money.”  He won and that’s all he cares about.  In his mind, end of story.

Secondarily, as the investigation of the Russian interference deepened, it became apparent that there may have been some interaction between members of the Trump campaign and the Russians.  The who, why and what questions remain unanswered.  This also is considered “fake news” by the president and he constantly tweets about issues he thinks are “ridiculous” in connection with the investigation.

He does so even though his first National Security Adviser Lt. General Michael Flynn USA (ret.) was fired by the president for working with the Russians, being paid by them, and lying about it.  I suppose we should just let that go.  Nothing to see here, folks, just move along.

This is the short version of the context surrounding the firing of Director Comey.  The president showed real class by not notifying Director Comey of his dismissal, rather the Director learned about it on television while giving a speech in Los Angeles.

So the president whose staff members and campaign members are under investigation by the FBI and the Attorney General of the United States who was forced to recuse himself from the Russian investigation because of his own role in the campaign and “forgetting” to reveal his own Russian contacts, are the folks that fired the Director.  It most definitely does not pass the smell test.

Thus the question, is the president incompetent of trying to cover up misdeeds in his administration? Does he not know what he is doing or is he deliberately undermining our Constitutional balance?  I do not know, but either one is dangerous.

The alleged reason for the firing was the mishandling of the investigation of Secretary Hillary Clinton’s emails back in July.  Of 2016.  The investigation that then Candidate Trump applauded.  Hmmm.  The timing is also suspicious.  Remember the Trumpian tactic of changing the headlines whenever something critical of him makes the news?  On Monday former Director of National Intelligence James Clapper and former Acting Attorney General Sally Yates testified before a Senate sub-committee looking into the Russian connections.  Their testimony was less than flattering to the Trump Administration and in some cases directly contradicted statements made by the president and his spokespeople.  On Tuesday, Director Comey is fired, thus changing the headlines.  I’m just sayin’….

From the time Attorney General Yates notified the White House that General Flynn was compromised and a potential agent of the Russians until he was fired — only after it all became public in the Washington Post — was 18 days.

From the time that the current Deputy Attorney General and Attorney General recommended the dismissal to the president and the FBI director was fired — for something that happened in July 2016 — was minutes.

Also remember that the FBI Director is appointed for a 10 year term.  This is to keep politics and partisanship out of law enforcement in the most critical areas of our national security.  Only one other active Director was fired, and that was William Sessions in 1993 by President Bill Clinton for ethics violations, not for investigating anything to do with the administration.

Many people were upset by the way that Director Comey handled the email investigation of Secretary Clinton.  Some even argue that the way he handled it (a news conference about a lack of evidence to prosecute) was unprecedented and unprofessional and effectively handicapped the campaign of Secretary Clinton.  In a larger context, even as one may have no love for Director Comey, his firing is very troubling at this particular point.  It seems that as the investigation gets closer to the truth, the resistance from the White House increases.  Director Comey must have been very close to finding damaging information.  It only takes a cursory look at any newspaper or other news source to see that this has raised significant bi-partisan concern in the Congress as to the meaning, appropriateness and impact of the firing.  Most Republicans and Democrats have expressed serious concern.  It is not right.

Alarm bells should be going off when taken in connection with this quote from White House spokesperson Sarah Huckabee Sanders during an interview last night with Tucker Carlson on Fox News. In the same vein as the president and other spokespeople in the White House, she spoke about the Russian investigations and said:

I think the bigger point on that is, “My gosh, Tucker, when are they gonna let that go?” It’s been going on for nearly a year. Frankly, it’s kinda getting absurd. There’s nothing there. We’ve heard that time and time again. We’ve heard it in the testimonies earlier this week. We’ve heard it for the last 11 months. There is no there there. It’s time to move on.

President Trump wants the investigation to go away.  Countless efforts by the president and his spokespeople to undermine the investigations have not worked.  They pretend, as does Ms. Sanders, that the American people do not care.  We won.  End of story.  Yet, the investigations continue and it does not go away.  Next step — fire the Director of the FBI.

One can only conclude that the president must really be trying to hide something big.  Maybe yuuge. Reporting today indicates that last week Director Comey quietly asked Congress for a significant increase in funding for the Russian investigation.  Another coincidence?

