Ken’s Take on the World


Resisting 45!!

For those of you who follow me on Facebook or on Twitter, and those of you who have read my blogs on WordPress, you know that I have expressed opposition to many of the things that candidate Trump, and now President Trump, has done. I have also expressed opposition to many of the positions and legislation advocated by elected Republicans including the Affordable Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA). As a result of statements I have made, I have recently noted a number of folks who support the current President reply to these statements on social media with a variation of “Well, what have Democrats proposed?” Or, “Democrats will continue to lose elections if they have no policy position to promote and only function as an anti-Trump party!” Comments such as these are beyond annoying as they are simply the comments made by talking heads in the pseudo-conservative media environment and completely ignore the realities of what is happening in our American democracy.

 

Let me address the comments about Democrats losing elections, first. In the 2016 Presidential election, the Democrat, Hillary Rodham Clinton earned nearly three million more votes than her Republican rival in the general election. Of course, her opponent has claimed that millions of illegal votes were cast and that he, without providing any evidence to support his claims, actually won the popular vote. This is a position that is still supported by many of his most stalwart supporters. Likewise, only 33% of Republicans agree with the evidence that Russia, specifically, interfered with US election processes in 2016. This is in stark contrast to what Democrats and Independents believe on the matter of Russian interference in the election. The Republican view also stands in contrast to what US and foreign intelligence services have confirmed which is that Russia, and groups affiliated with the Russian government, made a concerted effort to interfere with the US Presidential election in 2016.

 

With regard to Congressional races and state legislative races, multiple studies and commentary here, here, and here have demonstrated that a major culprit contributing to the makeup of legislative bodies is a result of how district maps are drawn. Several reports including this interesting study looked at whether Democrats or Republicans tended to produce more gerrymandered districts when entrusted with the responsibility of drawing lines. While these demonstrate a modest benefit for Republicans currently, this does not explain the entirety of GOP gains at the legislative levels. Furthermore, gerrymandering does not impact races for state governors as these are decided strictly upon a popular vote within the particular state. Other factors are clearly at play in these elections as well. This brief primer demonstrates some of the changes in voting trends since the early 1900’s. The role of media, specifically Fox News, also appears to drive some of the support for Republican candidates as researched in this older piece by the National Bureau of Economic Research position paper.

 

This May poll from Pew demonstrates the largest historical gap between Democrats and Republicans on the role of the media in providing news and information. This January analysis from Pew found that Trump voters received the bulk of their news/information from Fox News. Among Clinton supporters, no single news or information source provided the bulk of decision-making input. A report from December 2016 pointed out bipartisan concerns relating to the role of “fake” news and its negative impacts. Coincidentally, a fact check of leading political pundits finds that pseudo-conservative pundits have more false statements (> 50%) than progressive/liberal commentators.

 

The second point to address is this very recent claim I have been seeing that Democrats have no agenda other than to oppose the current President and his efforts. This claim is puzzling, not because it is simply what has been put forth by pseudo-conservative talking heads over the past couple of months, but because it is simply false. Democrats are united in their opposition to simply rolling back all of the advancements that were made under the previous Administration. A review of President Trump’s Executive Orders demonstrate the majority of EO’s he has signed thus far are to repeal EO’s signed under the Obama, and to a lesser extent, the Bush (43) Administrations. Even the centerpiece of his legislative agenda thus far, the repeal (and replacement) of the Affordable Care Act, is not a new proposal but merely the rescinding of an Obama-era achievement.

 

It is hypocritical to suggest Democrats do not have anything of value to contribute to the legislative process when they are not even invited to participate in the drafting of legislation that would impact nearly 1/6th of the entire US economy. Republicans, when their healthcare proposals faltered caused folks like Majority Leader McConnell to state that the GOP might have to work with Democrats if they were unable to gather enough votes from their own side of the aisle. As if working across the aisle is a distasteful act that should be avoided at all costs. The fact the Republican proposals from the House and the Senate would be harmful to the most vulnerable of Americans, including large numbers of Trump voters, ensured Democrats would not support these measures. Republicans spent the last eight years obstructing the efforts of President Obama. Democrats have not even had to seriously obstruct the efforts of President Trump. His failure of leadership has meant that even the majority Republican Congress cannot get legislation to his desk.

