It Just Will Not Stop

Just when one thinks that just about everything that could happen under the Trump Administration has already occurred — it can’t possibly get any crazier, but it does.  Last week was chock full of newsworthy items, any one of which would have been worthy of discussion but they just kept coming and coming. Over the last week or so, we’ve seen proof that President Trump still does not understand the dignity and impact of the presidency.

To quickly cover a few of the highlights before getting to the main event — health care bills — let’s do a tour d’ horizon.  Two venerable institutions, the Boy Scouts of America and Police Departments across the country, had to issue apologies and “clarifications” following President Trump’s speeches to the annual Boy Scout Jamboree in West Virginia and to a Long Island New York police department.

In the former he gave a political speech that was short on inspiration to America’s youth and long on past grievances, politics, and a reminder of how personally great everything Trump is and will be. Some parents threatened to pull their kids from the Scouts.  President Trump supporters opined that the “kids loved it” forgetting that they are boys and teens and that when you get 40,000 kids together in one place, especially mostly boys, they will laugh and cheer at just about anything, especially if flatulence is involved. On Long Island the president seemed to say that police brutality when arresting suspects was okay.  As usual, whenever called out on similar pronouncements, it was proposed that it was a “joke.” Police departments around the country could only cringe and issue statements that such statements were no joking matter and that their (fill in the city) police department does not condone such action.

Within days of President Trump announcing the new White House Communications Director Anthony Scaramucci, aka “The Mooch”, aka “Mini-me” Mr. Scaramucci went on a rant to a New Yorker Magazine reporter that disparaged key senior members of the White House staff and included numerous references, in full graphic detail, to acts of biology that to my knowledge are impossible.  No comment from the president at the time.  Others in the Administration opined that he’s just a “New Yorker” and apparently that’s how New Yorkers talk about co-workers.  Having lived for a number of years in New York state I don’t recall anyone talking that way and certainly not in the name of the President of the United States.

In Tweets (Tweets!) the president continues to disparage his own Attorney General and his first and for a very long time, only official supporter for president.  According to some accounts this is a prelude to cleaning out the senior levels of the Department of Justice including the Attorney General, his deputy, the Acting FBI Director, and Special Counsel Robert Mueller.  No problem there.  In another Tweet the president arbitrarily told all active duty transgender military personnel that their services were no longer required “in any capacity” because they are a burden and “disruptive.”  Suddenly somewhere around 7,000 soldiers, Marines, Sailors and airmen are in limbo and told that somehow their patriotism and willingness to defend the nation does not count.

In yet another Tweet, the president fired his chief of staff Reince Priebus.  The Tweet announced that retired Marine general and serving Secretary of Homeland Security John Kelly would be the new chief.

Whew!  A full week.

On the upside for those of us rooting for a successful and appropriate presidency there were several positive developments.  As I write this, reports are that Anthony Scaramucci was removed from his job of ten days as the Communications Director.  I have no inside information but I suspect that the new chief of staff had something to do with that as Mr. Scaramucci bragged last week that he only reported directly to the president and did not have to answer to anyone else on the staff.  My knowledge of General Kelly, although limited, would indicate that he would absolutely not tolerate antics such as those of Mr. Scaramucci.  Perhaps the General can bring order to the White House staff.  We’ll see, but a good first step.

Also positive, the Chairman of the Joint Chiefs of Staff General Joseph Dunford, USMC let it be known that the military does not act on Tweets or any other form of informal communications when a policy decision is to be made, even a Tweet by the president concerning transgender policy.  Hurrah. It remains to be seen what actual policy evolves, but it is good to know that spontaneous utterances by the president will not precipitate military action.

Further good news came out of the Congress that overwhelmingly passed a bipartisan bill strengthening sanctions primarily against Russia, but with some additional provisions against Iran and North Korea. The Congress felt it necessary after listening to, and observing the actions of, President Trump with regards to Russian President Putin and our president’s apparent fascination with him.  The White House staff had worked hard behind the scenes to stop the passage of the bill but both houses of the Congress got up on their hind legs and said “no” to the president on this issue. A positive sign that they may increasingly exercise their role in governing as an equal branch of the government.

