Petulant bombast is a dangerous approach to governance – what the Founders associated with the British crown – but now President Trump has brought that style to U.S. policymaking on healthcare, as Michael Winship observes.
By Michael Winship
A couple of things observed after successful surgery and a week in the hospital: For reasons seemingly unrelated to your operation, you will find bits of surgical tape attached to odd parts of your body for days after your return home. While confined to your hospital bed, you will hear and say the words “urine” and “urinate” more than you have in your entire previous life.
President Barack Obama, Vice President Joe Biden and senior staff celebrating the passage of the Affordable Care Act on March 21, 2010. (Official White House Photo by Pete Souza)
Most important, time and again you will be amazed and comforted by the dedication, competence and patience of virtually every doctor, nurse, nursing assistant, physical therapist and cleaner you meet — especially the nurses and nursing assistants, who clearly are in charge of the joint.
Which is why it’s so infuriating to compare the true public service of these men and women to the man who is supposed to be our public-servant-in-chief — he who insists on trying to torpedo Obamacare and on running our country and government into the ground by fomenting policies fueled not by duty or patriotism but by incompetence, ego and petty vindictiveness.
It’s a given that our health care system, one-sixth of our nation’s economy, is a nightmare. And that despite my encomiums of praise for the medical profession stated above, there also are stinkers out there quick to abuse the system and make a big fast buck, especially in the pharmaceutical and health insurance industries.
Yet while Obamacare is a deeply flawed program — ultimately, single-payer is the way we must go or face economic and social ruin — it still has been a step in the right direction (“the end of the beginning of the reform we need,” in the words of advocate Wendell Potter), and could in some ways be patched until we yield to the obvious and make universal health care a right for every one of us.
But no. Dear Leader, frustrated by the Republican congressional majority’s repeated inability to repeal and replace Obamacare, decided to take matters into his own hands and issue executive orders that make a mockery of medicine’s guiding principle: First, do no harm. And all to take revenge on his predecessor, whose name he believes must be expunged and thrown down the memory hole.
One executive order allowed cheaper policies but fewer protections and benefits. The other cut subsidies to health insurers that help cover the costs of medical insurance for low-income individuals and families, resulting in projected premium increases of up to 25 percent by 2020 and, according to the Congressional Budget Office, costing the government $194 billion over the next 10 years. Genius.
Helping Nobody
As Sarah Kliff at Vox observed, “This is a policy that helps nobody and hurts millions.”
President Trump celebrates the House passage of Obamacare repeal with House Speaker Paul Ryan and other House Republicans at the White House on May 4, 2017. But the legislation stalled in the Senate.(Screen shot from Whitehouse.gov)
But at his Monday Cabinet meeting, Trump brayed, “Obamacare is finished. It’s dead. It’s gone. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore.
Yet like so much of Trump’s bragging, it wasn’t so. Or so we thought. Democratic Sen. Patty Murray and Republican Sen. Lamar Alexander came forward with a bipartisan compromise that restores the subsidies for a couple of years but also yields to conservatives and gives states more leeway in regulating health plans. Trump seemed to say he supported it. And then he didn’t. What’s more, many conservatives, especially in the House, are opposed. So… more mayhem.
All of this is reflective of what commentator Andrew Sullivan calls “nihilist, mindless reactionism.” The President, Sullivan writes, is “a reactionary fantasist, whose policies stir the emotions but are stalled in the headwinds of reality. He can’t abolish Obamacare because huge majorities prefer it to any Republican alternative, so he is sabotaging it.”
On the campaign trail, Trump bragged how he would immediately “terminate” Obamacare and replace it with something “really, really great that works.” But if for some reason you don’t know by now, he’s all radio talk show bombast and no substance. To fix our health care system requires hard work, study and a solid determination to create something that serves the collective need and protects each of us at our most vulnerable. There’s no evidence of that hard work happening in the White House or on Capitol Hill.
As I’m recovering from my time under the knife, I’ve been reading Keeping On Keeping On, the latest volume of diaries and other ephemera from the English playwright and essayist Alan Bennett. Now in his 80s, one of his bête noires is conservative attacks on Britain’s National Health Service.
“The word patient means a sufferer,” Bennett writes, “and when someone comes to the doctor they are coming not because they want to buy something but because they want help. Structure and restructure the Health Service how you will doctors are not shopkeepers, patients are not customers and medicine is not a product.”
