Donald The Muddler & The Ones That Know Better

Those who voted for Donald Trump as the "change" candidate didn't really get what they bargained for, but they don't seem to mind. What they really got was a "muddler".

noun1. a person who creates muddles, especially because of a disorganized method of thinking or working.

So what are muddles?

noun1. an untidy and disorganized state or collection. synonyms: mess, confusion, jumble, tangle, mishmash, chaos, disorder, disarray, disorganization, imbroglio, hodgepodge

Yep! That pretty much sums it up. And, I guess, in a bizarre sense, it is a form of change. And, in fact it's pretty consistent with the expressed national goal of one of the President's right hand men -- Steve Bannon.

"I'm a Leninist. Lenin wanted to destroy the state, and that's my goal, too. I want to bring everything crashing down and destroy all of today's establishment."

If you take a look at the first six months of the Trump Presidency, I guess we're pretty much on track.

So do the people who voted for Donald Trump feel like they got swindled? Hell no! They're loving it. It's a movement; and it's solid. 

With all that's gone down in the last six months -- constant lying, fake news, Russian collusion/coordination; women, minority and media bashing; bigotry, bullying, betrayal of allies, nepotism, financial deception, disrespect for norms and embracement of indecency -- the Muddler's support has hardly waivered. It appears to be solid at about 40%.

So what does this say about the good old U.S.A.? It's not so much about the Muddler himself? It's not about healthcare, tax reform, infrastructure, environment or other important policy issues. The Muddler promised to fix all those things and make them "beautiful" and "amazing", but he's not going to do it.

It's about the 40%. That's not "small potatoes" as my Grandma would have said. That's a huge chunk of the American population that is willing to support, praise or just tolerate the behavior of the Muddler. I think we should be concerned.

I would break the 40% down into basically two major groups: (1) the group that truly supports what the Muddler stands for (that's scary); and, (2) the group that is tolerating him because, despite his abhorrent behavior, he will allow them to advance their ideological political agenda. This group includes most GOP Congressional members, leaders, surrogates, strategists and D.C. insiders; all willing to sacrifice fundamental, human and democratic principles for party passion and ideology. 

It's the second group that bothers me the most. Maybe the country can endure 15 to 20 percent of the population that actually supports what the Muddler stands for; but, it's the ones that know better who continue to fall in line that is really troubling.

I'm convinced that there are many, diehard Republicans that are appalled by the Muddler's disingenuous (I'm being nice) statements, Tweets, treatment of our allies and puzzling relationship with Russia; but they are willing to continue their support for this intolerable, immoral, and embarrassing conduct of an American President.

What will it take to make them snub this insult to our Presidency and country? Or will they ever? The Muddler's shenanigans and malfeasance would have already brought down any President known to modern man. The mischief, indiscretion and misdeeds of the likes of Richard Nixon and Bill Clinton seem like child's play in the wake of the Muddler. Yet, the ones that know better continue their toleration.

Our future is the hands of the GOP members that know better. Because they're in control of the House and Senate, they are the ones who must lead. So long as they remain silent and let the travesties of leadership continue they are empowering the worst among us from both sides of the political spectrum. 

Unfortunately, it's not looking good. As I have pointed out previously, the tolerance of the American public for this continued malfeasance and incompetence is not sacrosanct -- it will reach a point of eruption. The creaking sounds of a breaking democracy can already be heard. 

If the GOP leadership, the ones that know better, continue to force a one-sided, reckless, heartless health care bill through the process simply to fulfill a 7-year, half-baked, mantra ("repeal & replace") the democratic underpinnings may fracture.

Meanwhile, the delusional Muddler, who resides in an alternative fantasy land, amuses himself by Tweeting:

Donald J. Trump‏Verified account @realDonaldTrump The W.H. is functioning perfectly, focused on HealthCare, Tax Cuts/Reform & many other things. I have very little time for watching T.V.9:39 AM - 12 Jul 2017

#BetterGovmt

Rattling the Underpinnings of Democracy: What Have We Become?

How can it be that our governmental processes have degenerated to the point where it is considered okay by a large portion of the public and political leadership to deny funding for needed health care services to children, old people, poor people and the sickest among us, and at the same time give huge tax rewards to the richest among us? With nearly a trillion dollars involved, this is not an incidental action; but, a massive transfer of necessary human survival services for unnecessary individual enrichment.

Tax breaks for the rich and "trickle down" economics have been a part of the political landscape for years, but the direct taking of money for lifesaving services to provide windfalls to the wealthiest has reached a new level of cold-heartedness.