Many Republican Senators and Representatives also went on the record along with their Democrat colleagues to oppose President Trump’s Tweet policy on transgender individuals in the military and the treatment of Attorney General Sessions.  Clear signs that the president will not get blanket support from them.  As an aside, the president now taunts Republicans as well as Democrats via Twitter seeming to make it clear that he does not consider himself a Republican.  But to most of us, that is no surprise.

And of course let’s not forget that North Korea tested new Intercontinental Ballistic Missiles (ICBMs) that experts think can reach targets on the U.S. mainland as far as Chicago.

Arguably the biggest news of the week was the failure to repeal or repeal and replace or otherwise get rid of the Affordable Care Act (ACA) lovingly known as Obamacare.  Most of us followed the news and at least heard of the ins and outs of the entire suspense filled week of “will they or won’t they?”  They did not.  One could ask why after seven years of clamoring for (and voting over 50 times for) the repeal of Obamacare the Republicans were not ready to put forward their own coherent health plan. One could also ask why the only argument put forward by most Republicans, and especially by the president, had nothing to do with the merits of the proposed replacement plan(s) but rather the only argument was that Obamacare was “bad” — nothing about why the new plan would be better.  SAD!

But be careful.

I do not think the health care battle is finished, only in a strategic pause.  There will be further efforts to repeal or repeal and replace.  For supporters of Obamacare, or supporters of a bipartisan effort to repair Obamacare and to make it better, do not relax.  The fat lady has yet to sing.

Over the weekend President Trump tweeted out (how else?) that Obamacare was going to implode and implicitly that he would make it happen.  On Sunday the Director of the Office of Management and Budget (OMB) Mick Mulvaney went on television to be explicit about the president’s threats/promises. As I have written in this space before, the president can do grave harm to the current Obamacare system, primarily through non-enforcement of the mandate and by withholding funds to subsidize premiums. He also made news by threatening the Congress and Congressional staffers with actions to increase their premiums.  I am no expert in this area, but this is what I understand is the issue.

Is it possible for the president to make Obamacare “implode” as he promises?  As with most things, the answer is “it depends” on what part of Obamacare one refers to during the discussion.  Since Obamacare remains the law of the land, the president cannot make it go away at once.  He can, however, create enough chaos in the system that it can degrade over time.  Remember that most Americans get their health insurance through their employers or through the government (military, VA, military retirees, Medicare, etc.).  For middle to low-income working adults and for children that do not have employer or government health insurance they mostly get their insurance through Medicaid or in a market place created by the ACA.  Although a major factor in the latest debates, Medicaid is provided by law and cannot be legally changed without a change to the law. What is really under discussion are the ACA market places.  Since the ACA was fully implemented, about 10 million Americans get their coverage via the government market place.  These are the people you most hear about on the news and in political rallies, be it how bad the system is or how wonderful the system is.

The administration has a number of ways to degrade the ACA.  In a slow motion effort, they could stop advertising and marketing the exchanges so that people either don’t know that the markets still exist (a lot of Americans are unsure as to what is available after all the latest hubbub) or miss deadlines to sign up because there was no public advertising as to how or when to get on board.  Additionally, if the administration follows through by not enforcing the mandate (either get insurance or pay a fine) healthy people will get out of the market which causes costs to rise for the insurers which is then passed on to those still in the market — their premiums rise — or the insurer gets out of the market because it isn’t profitable for them if they have to eat the added costs.  (Remember the three legs from my 23 June post. To work, if we want to cover pre-existing conditions, the system needs a mandate to keep the pool costs low by balancing healthy folks with those that we already know have problems, but then to be fair, we subsidize those that have to have insurance but cannot afford it.  Get anything out of whack, and the system starts to wobble — the promised “death spiral.”)

