Saturday, April 22, 2017

Milestone / Miles From Nowhere

Thirteen. At thirteen, a milestone, a Jewish boy is viewed to be a man. He has a Bar Mitzvah, becomes responsible for his actions, and three days later is reprimanded by his parents for failing to do his homework. So which is it? Is thirteen a milestone or is it really miles from nowhere?

We have a lot of artificial milestones, deadlines to get something accomplished, a deadline to be somebody. Twenty-one seems to be the threshold to adulthood. Fifty to being whatever we might actually accomplish professionally. Retirement at 65. But these are just numbers, an average, perhaps, maybe even a goal for some, but these numbers. These milestones are not law, not mandatory, and the first true sign of maturity is to understand that in our quest to achieve our best we must first discard artificial, imposed timelines. While some may peak at 23, others are still honing their skills in their 70’s. Limiting oneself to someone else’s milestones might even force someone into foolish actions.

And that brings us to Donald Trump and the rush to pass a healthcare bill next week.

Donald Trump has decided that he must repeal and replace Obamacare (The Patient Protection and Affordable Care) within his first 100 days. This is not because he has a prescription for better, cheaper, or even easier access to healthcare for most Americans. It is strictly because the first 100 days is a milestone. He has no concern about leaving us miles from nowhere.

President Trump is trying to get the House Republicans to pass a bill by next Friday. And though the legislation hasn’t been written, the Congressional Budget Office hasn’t revised its scoring, and no House committee has held a single hearing, Trump thinks he can get a bill passed. Of course, it could be passed if the details don’t matter. Just a reminder – we are talking about close to 20% of our economy and how the doctors and hospitals get paid if you happen to get sick or injured. The details are important.

Trump’s latest partners are two Republican House members representing two different wings of the party, House Freedom Caucus Chairman Mark Meadows and Tuesday Group co-chairman Tom MacArthur. Together they have crafted a compromise that is more likely to anger the members of their caucuses than to garner their support. The MacArthur Amendment (draft provided to Politico) to the American Health Care Act does not fulfill the Republican promise of repealing and replacing Obamacare, guarantee that Americans won’t lose their healthcare coverage, or even deliver more coverage for less. They have shuffled the deck, added a couple of jokers, and then mistakenly dealt the cards face up.

The MacArthur Amendment reaffirms the value of having real standards of insurance. The Essential Health Benefits, a list of ten benefits delineated under the PPACA, were scheduled to disappear under the original Republican plan. This amendment brings the EHB back, but only for a moment. Section 1 reinstates the EHB. Section 2 allows states to seek a waiver to eliminate the EHB if they claim that this would lead to lower premiums or the possibility of more insureds. And it isn’t just the Essential Health Benefits. Section 1 guarantees useful insurance and Section 2 guarantees that usefulness won’t be around for long.

We are rushing towards a milestone – Trump’s first 100 days. It is an artificial deadline. But healthcare, taxes, war and peace are not artificial. These issues are real. And when it comes to reality, he is miles from nowhere.


Thursday, April 13, 2017

Donald Trump Needs A Friend

It may be a little late in the game, at age 70, to finally make a friend, but Donald Trump needs a friend. A real friend. This is becoming a priority. I’m not volunteering, but I would at least try if no one else is available.

It is obvious that our current president has never had a friend. He has never learned the importance or value in real friendship. Instead his relationships, with people or the truth, have been of convenience. He is transactional and of the moment. In the last few weeks he has demoted Steve Bannon, Michael Flynn, and Paul Manafort. The president now claims that these three men, previously among his closest advisors, played small, insignificant rolls in his campaign. Let’s be clear. Removing Bannon, Flynn, and Manafort from the executive branch of our government is a good thing. The issue is how it happened and what that means for other areas affected by President Trump’s leadership “process”.

Let’s look at healthcare. Candidate Trump campaigned in superlatives. He was going to replace Obamacare with something BETTER. It was going to be GREAT. Only Mr. Trump’s biggest fans believe that he ever had any plan or knows anything about our healthcare system. The less charitable might also point out that he probably doesn’t give a damn about any of the details. His relationship with the healthcare issue is strictly one of convenience. All of the details are negotiable since the only, I do mean only, goal is the opportunity to declare victory. This was supposed to be a series of transactions.
  1. He told the American people what they wanted to hear – He got votes
  2. He tells Congress to give him a bill, any bill – He signs it
  3. He then declares victory and claims to have killed Obamacare – He then moves on to the next victory
The issues are not relevant to him. And whether you are accusing the Chinese of currency manipulation or bargaining away coverage for preexisting conditions, details matter. Bluff and bluster might work in the real estate market where it may be assumed that little of what he said was true or relevant. Governing is different. At some point they either call his bluff (see Freedom Caucus) or just ignore him.

Monitoring the rumors swirling around Washington could become a fulltime job. One day President Trump is all in on the American Health Care Act, the hastily assembled Republican healthcare bill. It quickly devolved into Trumpcare, a collection of disparate bargaining chips unloved by even its creators. The AHCA didn’t have a champion, just Trump offering one more deal to find a vote or two. The AHCA died without a vote. And who was the first to kick dirt on the grave? Donald Trump!

I'm a little surprised, to be honest with you. We really had it. It was pretty much there within grasp. But I'll tell you what's going to come out of it is a better bill -- I really believe a better bill. Because there were things in this bill I didn’t particularly love. And I think it's a better bill.

The big rumor today is that Trump is threatening to undermine the tax credit subsidies in an effort to torpedo The Patient Protection and Affordable Care Act (Obamacare). The other alternative is that this is a bluff to force Democrats, legislators that have exhibited a certain level of seriousness on the healthcare issue, to come to the table. This would not be to discuss improving the way we pay for healthcare. No, this would be about the dismantling of Obamacare. It is important to remember that repealing Obamacare does not get one more patient admitted to a hospital nor does it guarantee the payment of a single doctor’s fee. Repealing Obamacare is the political exercise of the intellectually flabby.

Jeffrey Lord has represented Donald Trump on CNN for the last year. Today he declared Trump to be the Martin Luther King, Jr. of healthcare. Honest. I can’t make this stuff up. Two days ago Sean Spicer lauded Adolph Hitler’s restraint with poison gas as compared to Assad in Syria. Why appropriate other people’s heroes or minimize other people’s suffering unless they are simply means to an end. Why shift positions on ALL issues unless no position has any value save as a stepping stone to a deal, regardless of the terms. And why pledge loyalty to someone who places no value in relationships that fail to yield results.

Loyalty. Truth. The ability to look someone in the eye and tell him when he is wrong and demand a heartfelt apology. Friend, the person that brings out the very best in each of us. American needs Donald Trump to find a friend.