President Trump undoubtedly thought that by making Director Comey go away, his troubles would go away as well.  They are just beginning.  Reportedly, the president has little interest in history or understanding exactly how the government works.  Fine.  But someone should tell him that time and time again the cover-up is what brings folks to their knees, doing more damage than the “crime” ever would have.  Maybe he should read up on it.  He may learn something about it when he appoints his next Director of the FBI and the Senate holds confirmation hearings.  If you think there is a fire in the Senate during the current hearings, you haven’t seen anything yet.

A civics lesson might help as well.  Trying to run the United States as a family business operation does not work so well.  Unless his aim is to make a lot of money, which that part so far is working. But that’s a piece for another day.

The investigations will not go away.  They will be slowed down dramatically in the near term.  The FBI is extremely unlikely to report the results of their investigations without a Director in place.  That will take weeks or more likely, months.  James Comey was a Republican appointed by President Obama. President Trump should appoint a Democrat with an impeccable reputation as the next Director.  I am not holding my breath.  His appointment will tell us a lot about the future integrity of anything that comes out of the Department of Justice.

The investigations will continue in the interim.  However, the integrity of those investigations is now compromised. Only by appointing a special prosecutor — which the White House and Senate Majority Leader Mitch McConnell (R-KY) are mightily resisting — will there be some assurance to the American people that an independent investigation, unencumbered by political and partisan elements, reports believable results.

This is fundamental to our national security.  Stay awake and keep the pressure on.  Silence and “getting tired of it all” will erode our freedom.

 


Deal or No Deal? No Deal…. This Time. But More Will Come

“Obamacare is the law of the land. … We’re going to be living with Obamacare for the foreseeable future.”  — Speaker of the House Paul Ryan (R-WI) on 24 March 2017

The last ten days of the Donald Trump Administration has had more drama and newsworthy events than any recent presidency in memory.  Most of it was not good news.  Not good for the country and not good for the Trump Administration.  Ranging from the revelation that the FBI is conducting a long-term investigation into ties between the Trump campaign and foreign entities, to the failure of the House of Representatives to vote on a replacement for the Affordable Care Act (ACA). The American Health Care Act (AHCA) was pulled by Speaker Ryan because of its sure defeat in the House.  A defeat I may add, that came despite the fact that the Republicans had a majority in the House of Representatives, the Senate, and the White House.

There are many reasons why the bill failed, and I am sure that pundits will dissect those reasons at length as time goes by.  Among the most prominent in my view, is that as the final push began to go from theory to an actual bill, the Republicans lost sight of policy and focused primarily on politics. In so doing they ended up changing the bill in ways that left only 17% of Americans in favor of it replacing the ACA.

Despite President Trump’s promise on 17 January 2017 that his health care bill was nearly finished and would be revealed shortly, he apparently did not have one of his own and went with the proposal crafted by Speaker Ryan.  In that January interview, President Trump also insisted that his health care bill would provide “insurance for everybody” and that people “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”  Which, surprisingly from this administration, turned out not to be true.

One could also ask why after seven years of campaigning on “repeal and replace” the Republicans did not have a viable plan, worked on by all factions of their party, with the contentious issues litigated before hand, ready to go?  It became a lesson for the new majority that opposition is much easier than leadership.

Speaking of leading, President Trump learned that leading the nation and a divided government is much different, and I would add more difficult, than running Trump, Inc.  The “closer” couldn’t close and he found that threats to an equal branch of government do not carry much water when the president’s approval rating is only in the 30’s and his disapproval rating is in the high 50’s.

There are other significant issues at play and we will see how things work out in the coming months as the president moves on to more “fun” (his word) endeavors such as tax reform and infrastructure renewal.  However, I think that all concerned are naive to believe that health care is resolved for the future.  In many ways, this is just round one of a longer, continuing saga.  As always, the devil is in the details and there are many details yet to be resolved before the battle of the ACA vs. AHCA is over.

Recall that President Trump and others continually repeat that the ACA is a “disaster” and in his usual method of communicating complicated issues, tweeted that “ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!”  One of many such tweets where he constantly reiterates that ObamaCare (the ACA) will “explode” or “implode” depending on his mood of the day, and blaming everyone — Republicans, Democrats, bureaucrats, a long list — for the failure of the bill to pass the House.  He blames everyone but himself or his dogmatic but very inexperienced staff, even as insiders say that he never really understood the policy behind the bill, nor really had much interest in it other than as a tag line during the campaign.