President Trump is threatening/promising to speed up the process by withholding cost sharing payments. As I write, they are only released through the end of July — today. (The next deadline is in late August.)  The ACA requires insurance companies to hold down the deductibles, co-pays and premiums for those in the individual market place. However, the insurance companies are not charitable organizations and they are in business to make money.  To make up the loss of revenue to those companies every month the government makes up the difference on the costs — currently about $600 million a month.  Should the Trump administration stop paying those subsidies, premiums for those on the market place would sky-rocket or the insurers would just pull out of the market.  This is a lot of what you hear about when those that oppose the ACA say it is “collapsing.”  Health care and health insurance is not “collapsing” for most Americans, but it could for those middle to low-income Americans that are on the individual markets should the president follow through and try to cause the ACA to “implode”.

He claims the Democrats will “own it” and he will take no blame.  I think he is fooling himself if he takes deliberate action to make it tough on the citizens he swore to protect.

There is one more esoteric wrinkle in the president’s threats that you may hear more about this week. Mr. Mulvaney explained the issue and says that the president is serious about implementing it.  This involves the health insurance for members of Congress and their staffs.  Despite rumors to the contrary, by law the entire Congress and their staffs are on the ACA — they get their insurance from Obamacare. But with a wrinkle.  President Obama’s administration put out a policy that allowed them to treat each individual office of each Senator and Representative each as a small business.  This means that they are eligible for the subsidies just talked about above, saving them lots of money out of their own pockets. Before setting our hair on fire, take a minute to think about it.  Certainly the individual Senators and Representatives could afford to pay full price in an employer plan, but most staffers, interns, administrative personnel, etc. working in their offices are young folks not making much money.  It would have a huge impact on them should President Trump change the policy to exclude them from the subsidy program.

Today is the start of a new week.  Let’s hope it is a dull one.  We need to take a collective deep breath and take a few minutes to enjoy the summer.  And summers in official Washington D.C. are supposed to be dull.  Nothing going on.  If so, hold on to your hats come September.


That Was The Week That Was

Some of us of a certain age can remember the 60’s political satire show “That Was The Week That Was”, or TWTWTW, or simply TW3.  The show launched the American career of the British television host David Frost who went on to do many serious interviews including the definitive series of interviews with former president Richard Nixon.  But in the beginning, think of TW3 as an early, ensemble cast version of the “Daily Show.”  I can only imagine what fun they would have had with this week’s news out of Washington D.C.  Actually, it is hard to keep up with the news from the last 72 hours, but I will try to hit some of the highlights.

First, on the Russian front.  No, not that news, but rather the news that President Trump decided to withdraw the U.S. from a CIA program to provide training and equipment to Anti-Assad forces in Syria. One could argue whether that secret program — different from the American involvement in Syria fighting ISIS — was effective or not, but it was relatively low-cost and showed U.S. support for freedom fighters in Syria.  By pulling the rug out from under them, it seriously undermines confidence in U.S. commitments in the Middle East. Oh, by the way, the Russians’ number one request from the U.S. was to withdraw support from those forces.  They have been demanding it for years.  And now the U.S. has given in to the demand in exchange for, for, well apparently for nothing.  A significant bargaining chip for the U.S. in its relations with Russia (and a symbol of our desire for Bashar al-Assad to go away) is now off the table.  Not sure how or why because the Trump administration doesn’t want to talk about it.

In an extraordinary (in every sense of the word) interview with the New York Times President Trump talked about everything from the healthcare bill, to the French Bastille Day celebration, to Napoleon, to Hitler to NATO and many more topics (you can’t make this stuff up).  In total, a bit disconcerting when it is all put together.  Reading the transcript is actually frightening as it shows that the president thinks that the entire federal government is his personal staff — that they owe allegiance to him first, foremost and only, rather than to the American people and the Constitution.  It cements in my mind that he has no real understanding of what it actually means to be president of the entire United States. It is particularly disconcerting when he speaks about the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI) and the senior leaders in both.  By name and with apparent malice of forethought he disparaged Attorney General Jeff Sessions, Deputy Attorney General Rod Rosenstein, Acting FBI Director Andrew McCabe, and Special Prosecutor Robert Mueller.  For one example, how would you interpret what he said about Attorney General Sessions?