A hospital stay has a way of making you focus and realize things about yourself and the structures that keep us alive and well. Proper medical care for all should be a boon to our society, a miracle of public policy that sustains and protects. Mindless cant and empty braggadocio are not policy. They’re a disease that threaten the health of the nation. And Mr. Trump, you’re the Typhoid Mary spreading the contagion.
Michael Winship is the Emmy Award-winning senior writer of Moyers & Company and BillMoyers.com. Follow him on Twitter: @MichaelWinship. [This article first appeared at http://billmoyers.com/story/obamacare-trump-sickness-and-health/]
You remember the lie “cost of a cell phone bill” and “you can keep your Dr.” Do you remember Obama’s senior consultant for the healthcare policy Grubber, stating that it was necessary to lie and the American people aren’t smart and can’t focus. Single payer will bankrupt the country reduce employment increase taxes and decrease tax revenue. Single payer for your abortion and for your sex change surgery those of which will undoubtedly become the next civil right to fleece tax payers. You will not have healthcare for all you will have health insurance for all, similar to healthcare provided by the dyfunct VA hospital system.
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Single payer means an individual is prohibited from paying extra for their medical care? And a doctor cannot accept direct payment for the medical services they offer? Can’t we all concede that such an arrangement is nuts?
Health Care plus Opioids; why and how “the love of money is the root of ALL EVIL.”
— The Secretive Family Making Billions From The Opioid Crisis
(this IS Capitalist America)
We turn now to look at America’s staggering opioid epidemic, the secretive family making billions from the crisis, and how Congress undermined efforts to restrict the flow of pain pills that have led to tens of thousands of deaths. President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis has said, quote, “America is enduring a death toll equal to September 11th every three weeks.”
But this week, his nominee for drug czar, Republican Congressmember Tom Marino, had to withdraw from consideration, after a Washington Post/60 Minutes investigation found he led a drug industry-backed effort to pass a law that weakened the U.S. Drug Enforcement Administration’s ability to crack down on addictive opioids and keep them off the black market. The Ensuring Patient Access and Effective Drug Enforcement Act passed in 2016. It made it nearly impossible for the Drug Enforcement Administration to intervene in cases where large, suspicious shipments of opioids are delivered to pharmacies bound for the black market. The drug industry lobbied heavily to win passage of the bill, contributing $1.5 million to its 23 congressional co-sponsors. Marino alone accepted nearly $100,000 in campaign cash from the industry.
http://www.esquire.com/news-politics/a12775932/sackler-family-oxycontin/
I would say the public itself is the main problem. We in the USA simply live in fantasy world and our unable to fix anything. We allow highly corrupt systems to flourish by continually providing perverse incentives simply because we refuse to acknowledge the idea of class struggle. The oligarchs in charge are nothing more or less than criminal gangs at this point in history but few people are willing to face up to that. Only a very few people have even a slight degree of ability to think critically. I’m really only repeating the opinion of one of our most astute social commentators George Carlin.
There is NO “health care system” in the USA, any more than all the reckless spending provides “defense” from attacks, as 9/11 and Trump’s terror of the DPRK show only too well. The USA’s excessive consumption of fake food, drugs, lead from bullets self- inflicted or from other Americans, make their ability to resist illness difficult, and paying huge costs for insurance is not a real cure.
Unless the rich and the corporations are made to contribute to a real system and the people trust their “reps” to install it, Republicans and others will keep funding those who wish to destroy any form of fair distribution of services for the members of the population which are not part of the 1% or 0.1%.
The author acknowledges that our healthcare system ‘is a nightmare’ but then goes on to state that we should keep sleepwalking through it (or words to that effect). He says NOTHING about the outrageous costs of both ‘healthcare’ and (the other side of the coin) getting a medical education in the first place, a process which takes a long time and puts practitioners into extreme debt for many years.
The ACA basically shifts costs to make ‘insurance’ more affordable for some and totally unaffordable for others. There are many small business owners, especially those who have been successful and been in business for quite a while, who are by no means rich but do not qualify for premium subsidies. These people often provide vital services for their communities, but are being forced to go without insurance thanks to the ACA. For my husband and me, the cheapest bronze plan premium runs about $39,000/year.
Add a $13,000 deductible on top of that and there goes over half our income. We are low end users of health care and were very happy with an actual ‘catastrophic’ plan which had low premiums and high deductibles, before the ACA. That worked well for us and we never even filed a claim but felt secure that, should something happen, we would not lose our business / home / farm.
Now such plans are illegal or dismissed as ‘junk’ plans. Ours was not junk and would have functioned as intended, to prevent bankruptcy, which is the usual intent of all many of insurance.
last sentence got garbled ! To prevent bankruptcy, which is the usual intent of many insurance policies.