“Nobody knew that health care could be so complicated.” — President Trump on 27 February 2017

Here is the real point.  In fact, President Trump and his administration can turn his prediction into a self-fulfilling prophecy.  By regulatory action, or inaction, and by refusing to defend or promote the current system, they can indeed cause it to fail.  Not tomorrow, not the next day, but over time they can ensure that it fails without the proper attention to implementing its provisions.

Nearly all impartial adjudicators, including the Congressional Budget Office, state that under current provisions, the ACA will not explode, implode, or otherwise become a disaster.  It is working. However, it is not working perfectly and could use improvement.  In particular the number of insurance companies participating are decreasing, and deductibles in some areas are increasing. There is some debate as to whether this is happening because of the uncertainty that surrounded the ACA leading into the introduction of the AHCA or other factors.  Generally, the experts say that this trend can be reversed and in any case, does not impact all Americans.

The ACA — ObamaCare if you will — can be improved and should be improved.  Just like Social Security and other programs, the original plans are rarely perfect and it is entirely reasonable to see changes that improve the process and benefits.  Hopefully, now that the histrionics from both parties are over, the real leaders of the House and Senate can sit down in a bipartisan way and work on fixing the things that need to be fixed in the ACA.  I am not optimistic that it will happen. It will be difficult because from a policy viewpoint it is expensive and from a political viewpoint the Republican majority cannot pass such legislation without significant numbers of Democrats on board.  Thus far they have shown themselves to be unbelievably reluctant to pass anything that needs Democrats to carry the day. Conversely, at this point in time, Democrats are unwilling to show support for much of anything that President Trump is pushing.  That said, I am more confident that President Trump will be willing to work with Democrats and they may in turn be willing to work with him, on the right issues.

Unfortunately, the Secretary of Human Health and Services Tom Price made a career in the House of Representatives by opposing the ACA.  Now that he is the Secretary he can make regulatory changes that lessens the coverage provided by the ACA.  He can refuse to defend in it court when challenged and he can refuse to advertise re-enrollment dates and other factors that makes it harder for people to access and benefit from the Act.  Whether this will happen or not,  time will tell, but as the president and others continue to insist that the ACA will collapse, it is entirely possible that Secretary Price will help to make matters worse.

President Trump now has the opportunity to demonstrate whether or not he is the great negotiator that he claims to be.  He can choose to show real leadership and bring the parties together and do something positive for all Americans or he can show us that his “repeal and replace” sloganeering was only that — an applause line without substance.  So far his stated intention is to “move on.”

What he cannot do is claim that he no longer has any responsibility for the future of health care in the United States, which is what he tried to do last Friday.

“I think the losers are Nancy Pelosi and Chuck Schumer because now they own Obamacare. They own it – a hundred percent own it. And this is not a Republican health care. This is not anything but a Democrat health care. And they have Obamacare for a little while longer, until it ceases to exist, which it will at some point in the near future.  And just remember. This is not our bill. This is their bill.”  — President Trump on 24 March 2017

Sorry, Mr. President.  I regret to inform you that you are the president of the entire nation and that you are responsible for the well-being of all its citizens.  And oh, by the way, it was the Republicans that could not get themselves organized to pass their own bill.

Let us all work for a better deal in the future.

 

 

 


Keep Your Eye On The Ball

A basic admonition for success in a variety of sports such as baseball, golf and many others, is to keep your eye on the ball and follow through.  The same is true for politics.  Distractions come easily and it is easy to lose track of the original issue.  Such seems to be the case with the fireworks surrounding the knowledge that Russia interfered with our 2016 presidential election.