TRUMP: Well, Sessions should have never recused himself, and if he was going to recuse himself, he should have told me before he took the job, and I would have picked somebody else.

HABERMAN {NY Times}: He gave you no heads up at all, in any sense?

TRUMP: Zero. So Jeff Sessions takes the job, gets into the job, recuses himself. I then have — which, frankly, I think is very unfair to the president. How do you take a job and then recuse yourself? If he would have recused himself before the job, I would have said, “Thanks, Jeff, but I can’t, you know, I’m not going to take you.” It’s extremely unfair, and that’s a mild word, to the president. So he recuses himself. I then end up with a second man, who’s a deputy.

To me two things jump out.  First, in the best case scenario, the president does not understand the role of the DOJ and that those attorneys do not work for him as Mr. Trump.  They work for the American people and need to have a loyalty to the Constitution rather than to an individual in the White House. Mr. Trump always insisted on loyalty from employees and so it appears President Trump insists on loyalty to him from his “employees.”  A second more sinister interpretation would be that President Trump would not have nominated Mr. Sessions if he knew that the Attorney General was not going to keep any investigation into the Russian interference in the election and possible Trump campaign involvement in it from gaining any traction.  Apparently, he expected the Attorney General to keep things under control and away from the president and his family.  Otherwise, why appoint him?  Read it for yourself, but if you look closely, you will see that he is castigating Mr. Sessions for doing the right and honorable thing.  There are now reports from multiple sources revealing that President Trump is reviewing his options on pardoning friends, family, and himself.  Very Nixonian.  Take a look at these three quotes and guess which are which from President Trump and President Nixon.

“When the president does it, that means it is not illegal.”

“When you’re a star, they let you do it.  You can do anything.”

“The law’s totally on my side.  The president can’t have a conflict of interest.”

The first one is from President Nixon, the other two from President Trump.

The biggest issue of the last few days is healthcare.  What the House and the Senate decide, or don’t, in the coming days and weeks will have an impact on millions of people and on billions of dollars in our economy.  It should not be something that is just pushed through for the sake of “getting something done” alone.  I agree that the Congress should get something done — so far not much of substance has gained escape velocity from Capital Hill — but something this big should be carefully considered. Kudos to Senator Susan Collins (R-Maine), Senator Lisa Murkowski (R-Alaska) and other Republican Senators that examined the proposed bill and found it woefully wanting.

Claims that Trumpcare is dead are, however, exceedingly premature.  Likewise reports of the death of Obamacare are premature.  But the president can murder Obamacare if he wants to, and there is some indication that he wants to do so.  By withholding subsidies for insurance premiums, which he says he may do, and by not enforcing the mandate, which is already the case, the president can make portions of Obamacare collapse — not the whole thing, but parts.  Claims that he “doesn’t own it” will not hold.  If he actively undermines the law, people that lose it will notice.  Bad policy.  Hopefully some of his advisers and others in Congress will convince him not to take that path.

The Senate will vote on something next week, but even the Senators themselves do not know what that will be.  Not good news. Currently there are at least two basic versions of “repeal and replace” legislation, with the possibility that those two bills will change before voting occurs, and one version of “repeal and replace later” with the possibility that one will also change.  It is surprising and disconcerting that a vote will be held early next week, with wide-ranging consequences on real people’s lives, not just in theory, and no one yet knows what will be up for a vote.

Dare I hope?

Here is what I hope for.  There are definite signs that moderate Republicans and Democrats are making the early moves to work for a bipartisan bill to “repair” the flaws in the Affordable Care Act (ACA), aka Obamacare.  Flaws do exist.  But there is no reason to get rid of the entire program — assuming one believes that health care should be affordable and available to all as I wrote about in my 23 June post. To be realistic, no Democrat will budge until the word “repeal” gets buried.  They also won’t support anything called Trumpcare.  Conservative Republicans such as Senator Rand Paul (R-Ky) won’t support anything that does not completely repeal the ACA “root and limb.”  But I hope that enough good folks, willing to put country above party, still exist in the Senate in both parties and that cooler heads will prevail.  If that happens, it could be the beginning of a wonderful relationship.  Getting something as tough as health care tackled on a bi-partisan basis would go a long way in having Republicans and Democrats getting back together to tackle other long-standing problems.  What a concept. I am always told how naive I am, but I hope that we have a break through on this issue and that it leads to accomplishments in many more areas.