Today, we are confusing health insurance with comprehensive health care coverage. Not the same thing at all.
What ACA did wrong is pretty much guaranteeing profitability for health insurance companies. For one thing, it changed how the MLR (Medical Loss Ratio) is calculated in percentage. Prior to ACA, the old MLR had been simple:
MLR = Health care claims / Premium*
After ACA:
MLR = Health care claims + Quality improvement expenses / Premium* – Taxes, Licenses, Regulatory fees, etc.
*-Indicates policy premiums collected from policy holders
It basically increased the value of dividend and decreased the value of the divisor.
Why is this important, you may ask? The ACA requires the MLR to be between 80-85%. While an insurance company may have not been compliant to this requirement under the traditional MLR, it certainly would be under the ACA defined MLR.
Accordingly, health insurance companies stock prices quadrupled in five years and companies, like Anthem (ANTM) that had not paid dividend, started to pay dividend a year after ACA had became effective. In year 2016, ANTM paid out $685M in dividend for about 263M shares.
Yes, corporations do need to make money, even if the profit is generated on people’s suffering. But the same corporation has never done that, prior to ACA becoming effective in March 2011.
What the author calls “Trump’s nihilism on health care” merely reflects America’s economic nihilism of recent decades. In recent decades, much work has gone into phasing out the socialist (New Deal/Great Society) aspects of US policies, with the support of the mainstream. Tragically, Trump’s ideology and agenda are a clear reflection of much of today’s US.
We’ve been implementing the austerity agenda for years, from the bottom up. Congress knows that anything resembling universal health care would make no sense in a country that’s 20-some years into its war on the poor. There’s no logic in providing anything more than emergency room services to our poor, just to dump them back on the streets. Lack of adequate food and shelter take a heavy toll on human health. We can ignore this, but Congress cannot.
THANK YOU for so eloquently gong to the HEART of WHY the U.S> has no national health care system—like the 34 OTHER industrialized nations do. The WAR ON THE POOR in the U.S. is perpetrated as a BIPARTISAN project—remember what Bill CLinton did with “welfare reform” & policies that made the U.S> #! in PRISONERS in the world.Finally, most Americans pay no attention to foreign policy & simply mouth “patriotic” slogans, sing the anthem, worship the flag—while ALLOWING the U.S> to be AT WAR with SEVEN countries & senidng in “advisors” to DOZENS more. Every WEAPON gets BIPARTISAN APPROVAL—but, anything for HUMAN BEINGS BENEFIT is a FIGHT OVER PENNIES.
Let me preference my statement on this article by saying I support single payer. With all due respect to Mr. Winship, his article lacked substance, and came across as more of a rant against Trump, which ultimately diminishes the validity of what he has to say, and he didn’t say much. I don’t appreciate articles like this.
I couldn’t agree more…
You are right Annie. This libertarian idea of throwing healthcare out to the very competitive insurance industry like Geico or Allstate has merit, but it will never happen, because it just won’t. I agree a sound run single payer healthcare system is the only way to go. Enough with our feeding the wicked beast of capitalism for the wealthy. Now is the most perfect time to introduce a Medicare health system for all. Joe
Most state governments have their own health insurance plans for state employees, just like they have their own retirement plans separate from Social Security. Part of the monthly premium is deducted from your salary or your pension and the state pays the remainder. Over the past decade or two, they’ve taken to contracting with one or more private insurance companies to manage the selected plan. They claim it saves money, even though it adds a middleman to the process. They seem to mainly rotate amongst the UHC, Aetna, and Cigna networks, as well as the main prescription drug plans like Express Scripts. I’m surmising they accept the lowest bid from year to year.
They say it’s cheaper for the state since they’ve been able to jettison many employee lines, but for the patient? The state is the ultimate payer, the insurance company is basically a paper shuffler that contracts for the most advantageous fees with the providers, obviously for some percentage commission or a flat fee. When the patient really gets stung is when he is unknowingly hit with an “out-of-network” provider–his share of the bill can easily triple or quadruple, as I can attest. Presently, you can never predict when that might happen in the operating room or the emergency room. This system might work on a national level if every licensed provider was mandated to practice in network at pre-negotiated rates.
It’s probably a fact of life that provider costs will always be higher in places like New York City or Hollywood than in Podunk, Iowa. Does Medicare have the latitude to negotiate local charges the way a private firm does? If so, I guess the issue becomes, is it cheaper to have a public or a private interface between provider and patient? Who will pay their employees less, the government or the private firm? (Which is preferable for society as a whole, if the result is a general downward spiral in incomes, is a matter apart.) Will the overhead paid in the form of profits to management be less than the money saved by reducing the government work force? If not, privatization of public plans is self-defeating.