 

The progressive agenda remains committed to improving the lives of working Americans and their families by reducing tax burdens on the middle and working class, providing educational opportunities for all, and ensuring affordable, accessible healthcare for every American. Democrats have supported an increase to the Federal Minimum Wage, equality for all Americans, the right of workers to organize and collectively bargain, the right of women to decide what medical care is appropriate for themselves, and improving the ease of voting in democratic elections. Considering that the Republican Party opposes these things, I can understand why there are some who think that opposition to the current President and the GOP legislative agenda is demonstrative of a lack of a political agenda. It is, I assure you, not the case. Refusing to stand by while pseudo-conservatives roll back advancements that have been made for the environment, for our kids, for the elderly, for the economy, for the working class, for the sick, and for our veterans is actually part of an agenda. An agenda that continues to maintain that the United States is a great nation that will continue to get better. If only the Republican Party would finally climb aboard that train. Until then, I will resist!!



Tomahawks and Trump

A few days ago, President Trump ordered the launch of 59 Tomahawk missiles to strike an air base in Syria.  Ostensibly, this was a response to the use of chemical weapons against the civilian populace.  Responses from critics and supporters have been mostly predictable.  Unfortunately, these responses miss crucial points.

 

The Constitutional conundrum:  Critics of the President’s actions point out that he lacks the Constitutional authority to initiate military actions without Congressional approval.  Article I, Section 8 clearly defines the role of Congress in declaring war.  Article II, Section 2, however, vests the authority of Commander-in-Chief of the Armed Forces with the President.  Congress passed the War Powers Act (WPA) to permit a President to initiate military action to immediately protect “vital national interests.”  Since its inception, every President has used this as a justification for carrying out military actions.  President Trump is no different than Presidents Carter, Reagan, H.W. Bush, Clinton, W. Bush, or Obama in claiming their actions are covered under this provision.  While it may be worthwhile to debate the legal merits of Trump’s justification, it is unlikely (particularly with a Republican Congress) that anything significant will come of this in the form of restricting legislation on a President’s authority under the WPA.  It is inconceivable the President acted against an imminent threat to crucial national interests that prevented him from seeking approval from Congress, as his predecessor did in 2013.  While Republicans in Congress rebuffed President Obama’s request for authorization of military force when President Assad used chemical weapons against his own citizens then, it is not clear how Congress would respond to a similar request made by the current President.

 

Moral maladaption:  Republican talking heads claim the President, even if lacking legal justification for launching an attack on Syrian territory, had a moral imperative to take action against the use of chemical weapons.  The President, himself, states that he was moved by the images of small children killed by the heinous use of such banned weapons.  I do not doubt that he, like the rest of us, was indeed moved by the horrific imagery of babies, children, women, and men suffering the effects of what appears to be the nerve agent, Sarin.  To suggest President Trump was not touched by these images is unfair to him.  We actually expect our President to act as a moral leader, promoting our values as a civilized nation.  A moral leader, however, would likely have sought the support of our allies in formulating a strong and clear message of condemnation on the use of chemical weapons rather than appearing to act impulsively, and alone, in carrying out an act of war that violates international norms.  There is an argument to be made that it is actually immoral for the President to order the launch of military actions that could lead to civilian casualties.  There is plenty of history of the United States, accidentally, or intentionally, launching military strikes that led to the deaths of many more women, babies, and children than the recent chemical attacks have caused.  A stronger counterargument to his supporters suggesting that Trump had a moral obligation to act would be to note that President Trump has repeatedly attempted to block all refugees from Syria entering the United States.  Perhaps, his rationale for striking the air base in Syria would ring less hollow had his ongoing efforts pertaining to the Syrian people not been construed as hostile to them and ambivalent toward the Syrian dictator.

 

Pocketbook penumbra:  To those who have suggested the President authorized use of Tomahawk missiles because he owns stock in Raytheon, the manufacturer, just stop!!  Of all the reasons one might consider for why the President selected this option, this is not going to be one of them.  While I have stated on multiple occasions that Donald Trump acts only in the interest of Donald Trump, even this claim is ridiculous to me.  Now, I will state that I am disappointed, make that disgusted, that with nearly $90 million in military weaponry launched into Syria the other day we did not even negatively impact the capabilities of the Syrian government to continue its air campaign against rebels for even a single day.  It is unclear whether we even sent an effective message deterring the regime from future use of chemical weapons in these strikes.

 

Donald’s doubletalk:  We know the current President changes his positions constantly.  We know that he lies and misleads.  In 2013, Donald Trump strongly opposed any military action in Syria.  He demanded then-President Obama seek approval from Congress prior to undertaking ANY military action in Syria even after it was confirmed the Assad regime had used chemical weapons against the Syrian people.  Why, then, would President Trump launch military strikes in Syria without prior notification of, and approval from, Congress.  President Obama actually DID seek approval from Congress to take action against Syria.  What, from a legal perspective, has changed in the interim?  Nothing.  To those who suggest these actions made him appear “Presidential,” need I remind you of comments made regarding the President’s State of the Union Address in February?  Within 36 hours, he had demonstrated that he had not made the “Presidential Pivot” that people on both sides of the political spectrum have implored him to make since gaining the nomination last July.