Finally, and I leave it here despite many more developments of the last 72 hours, speaking of putting country above party I have always had the deepest respect for Senator John McCain (R-Ariz).  That doesn’t mean I always agreed with him but I always thought he was trying to do what he thought best for the nation and its people.  As you know, he is battling a particularly nasty form of brain cancer. I hope that he is back on his feet and back to the Senate before too long.  There are not many like him left in today’s Senate chamber.


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 Medicaid 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 Medicaid and there is significant concern over the reduction of those Medicaid 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 Medicaid 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.


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.

 

 

 


What Just Happened?

It turns out it is impossible for me to resist writing about the recent shenanigans in the House of Representatives.  I did not intend to write more about it as it seems self-evident to me as to what occurred, but here I am writing none-the-less.  I’ll try to be brief in addressing two main points.

I think what we just experienced is primarily a battle for the future of the Republican Party.  I feel strongly that we need a vibrant two-party system as part of the checks and balances inherent in our way of government.  For this citizen, I hope that the mainstream Republicans in the Senate and the House prevail over the Tea Party zealots that prefer ideological purity over actually running the country.  To this observer, it seems a lot like fundamentalists trying to take over our nation.  Thankfully the cooler heads in the Senate prevailed, which actually is not unusual in the history of our legislative process and a reflection of the way it was intended to be done.  The House tends to be more impetuous and the Senate tends to be the more deliberate body willing to look at long-term impacts rather than the fad of the moment.  Obviously, there are exceptions to the rule on both ends of the equation, but generally the system works.  It worked this time, but it took way too long.  Time will tell what this all means for the future, but I hope that the fundamentalists in the House have figured out that Senator Ted Cruz is not the Speaker of the House.  In my view, Ted Cruz really is only out for himself and has merely hitched a ride with the Tea Party in order to gain attention for self-promotion.  The majority of Republicans in the House and Senate need to stand up to Cruz and his kind and appeal to the large majority of us that take a middle of the road approach.

I’m no fan of his, but kudos to Senator Mitch McConnell who is fighting his own re-election challenge from the far right.  He was missing in action for far too long, but got it done in the end.  Hopefully the experience for both he and Senator Harry Reid will lead to some productive efforts to straighten out the problems that we face in a bi-partisan manner.

My second thought has to do with opposition to Obamacare which, ostensibly, was the reason for the shutdown.  For now I will ignore the view that simply because it was championed by President Obama that there was visceral opposition to it regardless of its possible merits.  Instead I have several thoughtful colleagues that worry that our country cannot afford it.  This is a more reasoned argument and one that needs to be further explored.  As I have said in earlier posts, I do not believe that Obamacare will be trouble-free — no undertaking of such magnitude can be counted upon to be trouble-free.  However, the fixes should be well thought out and not attempts at outright sabotage to ensure its failure.  But I digress.  While I do not accept that the Affordable Care Act will be the ruin of our country, either socially or economically, let me concede for arguments sake that it may put a burden on our national finances.  I still do not get the logic behind the reasoning that what may (may) be a burden over the long haul — several years into the future — needs to be “fixed” by destroying the nation’s economy now.  That is what many Tea Party supporters and Congressmen tried to do with the run-up to the current Continuing Resolution (CR).  Some still say it would have been worth it and given the chance, they would do it again.  I do not get it.  While I am no Nobel Prize winning economist, I do understand what the Nobel Prize winning economists are saying, along with financial experts of every stripe and leading CEOs of major corporations.  All indications were that a failure to extend the debt ceiling would over time have a catastrophic impact on our economy and destroy any chance for a continued recovery.  Even those staunchly opposed to Obamacare were appalled that the Tea Party Republicans would be willing to cripple our nation economically in order to stop it.  I will never understand it.  Never.  Such an approach runs counter to everything that I understand as a patriotic American.  If every one of us acted this way to oppose laws that we disagree with (and there is probably some significant law that most Americans oppose and it is unlikely that it is the same one) then we would be a nation without laws and anarchy would prevail.