Let's pause and take stock. It's 2017. The Presidency is a national and international embarrassment led by a man who is supported by about a third of the public. His actions scoff traditional norms of decency, undermine the basic foundation of American government, and threaten national security. He has established a new normal where facts can no longer be distinguished from lies. Hard to believe, but the good old U.S.A. is being led by a man so in love with himself, that he prints a fake Time magazine cover "trump"eting his phony accomplishments and resides in a constant state of alternate reality. 

Congress is non-functional because of intense political polarization that has reached a point of frantic implausibility. The two major political parties have morphed into factionalized tribes, trading patriotism for partisanship, to the point that they can no longer define or articulate what they stand for and being led by the extreme elements of their ranks.

We can't blame the current state of affairs solely on our bungling President. There are two prominent and skilled GOP leaders -- Mitch McConnell & Paul Ryan -- who could stop this madness in a New York minute if they chose to elevate reverence for country over their dogmatic passion for Party supremacy.

The breakdown of the major political parties and their growing dysfunction has led to their inability to provide the required "check" on the executive branch. Congressional paralysis in recent years provided the underpinnings for the movement that led to the election of Donald Trump and its persistence now allows the continuation of this national and international insult to the American brand.

The more extreme ends of each party remain active and continue to fan the rhetorical fires that further divide the electorate. The mainstream media continues to report the constant drumbeat of lies, dumbfounding tweets and statements, and unimaginable political faux pas. The alternative media distorts reality and rationalizes the GOP and White House shenanigans and demonizes the mainstream media.

At the same time, much of the public have allowed their eyes to glaze over and begun to tune out the constant frenzy of insanity. Many are in search of distractions to avoid the insults to their intelligence. Many have run out of adjectives to describe what is happening. Many avoid discussions with family and friends because the circumstances are so sensitive and confrontational.

The vehement debate over health care is indicative of what is to come as the country faces other major policy directives and issues. The political leadership of both parties is pushing the framework of democracy dangerously close to its breaking point. The tolerance of the American public for this continued malfeasance and incompetence is not sacrosanct -- it will reach a point of eruption.

Within the next few days the GOP leadership and Presidency have a choice: to either stop the current intolerable proceedings and start anew with a bipartisan approach; or, they can continue to ram through a one-sided solution constructed with no public hearing or scrutiny that is doomed to failure and will push the public to the brink. The choice is theirs.

From my perspective, the desired process would be to develop legislation via the shared committee power process which I have continually advocated in this blog. See more on shared committee power and links to further information: https://goo.gl/LwzeuA. #BetterGovmt

My Heart Died A Little Bit Today

Editor’s Note: I wrote this poem back in December 2016. It still seems timely six months later.

Editor’s Note II: Still timely, but worse than expected February 2020

My heart died a little bit today
I watched the news and felt it skip a beat
Seeing the death and destruction on the streets
I remembered back when things seemed right
And tried to figure out when I first noticed the slide
Where was I when my country cried?

My heart died a little bit today
It didn’t seem that long ago
But I’m getting confused and not sure I know
There were other times, I’m now remembering
I was lost in my mind and not able to cope
But this seems different – like there is no hope.

My heart died a little bit today
How could this have happened while we just lived our life.
We’ve lost our way and can’t see the strife
Yet it’s all around and hard to miss
But we’re all going on doing the stuff we must
While our leaders have stumbled and lost our trust.

My heart died a little bit today
It’s like we’re drifting in a sea of hate and divide
While serious things keep slipping aside
Simple decisions are hard to make without a fight
Working together seems not an option any more
People are thinking and talking about a civil war.

My heart died a little bit today
We can now see our globe from afar
And know that all our life depends on a little star
We’ve lost respect for land and water
The air we breathe -- the animals and seed
Have lost their value and been replaced with greed.

My heart died a little bit today
It’s becoming hard to find the truth
And I fear what will become of the world’s youth
It is now okay to ignore the facts and make things up
Education and learning may fail to meet the test
As officials and leaders claim they know best.

My heart died a little bit today
We see the oceans rise, the ice melt and the sun beat down
Yet some in power simply reply with a silly frown
They claim it’s a hoax, an international trick and a university scam
Their goals are uncertain but they confuse the masses and increase the gasses
Now with victory at hand they smile with glee and hoist their glasses

My heart died a little bit today
I try to imagine what the rest of the world perceives.
What happened to the global leader of the free world they believed?
Disrupting partnerships, breaking agreements and doing deals
Some countries and individuals may see opportunity and financial gain
But many I suspect may think we’ve gone insane

My heart died a little bit today
We have a new style that seems to be catching on
Civility, statesmanship, politeness and respect are all but gone
Bullying, bigotry, name calling, lying without guilt are now accepted
There’s no excuse; it seems senseless and cruel
But with leadership’s endorsement it is becoming the rule.