In a rare show of unanimity, last fall and again in January this year, the U.S. intelligence community briefed the outgoing and incoming presidents on the Russian meddling.  Much of the information is highly classified, but we as citizens can be sure that it happened, otherwise, we can trust nothing that our professionals in intelligence and highly respected leaders tell us.  They do not make such accusations lightly or without serious and deep consideration as to the facts and the repercussions. As a result of their findings, President Obama in September 2016, in a face-to-face meeting with Russian President Vladimir Putin, told him to “cut it out” with regards to Russian cyber attacks and hacking — notably before the election. Claims that he did so to create a “ruse” because the Democrats are “sore losers” holds no validity when the warning came before the election.  In October, again before the election, President Obama used the “red phone” — used to avert nuclear attacks between the two nations — to again warn Mr. Putin about the continued interference in the election. In late December President Obama implemented additional sanctions against Russia and expelled 35 Russian diplomats accused of spying within the United States because of the Russian attempts at meddling.  These are facts.

In and of itself, every American should be outraged that there is incontrovertible evidence that the Russians attempted to interfere with our most sacred ritual as a nation — the election of our president. This outrage should supersede any sense of Republican, Democrat, Independent, liberal, conservative or any other political category one can imagine.  America was under attack.  This seemed to be forgotten as our new president initially, and for a lengthy amount of time, refused to acknowledge these facts.  Facts that should outrage any serious leader of our nation.  Instead in a news conference on 11 January 2017 he attacked our intelligence community and compared them to “Nazis.”  He only reluctantly concluded that “as far as the hacking, I think it was Russia” before adding “it could have been others also.”

For whatever reason — ego, appealing to his base, purposely trying to create chaos for some political objective, or trying to cover up the truth — President Trump continues to deny that the Russians had any significant effect or were in fact trying to influence, if not to change, the election.  This continued denial, along with accusing the intelligence community of trying to undermine him and all the other shenanigans now coming out of the White House must stop.  Enough!  This is not a serious presidency if this is the way that they will conduct themselves over the next four years.  It is amateur hour.

The current brouhaha surrounds who did or did not meet with representatives and agents of the Russian government and for what reasons.  This is where the obfuscation continues.  While we argue over whether then Senator Jeff Sessions (R-Ala) met with the Russian Ambassador in his role as a Senator or as a member of the Trump campaign and oh by the way Senator Chuck Schumer (D-NY) ate donuts with the Ambassador in 1992 is beside the point.  Way beside the point.  One could argue, on purpose beside the point.  Deliberate distractions to keep our eyes off the ball.

Now Attorney General. Mr. Sessions says he “misspoke” about his contact with the Ambassador. Perhaps so. The problem is that in both oral and written testimony during his confirmation hearing he claimed that he had no contact with any member of the Russian government.  Just as former (remember he got fired) National Security Adviser Lt. General Michael Flynn said nearly the same thing. Just as more and more members of the Trump campaign claimed that they never had contact with any representatives of the Russian government and it is becoming clear that in fact, they did have contact.

Focusing on all of those individual circumstances may or may not have significance.  We simply do not know.  Here is what we do know.  Starting with the first reports of the hacking of Secretary Hillary Clinton’s campaign manager Mr. John Podesta’s emails (an event seemingly predicted by one of Mr. Trump’s then advisers Mr. Roger Stone before they were released by Wikileaks), Mr. Trump and his staff continually denied that any, repeat any, contact with the Russians simply did not happen.  For example, in November 2016 the Russian Deputy Foreign Minister Sergei Ryabkov responded to a press question about contacts with the Trump campaign and said that “there were contacts” with influential people in Trump’s circle. “I don’t say that all of them, but a whole array of them supported contacts with Russian representatives.”  In response, Trump campaign spokesperson Ms. Hope Hicks said, “It never happened. There was no communication between the campaign and any foreign entity during the campaign.”  This is one of at least twenty separate official denials that there had been any contact with the Russians. Assertions we now know to be false.

Remember that this is an administration that deals in “alternative facts.”

Still, I think all of this who-talked-to-who-and-when is beside the point.  It indicates that there is probably some “there” there, but in and of itself is inconclusive.  Any single or even series of contacts could have multiple explanations, some of which are benign.  What is concerning to me, when taken as a whole, is that so many of them occurred and that the campaign and now the administration, continues to cover up and deny that anything at all took place, even in the face of video and audio that refutes their claims.

What are they so anxiously trying to cover up?

Today was the last straw.  One might say that President Trump deployed the metaphorical nuclear option this morning when he tweeted out that President Obama broke the law.  More specifically, in a series of tweets this morning he said:

How low has President Obama gone to tapp my phones during the very sacred election process. This is Nixon/Watergate. Bad (or sick) guy!