 

Donald’s distractions:  The Trump Administration has been an epic lesson in incompetence, confusion, unethical behavior, obfuscation, and, perhaps, worse.  From a series of gaffes involving our allies, his inability to articulate a clear strategy on any policy position, allegations of collusion with an adversarial government, basement-level poll numbers, and infighting within his inner circle of advisors, it has been suggested the President, perhaps, sought a distraction that might cast him in a more favorable light.  If this is the case, it is reprehensible and inexcusable.  A more benign reason for ordering military strikes in the manner he did is the lack of competent advice from advisors who lack the breadth and depth of knowledge and experience to more carefully coordinate these strikes to produce greater effect and reduce potential negative consequences.  This, too, is unacceptable.  This failure in competence has led to a lack of support from our allies and jeopardized the safety of US service members, particularly in the Syrian theater of operations where we are currently active.  Despite prior notification of the Russian government which minimized damage to Russian military assets at the airbase, the missile strikes have led to amped-up rhetoric from Russia including statements that Russia will no longer advise US military officials regarding military operations which may lead to inadvertent US military casualties at the hands of Russian military munitions.

 

The current President has positioned the United States on a very dangerous path with his reckless missile strikes on Syria.  The strikes appear to be merely symbolic and provided no tactical or strategic gains for the US.  They did not hamper Assad’s abilities to carry out attacks, including chemical weapons attacks, on his people.  They pushed Russia into a potentially stronger alliance with the Assad regime.  His disregard for the Constitution continues his trend of undermining our institutions of democracy.  Along with his increased use of military action, including drone strikes, that have led to the deaths of hundreds of civilians in the Middle East, he diminishes the safety of deployed US forces and the security of US citizens throughout the world.  A US Administration has traditionally been a stabilizing feature of the global community.  Under President Trump, this is no longer the case.  The President, and his Administration (with certain exceptions) have injected a level of uncertainty and instability that is not only foolish but is also extremely dangerous.



Trumpets of Doom

This past week we were exposed to the spectacle that was the Republican National Convention.  I managed to catch bits and pieces of different speeches and read the running commentary on my Twitter feed and on Facebook.  I did take the time to watch the candidate, himself, give his acceptance speech on Thursday night.  What I observed this week is, to say the least, troubling for me as a progressive, voting, American.  The RNC convention was filled with darkness and despair.  It was, in a word, un-American, in my opinion.

 

From the refusal of the convention rules committee to respect the wishes of delegates in voting on the party platform on Monday, to the gaffes of color-coding elevator banks (White Elevators), posting white supremacist Tweets and anti-Semitic Tweets, and plagiarizing speeches, the promotion of an idea that the Democrat opponent would be arrested and jailed if Mr. Trump was elected President, and the very ugly idea that the Democratic nominee be marched in front of a firing squad by the Republican nominee’s veterans adviser, the campaign presented an ugly and hate-filled image to the world and, specifically, to Americans who are being asked to select the 45th President of the United States of America.  Even an innocuous photo showing Speaker of the House, Paul Ryan posing with the 2016 class of Republican interns demonstrated the big problem facing the Republican Party moving forward.  Surely, the Republican Party could have done better than this.

 

The events of this past week in Cleveland demonstrate a palpable anger of a large number of white Americans, a sense of frustration that transcends the typical values the Grand Old Party establishment has espoused for the past half century.  Make no mistake, the GOP has pushed the idea of racial politic for its benefit since the 1960’s.  The major difference during this campaign cycle is that the nominee has openly endorsed the idea that white people are losing ground to minorities in this country.  There is the explicit promise that Mr. Trump will, “take America back.”  Take it back from who?  Give the nation back to whom, exactly?  This nation belongs to each of us, Mr. Trump.  Each of us already has an ownership stake in the greatest nation on Earth!!  On the topic of greatness, Mr. Trump’s campaign slogan is, “Make America Great Again.”  Personally, I believe that any candidate who does not believe the United States of America is not currently the greatest nation on the planet is not fit to lead our country.  Hey, Donald Trump, if the United States of America is not currently the greatest nation in the world, tell us who we need to best to regain the title!!  Mr. Trump misses the point that greatness does not mean perfection.  The greatest leaders throughout history each had flaws.  This goes for individuals and nations.