My brother just went on Medicare and, based on his input, he receives far less in benefits and has to pay far more for ancillary insurance than the deal I have been getting from my state retirement plan–which, as I said, contracts with big companies to administer the plan. What percentage of the electorate will understand any of this to make a qualified judgement, assuming they are ever given the choice?
It’s almost funny, no expense is spared on sinking our national treasury into weapons development and production because they supposedly provide an essential function to a free enlightened democratic society, yet the same can’t be said about health, education or infrastructure. I must be missing the gimmick that hooks most of the public on this arrangement.
Realist,…Ultimately I believe this country has been too indoctrinated with the privatization scam to support a single payer health plan. Hopefully some of the more progressive states will lead the way but the Supreme Court could remain a major roadblock as it is dominated by corporate interests that could make the implementation very difficult.
I completely disagree with the authors views. Obamacare was a social program that half of the American people did not want. However, they were ignored and the legislation went through with zero support from Republicans. To predict what would happen next is not rocket science, but possibly outside the ken of a President who had spent only two years in the United States Senate. Had Obama spent a little more time reading books instead of writing them, he might have run into this:
But at least one veteran of the launch of Medicare — Joseph Califano, one of LBJ’s top domestic aides at the time — isn’t too surprised with the fallout of the decision to move ahead on Obamacare without GOP support.
Even though LBJ had huge Democratic majorities in 1965, he insisted that “we have to shoot for half the Republican votes, because if we don’t, they’ll drive us crazy — they’ll kill us on appropriations, they’ll kill us with the Republican governors,” recalls Califano, now the founder and chairman emeritus of the National Center on Addiction and Substance Abuse at Columbia University. It was a different GOP back then, but LBJ still managed to win half of the House Republicans and nearly half of the Senate Republicans.
h**p://www.politico.com/story/2013/08/obamacare-hurdles-higher-than-medicares-095642
So what are the two problems currently faced by Obamacare: APPROPRIATIONS & REPUBLICAN GOVERNORS. Hello. The lesson is, if you are going to do a piece of legislation like this, there needs to be buy-in from both parties. If not, the opposing party will do everything legally within its power to enervate the law, as we are seeing now.
I don’t blame Trump here, he is just doing what his voters have asked him to do.
And Trump’s supporters make up, what, 30% of the total population?
The ISSUE is the vitriol that is used.
Also note that it’s pretty clear that Trump made promises that had no substance and are, therefore, totally failing. Yes, “repealing” “Obamacare” is what will happen, but, as the article seems to point, out, the only constructive thing that Trump can do is to be destructive, which isn’t actually “constructive” in the sense of really making anything better.
Interesting, though, the notes about LBJ’s administration. Compare/contrast to the GOP from the start of Obama’s election in which their entire strategy was to BLOCK EVERYTHING, regardless of whether it was of benefit to their voters. The evangelical Christians are seeing to it that the images/history of the n*gger in the WhiteHouse is purged. While I was no fan of Obama (didn’t vote for him), it is this very thing that compels me to argue in his “favor.”
Doing things because the programmed masses want it so might not be the thing to do:in this day and age where the propaganda is so intense it’s nearly disingenuous to say that individuals are really independent thinkers and it is “they” who are asking for something.
What am I supposed to say here:
“And Trump’s supporters make up, what, 30% of the total population?” Trump isn’t supposed to act like Obama then? What is wrong with: “We won.” & “Elections have consequences.”? That was all the mode back in 2008.
The ISSUE is the vitriol that is used. I would say there is probably more directed at Trump than the reverse.
really making anything better. Depends on what you believe “better” is. A lot of people feel screwed by the ACA and voted for its repeal. I guess they feel Trump is making it “better”.
entire strategy was to BLOCK EVERYTHING I suppose the Democrats are showing us how bipartisanship works in 2016 after the Republican’s poor example in 2008?
evangelical Christians They are all racists…okay
programmed masses? So, the majority of voters are essentially brain stems that need to be governed for their own good by Ivy League educated superiors? Sort of like China? Where there is one Party?
Facts are what they are. That you don’t like them is your issue.
“Petulant bombast is a dangerous approach to governance”
The writer put out where he was going with this. I sounds like you jumped here to troll FOR Trump. That, again, is your prerogative, but what the writer says is pretty much fact.