–President Trump tweet 7:02 4 Mar 2017

Actual quotes from the President of the United States!  Unconscionable!  Statements such as these are unreasonable and can easily be interpreted to be a calculated effort to create turmoil and unrest in our nation.

There is so much that is wrong with his latest undisciplined reactions it is hard to know where to start. (And it is particularly interesting, or appalling depending on one’s view, that Mr. Trump’s in-your-face style was cultivated by his long time mentor, Mr. Roy Cohn, who was Senator Joe McCarthy’s primary adviser when the McCarthy witch hunt was in full bloom.  I suppose that the circle stays unbroken.) Keeping our eyes on the ball, there are a few facts involved with possible underpinnings in the law — unlike the tweets from President Trump who has offered no evidence or other substantiation of his claims.  This tweet storm is merely intended to divert attention and to change the narrative.  His usual, now predictable, tactic.  When under siege, attack.  (And exactly why do you think you are under siege Mr. President?  Something to hide?)

It is outrageous for a current president to call his predecessor “bad” and it is especially outrageous to call him “sick.”  Perhaps if the shoe fits….

But again, this is a diversionary tactic.  The facts tell a different story.  For example, the president cannot order wire taps on his opponents.  It is against the law and only the most screwball, or clinically paranoid, opponents of President Obama would think that he would blatantly break the law by ordering wire taps.

The most inconvenient fact of all for President Trump is this.  Should it be true that taps of some sort were placed on Trump Tower, they can only be done when a federal judge under the Federal Intelligence Surveillance Act (FISA) is presented with probable cause that “foreign powers” or “agents of foreign powers” — which may include U.S. citizens or permanent residents — are suspected of terrorism, colluding with agents of foreign governments against the interests of the U.S., or espionage.  When presented with evidence, the judge may approve physical and electronic surveillance of those individuals and their likely places of operation for espionage or other nefarious purposes.

If the FISA statute was implemented by the FBI and NSA through the Department of Justice, utilizing the provisions of the law through the proper court, then President Trump does indeed have reason to distract us from the real problem.

The president may be out of his league.  It may turn out that he is not so “big league” (often transcribed as “bigly”) as he assumes.  He is up against the full power and strength of the national government and the national press, sworn and determined, respectively, to uphold and protect the Constitution.

President Trump will no doubt continue to make wild, baseless and counter-factual claims.  Sad!  We need to keep our eye on the ball and follow through.


A Test Of Patience

In this space I recently wrote that I would be patient and give President-elect Donald J. Trump a chance to show that he understands what it takes to lead this country and to deal with the many issues confronting us today.  As we approach the three-week mark from the election, and as Secretary Hillary Clinton’s lead in the popular vote now approaches 2.5 million more votes than what Mr. Trump received, I find that my patience is being severely tested on many levels.  I am keeping an open mind, but several troubling incidents surrounding his transition are making it difficult.

One begins to wonder if he really understands what it means to be President of the United States. Admittedly, we are only three weeks into the process and he deserves more time to get his administration and, frankly, his act together.  Few (and I suspect that does not include Mr. Trump) truly thought that he would win the election.  He did, and now he and his aides are facing a steep learning curve to get ready to serve the country.  Not unprecedented, especially since he has no prior governing experience.  That said, there are several troubling aspects to his transition that signal that he may not be ready, and even more troubling, unwilling, to assume the responsibilities of the office in a manner consistent with the customs and traditions of our great country.  It appears that he has not yet figured out that he now works for us, the citizens that hired him, rather than the other way around. It has become a cliché that he promised to “shake things up” and that he was a non-traditional candidate so expect him to be a non-traditional president.  I get it.  However there are certain basic norms of good governing and representing our country that need to be appreciated and adopted by him.

Please!  Take away his cell phone and take away his Twitter account!

Extremely troubling to this observer is his what can only be called a bizarre Tweet yesterday claiming that he actually won the popular vote. (Why do we call it the “popular vote” since it is the vote?  It is the Electoral College that is the “other” vote.)  He said that:

“In addition to winning the Electoral College in a landslide, I won the popular vote if you deduct the millions of people who voted illegally.”