My heart died a little bit today
By hook or crook they’re now in control and arrogant in style
Previous enemies shed hate and disgust as they fall into single file
The rest of us wait with our fate in the balance as suspicion abounds
They insist they will act with our best interest in mind
But the actions we witness seem counter to promises and more mastermind.

My heart died a little bit today
I now feel a little hollow, sad and confused – extremely perplexed
Not knowing quite how to react or what to say – seriously vexed
It’s unfamiliar, strange, odd, weird, baffling and inexplicable
My faith and trust is now buried deep in the past
As I hope the Founders’ wisdom and written structures will last.

My heart died a little bit today. . .

Bipartisan, Democratic-Led Health Care Reform

Billy Wynne[1], writing for the Health Affairs Blog has done a wonderful job of outlining some of the essential ingredients necessary to address the national health care insurance issue. The posting on April 4, 2017, entitled, “What Now?: A Four Step Plan For Bipartisan Health Reform” is precisely what I have been saying is needed for Democrats to use in the development of an “Affordable Care Improvement Act” that could provide a sensible alternative to the GOP cobbled up, disastrous proposal known as the American Health Care Act (AHCA)[2]. See my March 27, 2017, post, “Democrats Could Lead The Bipartisan Revolution.”

I have been advocating for Democrats to take the lead now that the GOP efforts have failed and the President has declared:

“I think the losers are Nancy Pelosi and Chuck Schumer, because now they own Obamacare.  They own it -- 100 percent own it.”  And this is not a Republican healthcare, this is not anything but a Democrat healthcare. . .”

Following the GOP debacle[3], I said Democrats need to develop the "Affordable Care Improvement Act", designed to do what needs to be done to make the Affordable Care Act work better and introduce it in the House and Senate with 100% of the Democrats in both chambers supporting it. Simultaneously, they need to launch a massive public education and media campaign comparing the Republican and Democratic alternatives.

It is no wonder that the GOP is still divided on Healthcare? The House Freedom Caucus' 30+ votes will continue to block any effort that Speaker Ryan proposes. The GOP is getting so desperate to just pass something that they have now discounted rationale health care reform. The HFC's basic strategy is to reduce insurance costs for their constituents; an admirable goal, and they have found a guaranteed way to do it. Their "Plan" is don't cover anything including preexisting conditions. That should definitely reduce costs.

For example, items to be excluded under various GOP proposals in addition to preexisting conditions would include: outpatient care; emergency services; in-hospital care; pregnancy, maternity and newborn care; mental health and substance abuse disorder services; prescription drugs; rehabilitative services and habilitative services (including treatment for kids with autism or cerebral palsy); lab tests; preventive services (like vaccines, cancer screenings like mammograms and colonoscopies and, coverage of birth control); and pediatric services.

One can only imagine that eliminating coverage for these essential health care services would definitely reduce costs. Speaker Ryan said, "Instead of imposing arrogant and paternalistic mandates [like coverage for the above listed items], it [GOP plan] would increase choice and competition, creating a vibrant market where every American will have access to quality, affordable coverage."

Democrats need to step it up, lead the way, and not just be the party of “No” opposing all of the iterations of the GOP’s American Health Care Act. Instead of trying to get a few Democrats to sign on to a fatally flawed GOP proposal, why don’t Democrats turn the tables, propose a plan that makes sense and get 25-30 moderate, “Main Street” or “Tuesday Group” Republicans to sign on.

Billy Wynne has now provided the substance of what is needed in a Democratic alternative. Below is an extremely brief overview, but I highly encourage reading Mr. Wynne’s complete proposal. Some of this is fairly technical, but I am including it to illustrate the extent of Affordable Care Act (ACA) [Patient Protection and Affordable Care Act (PPACA) 2010 HR3590, or Affordable Care Act (ACA) for short] improvement ideas that exist which could be advanced.

Step 1 – Enhance The Individual Market: Wynne lays out a number of critical “mechanical options” to enhance markets and maintain the basic elements of the existing Affordable Care Act including continued funding the cost-sharing subsidies currently available to individuals in the exchange markets; actively marketing and supporting enrollment in available coverage options; and more substantial changes that would improve competition and reduce costs. Some options suggested have strong conservative support.

One major suggestion is that in lieu of the initial GOP approach of delivering tax credits of equal value to individuals at different income levels, the existing subsidy structure could be expanded to all households so that none are required to pay more than 9.5 percent of their income for coverage, which de facto phases out the subsidy at high income levels. While ensuring affordability for the middle class, this will also entice a broader array of consumers to get into the market.

Other significant suggestions include establishing default enrollment, perhaps into the lowest cost plan available with an opportunity to opt out; and ending the now four-year extension of plans that do not comply with the consumer protections enacted in the ACA.