I just do not understand how people who say they love their country actually hate it so much that they are willing to risk destroying it to get what they want.


What’s In a Name?

Some of you may have seen this already.  Even taking into account the randomness of the survey and the impact of editing, it still paints the power of propaganda.

On Jimmy Kimmel’s show the other night the “man in the street” interviewer asked  people which they preferred — The Affordable Care Act or Obamacare?   The overwhelming choice was The Affordable Care Act.   We know that they are the same, but apparently many people do not.

When the interviewer asked about specific provisions of Obamacare — such as allowing children to stay on their parents policy until age 26, no restrictions for previous conditions, etc. — the response was always positive, even as they continued to say that they did not like Obamacare.

Propaganda works.

You can watch it for yourself here: http://youtu.be/sx2scvIFGjE


Be Afraid, Be Very Afraid

John Boehner is allowing a small radical wing of his party to attempt to destroy the fabric of American democracy.  Sooner or later most Americans will realize the true nature of what is going on in the current fight over the Affordable Care Act.

Whatever one’s view of the Affordable Care Act or Obamacare may be, supporters of American democracy should be very concerned.  This is not business as usual, especially as the debt ceiling limit gets closer and closer.  Earlier Washington stalemates that resulted in government shutdowns in the 1980s and 90s concerned budget issues, where money should or should not be spent and which programs took priority.  This is about none of that.  This time around it is a radical minority of one party trying to undo the fabric of our democracy.  They do not like Obamacare and obviously have very strong opinions as to why.  In my view, most of those arguments are incorrect or mere assertions without a basis in fact,  but okay, I’ll respect your opinion.  Unfortunately, after over forty attempts to undo the legislation (without, I will add, any alternatives to provide healthcare to Americans in the greatest country in the world), they have decided that they will bypass the legislative system that we have and create their own.  Simply put, if they get their way on this issue, there will be more issues that take some portion of the American way of life hostage until they get their way.  Remember that they are taking our economy hostage for a six week continuing resolution.  It isn’t even about an actual spending bill.  Who is naive enough to think that if Congress delays Obamacare for a year that we won’t be right back where we are now in 2014?  It will never end.  It is time for the showdown and a restoration of the American way of democracy.

There is nothing that the Tea Party Congressmen are demanding concerning Obamacare that should be negotiated.  Period.  If they want to go to conference with the Senate to resolve budget issues and to negotiate a spending bill for this fiscal year, by all means, it should be done.  But that’s not what they want.  They continue to try to eliminate or cripple the health care act.  An act, again, that has withstood every conceivable challenge in our way of government.  They failed.  So now we have to put up with their antics outside of the normally accepted legislative process.

John Boehner is now Speaker of the House in name only.  He has seriously undermined the authority of that position by caving to the hard liners.  Every account coming out of Washington from both sides of the aisle is that a “clean” continuing resolution to fund the government for another six weeks would pass in about five minutes with sufficient Democrats AND Republicans voting for it .  Done and done.  Speaker Boehner won’t do it because he fears losing his Speakership.  In truth, it is doubtful that he would be voted out, but apparently, he’s unwilling to take the risk and is afraid to do the right thing.

This is also, in my opinion, a naked attempt by the Senate and House Tea Party members to severely hobble the President.  If President Obama gives in to the demands to delay or defund the health care act, he is done as president.  Indeed future presidents of both parties would be weakened if this undemocratic tactic being foisted on our country succeeds.  It would become a weapon for any dissatisfied minority to use that will hobble the ability of our country to operate.

We should be afraid, very afraid for the future of our country if this naked attempt by a minority to grab power from the majority succeeds.