No evidence.  No proof.  Just a reaction to the continued reporting that the gap in the vote continues to grow and another example of his wild and undisciplined need to lash out whenever he is criticized. Fake news presented as a fact.  For a president-elect to make such a pronouncement is a serious threat to the legitimacy of our nation and the voting process.  Very troubling. Even as he condemns the efforts of Dr. Jill Stein, the candidate of the Green Party to get recounts in Wisconsin and possibly Michigan and Pennsylvania where the margin of victory was very, very thin, he gives the best reason yet for holding such a  recount.  Investigate the results, in accordance with the law and established procedures, and see if all is okay.  Even Secretary Clinton’s senior aides say that a recount is unlikely to change the result.  So what is Mr. Trump’s problem?

Further evidence of his thin skin — and let’s face it, Democrat or Republican every president in this day and age is going to be criticized for something by someone every day — is his Tweet about the “totally biased” show that contains “nothing funny at all” when Saturday Night Live did a skit on him after the election (he has gone after them before).  Stand by.

But here is what is most bothersome.  He goes after SNL and other media presentations, which arguably is beneath the expected stature of the president-elect, but he does not go after the white supremacists that now believe they have a leader in Mr. Trump.  He has called for unity and in an interview with, as he calls it, the “failing” New York Times, Mr. Trump said that “I disavow and condemn them.”

My question is if that is so, and he claims that no one reads the newspapers anymore, and that he wants to communicate directly with America by using Twitter, why hasn’t he sent a Tweet, or better yet, a series of them, specifically denouncing them, their leaders and their actions?  For that matter, just saying “I want unity” is not the same thing as making a coherent speech to the American people, and I don’t mean on YouTube which appears to be his other outlet of choice.  How about a speech that lays out his plan to unite us and specifically denounces the hate crimes that have sprung up around the country following his election?  To borrow from the old Nike ads, “just do it.”  Incidentally, Mr. Trump has not held a news conference since July.  Just sayin’.

There may be a reason why he does not more forcefully denounce the white supremacists and other haters.  Another way that we can judge Mr. Trump and his administration is by the people that he picks to fill key jobs.  This is still a work in progress, but already some troubling appointments and processes are coming to the fore.  To me, it is a bad sign that among his first three appointments were Mr. Steve Bannon and Lt. General Michael T. Flynn, USA (ret.). Before joining the Trump campaign,  Mr. Bannon was the chief of Breitbart News, a publication known for supporting the white supremacist movement. (They call themselves the alt-right, but if you’ve seen any of  their work, it is just another name for white supremacist filth.) General Flynn is known for sharing fake news in his speeches (such as saying Democrats in Florida tried to impose Sharia law) and his hard-line anti-Islamic rhetoric includes this memorable line in a speech that I am sure warmed the hearts of our ISIS enemies, as it is great propaganda for them:

“We are facing another ‘ism,’ just like we faced Nazism, and fascism, and imperialism and communism. This is Islamism, it is a vicious cancer inside the body of 1.7 billion people on this planet and it has to be excised.”

So he believes a religion is the same as fascism and communism?  1.7 billion people need to be “excised”? Does that mean kill them all?

Both men are favorites of the white supremacists and so it is more than a little scary that the two most influential men in his administration that do not need Congressional approval to serve, are both haters of segments of our nation, and a larger segment of the world.

Published reports recount that Mr. Trump has been offered the same daily intelligence brief that the current president gets.  In three weeks, he has received the brief only twice, rather than daily.  (Vice President Pence, thankfully, is reported to take the brief almost every day.)  The stated reason is that “he is busy.”  I suspect that it has more to do with the influence of General Flynn who claims to know more than the briefers, and supposedly told Mr. Trump that the intelligence he was getting as a candidate was “wrong”.  If Mr. Trump has time to meet with business associates from India and elsewhere during his working days, much less to Tweet so much, it would seem he could take a brief more than twice in twenty days.  I fear that it reflects his lack of intellectual curiosity and his propensity to “wing it” rather than to have, you know, actual facts.

Other potential Cabinet appointments announced or considered by the Trump administration, such as South Carolina Governor Nikki Haley (R) may not have vast national or international experience, but I am at least confident that they are principled, earnest and respected individuals.  As Mr. Trump fills out his Cabinet, I hope that we see more nominations in line with the likes of Governor Haley and none in the line of General Flynn.