Step 2 – Rationalize The Employer Market: The majority of Americans with health insurance acquire it via their employer -- two key changes could be enacted to improve that market’s condition. First, the so-called “family glitch,” which denies subsidies to family members if one of them has access to relatively affordable individual coverage from their employer, should be fixed to allow those family members to acquire subsidized coverage elsewhere. Second, access to the small business tax credits in the ACA could be expanded to assist more workers in this market.

Allow small business employees to be merged into the individual market completely over time and provide large employers greater opportunity to provide their employees a fixed allotment with which they can purchase insurance in a private exchange. Finally, addressing the “elephant in the room” “. . .by capping or eliminating the “around four trillion dollars over ten years” of tax exclusion for employer sponsored insurance.

Step 3 – Embrace Medicaid & Step 4 – Don’t Forget The Big Picture: Wynne says “It’s time to drop the ideological divide over Medicaid, a program that covers 74 million Americans who truly have nowhere else to turn.” He also reminds that health insurance coverage is really just a method for helping consumers address the underlying issue: their health -- we need focus on patients and the providers who take care of them.

Yes, there are problems with House leadership putting such an alternative bill up for a vote, but that's why an aggressive education & media campaign is needed. Wynne concludes:

“The bottom line is that there are a host of policies that lawmakers and regulators can embrace to start drastically improving the condition of our health care system. This will not be easy, nor will it happen quickly. Policymakers of all political stripes can come together now, though, to begin the arduous process of identifying evidence-based solutions and building the necessary consensus to enact them. It’s a winning strategy for politics and for the public.”

While I agree, I don’t think the current GOP leadership or Republican base has the desire or will to lead this effort. They are too wedded to the 7-year mantra of “Repeal & Replace Obamacare.” That’s why Democrats must take the lead.

#BetterGovmt

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[1] Billy Wynne, J.D., is the Managing Partner of TRP Health Policy. A division of the Washington government relations firm Thorn Run Partners, TRP Health Policy combines industry-leading, actionable analysis and insight with sophisticated, informed advocacy to help healthcare organizations solve challenges and capitalize on opportunities in the Federal policy space.

                TRP Health Policy is also home to Policy Hub, an online portal and daily digest delivering in-depth intelligence on every important regulatory and legislative development impacting healthcare.

                Previously, Billy served as Health Policy Counsel to the U.S. Senate Finance Committee. He received his B.A. from Dartmouth College and his law degree from the University of Virginia.

[2]CBO report on H.R. 1628, the American Health Care Act, incorporating manager’s amendments 4, 5, 24, and 25, March 23, 2017.

[3]List and summary of opposition to GOP AHCA from nurses, doctors, hospitals, teachers, churches, and others, from Representative Jim Cooper (D-TN)

Articles & Resources of Interest

May 25, 2017: “Obviously we’re all united in opposition to Trumpcare. That’s easy. People know what we’re against, but we want to promote more what we are for.” A quote from Rep. John Conyers (D-Mich.), who has been introducing single-payer legislation (“Medicare for all.”) since 2003. House Democrats See Medicare for All as Answer to ‘Trumpcare’. H.R.676 now has 111 Democratic co-sponsors. There are 193 Democrats in the House.

"Mending Obamacare: Where Do Dems Go from Here?", The Democratic Strategist, Mar 28, 2017,  By J.P. Green https://goo.gl/CMPmh9

"Will GOP leadership work with Democrats? These Republicans hope so." The Christian Science Monitor, Apr 3, 2017. By Francine Kiefer. https://goo.gl/9H3ph5

"No ‘Death Spiral’: Insurers May Soon Profit From Obamacare Plans, Analysis Finds" The New York Times. Apr 7, 2017. By Reed Abelson. https://goo.gl/zPzqhR

HealthSherpa | Fast, Easy Obamacare Policy Information. Enter your zip code & find plans and prices. https://goo.gl/OZgWzn

Health Care Reform News Updates https://goo.gl/3LcBiP

“Funding H.R. 676: The Expanded and Improved Medicare for All Act – How we can afford a national single-payer health plan in 2014,” by Gerald Friedman, Ph.D., Department of Economics, University of Massachusetts, Amherst. https://goo.gl/xaUC9K

Physicians for a National Health Program - PNHP is a non-profit research and education organization of 20,000 physicians, medical students and health professionals who support single-payer national health insurance. http://www.pnhp.org/

Medicare for all bill reaches a record-breaking 104 [and counting] co-sponsors in Congress
Posted on Wednesday, April 26, 2017

H.R.676 - Expanded & Improved Medicare For All Act, Sponsor:Rep. Conyers, John, Jr. [D-MI-13] (Introduced 01/24/2017), Cosponsor statistics: 108 current  https://goo.gl/dIx4Bg