“So, the majority of voters are essentially brain stems that need to be governed for their own good by Ivy League educated superiors? Sort of like China? Where there is one Party?”
Yup, the world is black and white! I like how you took my 30% and turned it into a majority. Nice try!
I like how you took the 30% and turned it into a fact.
dfc: Many Trump voters are so ignoranct that they want to END “Obamacare” but, KEEP the ACA—NOT recognizing that they are the SAME thing! (During Obama Administration when the ACA was being debated I saw Republican protesters in my town (Minneapolis) with sings that said GET GOVERNMENT OUT OF MY MEDICARE—again a level of IGNORANCE of issues!!!). Also: you say Republicans were NOT included in the creation of the ACA but that’s NONSENSE. First, “Obamcare” was BASED on ROMNEYCARE (in Mass.) when Mitt Romney was REPUBLICAN Governor of that state. Second, Romney’s plan was CREATED by the CONSERVATIVE Heritage Foundation! Third, Republicans ADDED about 100 amendments to the ACA—they had INPUT—while Trump’s bill–which should be called “The Health Care Removal Act”—was written by 13 REPUBLICAN WHITE MEN (& features DIRECT ATTACKS ON WOMEN’S ACCESS to reproductive care). What Trump “voters are asking him to do” is IRRATIONAL: fact is if the ACA is destroyed many of Trump’s voters in RURAL areas will be harmed.
Another opportunity to note that Trump’s pet nation -Israel- has, by law/constitution, guaranteed health care for everyone (everyone that’s Israeli that is), and it’s possible thanks to the US’s subsidizing Israel’s other “activities.” So, the “CONservatives” are aiding and abetting “socialism,” socialism that they refuse to see happening in their death-dance (End Of Days) partner Israel.
Over here in the UK, as many Americans will know, we have a free health care system at the point of need. It doesn’t matter how little or how much money one has, the treatment is the same. Of course, people can pay for specialist or extra treatment if they want to and many do. Its true that well off people can jump the queue by going private, but they still have the same surgeons who do a bit of private work in private hospitals. On the whole the system works well and has been in place since the 1940s. However, we do have to pay for medicine but people on social security, special needs and everyone over 65 all have their medication free of charge.There is a similar arrangement for dental and eye care although its limited to basics. We seem to manage and I believe our economy is still in the top 5 in the world. The Rich, the almost rich and the well off probably wouldn’t be any better off if we made everyone pay for medical treatment. I suppose its a question of priorities: you either spend trillions of dollars on war, death and destruction, or you spend the money on the people and let the population have half decent lives. By the way, I say a free health service, of course it isn’t really free, we pay for it through taxes but at least those who have the most to spend, and boy do they spend, pay the most in tax by virtue of the fact they buy more taxable goods
…perhaps you can get the queen to turn her namesake aircraft carrier into a floating hospital. Sorry, John, my tongue was stuck in cheek and I’m actually jealous of your national health care.
John a friend of mine business in Canada which is a mirror image of my company here in the U.S. proved to me one day how in the U.S. we are being ripped off. My company’s chief bookkeeper got together with my friend in Canada’s bookkeeper, and the two of them compared our two companies fixed expenses. My American born bookkeeper was floored, when the results showed how we in the U.S. on the average pay 30% more for our basic fixed expenses. There were expenses like healthcare where the Canadians paid in taxes, we Americans paid private firms, but still the margins of equality were huge. In short we in the land of the free and the brave, are getting the royal screws. Good subject John and your English input is most gratifying, as well as informative. Joe
john wilson –
I know quite a few people in U.K. I think that in quality too, your medical system in U.K. is much better than the one here in U.S. I hope that you can keep your priorities straight in the future – tilted more towards human welfare.
Exactly. Trump is a despicable, mean spirited bastard. He doesn’t care about anybody but himself. To put him in charge of our government is a tragic disaster that may end up destroying all of us.
Yes, I agree, but he is also the true face of America minus the cant. Individually, we have our pluses and minuses, but collectively we have become a monster. It is no accident that Trump is the personification of America. I take great pleasure in seeing him puncture one sanctimonious bubble after another. The mask has come off America the Wonderful.
…”he is also the true face of America minus the cant. Individually, we have our pluses and minuses, but collectively we have become a monster”…well put, RinoDino…we have to constantly resist the MSM drumbeat that deludes us into simplistic solutions based on flattering our nationalistic ego. Trump is just the latest and most grotesque version of the pied piper leading us into oblivion. I wonder how many Halloween masks will sport his image this season?