Surprisingly there is a very public battle over the nomination for Secretary of State.  This will tell us a lot about the future of the Trump administration and their methods of governing.  Mr. Trump seems to be favoring former Massachusetts Governor Mitt Romney (R) as his choice.  The Governor is another individual that I can respect as having principles and a love for our country that is greater than his own ambitions.  In a nearly unprecedented move yesterday, leading Trump transition team advisers such as Kellyanne Conway were on the morning news shows publicly campaigning against Mr. Romney’s selection.  Statements and reports indicate that the Trump insiders, with the exception of Vice President-elect Pence, are pushing hard for former New York Mayor Rudy Giuliani (R).  Mr. Giuliani’s credentials are thin at best and if voters thought that Secretary Clinton’s speeches were over paid and to the wrong people, look up Mr. Giuliani’s record of having given speeches at very high prices to some not-so-nice folks around the world.  If Mr. Trump picks Mr. Giuliani over Mr. Romney (or another equally qualified individual) that will be a tremendous signal that he cares more about “loyalty” to him personally rather than what is best for the country.

Finally, and equally trying of my patience, and I really am trying because if he does well, we all do well, is his refusal to divest or otherwise separate himself from his business dealings.  To questions about releasing his tax returns and his intent to divest himself of his businesses, he basically said in interviews, “I don’t have to.  I won.”  He further pointed out that under the law, he has to do neither, which is true. The president and vice president are exempt under the law.

One would hope that a great leader would recognize the inherent doubt and constant conflict that will ensue if many of our citizens wonder about his decisions — are they based on the nation’s needs or on his personal business needs?  Importantly, a great leader would recognize that although perhaps legal, it is not ethical.  If everyone that will serve in his cabinet and below will be required to follow the law over conflicts of interest, tax returns and the like, shouldn’t the man at the top also reveal this information? To me, this will be another test of his character.  Does he hide behind the law and continue with his “I won” mantra, or does he man up and do the right thing?

Placing his business dealings with his children, while they continue to sit in on high level meetings with foreign leaders, as has happened twice already in the last ten days, does not solve the problem. There are so many twists and turns in this story that the more he enlightens the nation, the more credible he becomes and the better able he will be to focus on the nation’s issues.  We shall see.

It is early and there is still a chance for Mr. Trump to demonstrate that we should trust him and his decision-making ability.  Unfortunately, the early signs are not all positive. The time between now and the first of the year will tell us a lot about the fate of our country in his hands over the coming years. The early signs seem to indicate that it will be a bumpy 2017.  Hold on to your hats.

 


We Live In Interesting Times

“Donald Trump is going to be our president. We owe him an open mind and the chance to lead.”  — Hillary Clinton in her concession speech on 9 November 2016

In her concession speech, Secretary Clinton exhibited the best of our electoral traditions and history. She lost and he won and it is time to keep an open mind about the future.  Like it or not, he’s the guy.

But, man oh man, I didn’t think it would be this hard.

There is one thing that sticks in my mind as I try to get my head around the idea of a President Donald J. Trump, and that is that he is the same person on 9 November that he was on 7 November. That may not be a good thing.

So many things come to mind about the election and about the future of our country under a President Trump.  I could write multiple pages, and indeed I am sure people already have and any number of books will be written about this campaign in the coming months and years.  However, I won’t go into all of that now.  At the same time there are a few things that I do want to mention as I, and millions of others, try to make sense of this election.

I have been around the block a few times, and have believed strongly in other candidates that lost elections.  I was disappointed but did not think badly of the candidates that won.  I merely disagreed with their policies compared to my candidate, but as the Rolling Stones proclaim (and apparently Mr. Trump agrees as he used it as his theme song),

“You can’t always get what you want
But if you try sometime you find
You get what you need.”

I am not so sure this time around.

To me, this time it is not about whether a Republican or a Democrat won or even that Secretary Clinton lost. It is that Mr. Trump won.  Or at least he won the Electoral College, which in our system is all that counts.  But lest we forget, for the second time in 16 years a candidate lost the election even though they won the popular vote.  I will save for another time a discussion about the Electoral College.  It could be anachronistic, but it is probably a good thing over all in that candidates must think about the nation as a whole, rather than individual centers of population.

So, no, it isn’t that my candidate lost.  You have read in this space before about how I am confounded by Mr. Trump and his apparent lack of understanding of the important issues of our time, of the language he used while campaigning and his demonizing and/or demeaning every segment of our society save white men.  That is well documented and I won’t rehash all that here.  But it does have consequences.

Even though more people voted for Secretary Clinton than for Mr. Trump, I am worried that I thought the United States was something that apparently it is not.  Many good people, Democrat and Republican, did not feel that Mr. Trump reflected or represented American values.  What if we are wrong?  What if his words and actions represent the America that we have become?  That is truly chilling and worrying to me.  His approach was validated.  He gave validation to a worrisome fringe element in our society that now thinks it is mainstream.  Before you blow a gasket, I am not inferring that all of Mr. Trump’s supporters were on the fringe.  People voted for him for a vast number of reasons.  But it remains a fact that his persona is not what we think of, or maybe I should say it is not what I think of, when I think of America.  He took the politics of fear and anger and turned it to his personal advantage in the worst possible way. I will try to keep an open mind as his administration forms, but I will struggle to get beyond that fact.

I am particularly upset by the reaction of people close to me, and others that I have observed. Primarily women that worked in the 60’s, 70’s, and 80’s in an era where sexual harassment was a part of going to work.  Those women experienced some form of harassment and discrimination almost daily, worked through it, and worked very hard to change the system.  To them, Mr. Trump symbolizes every male that harassed them in the work place or on the streets.  The women coming of age today face a totally different work place environment than their mothers and grandmothers faced.  Thankfully. Unfortunately, the election of Mr. Trump in spite of his known actions, his recorded remarks and his crude on-the-record comments seem to many of these older, experienced women, to give the green light to go back to a time where women were judged on their appearance and not on their ability.  It is a very sad and difficult time for them to see Mr. Trump in the White House.

One potential positive outcome of the election is that Mr. Trump, who in reality is neither a Republican nor a Democrat but more of third-party candidate that managed to get the Republican nomination, will have his opportunity to govern with the support of a Republican controlled Congress.  To all of those disaffected voters who put him in the White House, stand by.  In my mind this is a domestic version of President Nixon going to China.  There will be no excuses if the lot of those supporters does not improve. Mr. Trump and the Republicans are in charge.  They can only blame themselves if things don’t go their way.  After years of “just say no”, anger and obstructionism, they have the chance to do all of the things that they promised.

But I am extremely skeptical that they can deliver.  Most jobs in the Rust Belt and elsewhere were not lost to “deals” and trade pacts.  They were lost to automation and technology.  They aren’t coming back. The coal industry is not coming back.  Steel mills are not coming back.  One industry towns are not coming back.  All of the things that white working class Americans think they will now see restored are extremely unlikely to return. We cannot turn back the clock to a nostalgia tinged 1950’s era.  Perhaps in the coming years when the realization sets in that none of that will ever come back again, we can move forward into the 21st Century.  We don’t need to bring back the old jobs, we need to educate and train our citizens for the jobs of the future.  We cannot hold out for a white dominated society, we are headed for a multi-cultural society, like it or not, and no amount of anger will change that.  So, perhaps when their guy is unable to deliver the goods, people will remember those days fondly, but finally move on and face reality.  Perhaps that is the positive side of Mr. Trump as our president.

I suppose a true test of how willing Mr. Trump will be to bring the nation back together again will be two-fold.  First, does he reach out to all of those he has offended during his campaign, and more importantly does he send a message to those that think it is now okay to demean and demonize portions of our society and tell them that he will not accept that?

Secondly, I think we will learn a lot about the direction he intends to take the country by his cabinet nominations.  He hasn’t made any yet.  Will he pick serious, qualified individuals willing to do what is right for our country even if it means disagreeing with the President, or will he pick a series of sycophants and has-beens?  Only time will tell, but it isn’t a good sign that many of the names floated as trial balloons so far fall into the latter category.

In the end, I hope he surprises all of us and ably and well leads our nation.  If he does well, our country does well.  I am willing to keep an open mind and give him a chance, but it will be a short window of opportunity for him to convince me that he can keep America great.