 

President Franklin Roosevelt, in his first inauguration speech said, “So, first of all, let me assert my firm belief that the only thing we have to fear is fear itself—nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance. In every dark hour of our national life a leadership of frankness and vigor has met with that understanding and support of the people themselves which is essential to victory.”  http://www.historymatters.gmu.edu/d/5057  Mr. Trump, in his acceptance speech pushed a sense of fear throughout his speech.  I have to give him credit in that he recognizes that fear is, perhaps, the most powerful motivator of all living things.  Unfortunately, fear is not what makes a nation, or a leader, great.  In times of trouble or anxiety, people look to a leader for inspiration and hope.  For confidence and a sense of security.  People look for firm, rational, statements and assurances of how safety and security can be established.  Mr. Trump stoked the flames of fear in his campaign speech but failed to offer any rational assurances that he could provide this.  This consistent lack of substance does not appear to faze his supporters.  In fact, Mr. Trump has said that his supporters don’t care about policy.  His supporters may not care, however, those of us who consider ourselves thoughtful and rational, demand this information in order to make an informed decision at the voting booth!!  He commented that he will be the law and order President, but has demonstrated through his comments and prior speeches that he has no understanding of the law nor a desire to operate within the law.  Mr. Trump has been described as having an authoritarian management style.  Studies on authoritarians who have risen to power demonstrate that when people are so fearful, they have a tendency to turn to an authoritarian leader, regardless of qualifications, or lack thereof.  This is what Mr. Trump is counting on—that people are so irrationally fearful they will fall in line behind his campaign.  Thus far this has worked as he managed to beat out his, much better qualified, opponents in the primary campaign.  The problem with authoritarian politicians is that they tend to be brutal and violent towards their opponents, both domestically and globally.  Regarding the wealthy, and the bankers, FDR further stated, “They know only the rules of a generation of self-seekers. They have no vision, and when there is no vision the people perish.”  I have said on multiple occasions that Mr. Trump is primarily out to benefit himself.  He is a narcissist and demonstrates an unwillingness to compromise with others.  He has boasted of this in interviews, speeches, and in his books.  This is not the attitude of our nation’s diplomatic face to the world.  Even more dangerous, Donald Trump has praised the ideas of other authoritarian leaders including Vladimir Putin and Adolph Hitler.  Likewise, the current leaders of Russia and North Korea have praised Mr. Trump’s leadership style.  I am concerned when foes of this nation begin to praise a candidate for US President.

 

Mr. Trump has further raised the ire of leaders of nations that we consider allies.  This past week, he suggested that the United States may not honor agreements made with European nations should they be attacked by another state power.  Nothing instills confidence in our friends, or gives pause to our enemies, like a potential US President who says you’re on your own.  He has said that other nation’s should be free to pursue nuclear weapons and has refused to rule out the use of such weapons if faced with a tactical threat or even as a deterrent to non-state players on the battlefield.  Such commentary is not only irresponsible from a Presidential candidate, it is reckless and dangerous.

 

Perhaps, the most concerning thing about Donald Trump is that he is not a, one-off, an anomaly within the Republican Party.  Mr. Trump has become the face of the base of the contemporary Republican Party.  This twice-divorced, socially-moderate, candidate for US President has gained the support of Evangelical Christians.  He has been endorsed by anti-LGBT and anti-abortion, so-called, “family values” organizations even though he does not support these views.  This is why he has selected Governor Mike Pence of Indiana to be his Vice President.  Governor Pence is staunchly anti-LGBT and anti-women’s rights.  He has actually been endorsed by white-supremacists, the American Nazi Party, and other racist individuals and groups.  This should serve to inform the logical, reasoned person that Mr. Trump is a dangerous individual to be considered for the position of Commander-in-Chief of our nation’s Armed Forces and as the principal law enforcement officer of the United States.  The battle for control of the soul of the Republican Party has been won by a racist, bigoted, theocratic-minded bloc.  The fight for the hearts and minds of the people of the United States of America now begins.  While irrational fear is an incredibly powerful motivator, I maintain confidence that hope is an even more powerful motivator.



Defunding “Obamacare?!”

Among a string of poor public policy positions advocated by members of the Republican Party, the recent decision to attach an amendment to a Continuing Resolution (CR) that would fund the government but withdraw all funding for various components of the Affordable Care Act (ACA) is among the dumbest.  There are several reasons for arriving at this conclusion.  The most dangerous is that it will potentially lead to a partial shutdown of government which affects every single American.

 

First, the amendment that was attached to the Continuing Resolution striking funding for the ACA is purely a political gimmick designed to appease a small, extremely regressive, faction of the Republican base.  It is highly unlikely this amendment will be attached to a Senate resolution for a floor vote.  If it is offered as an amendment, it will likely not be approved.  This means the Bill goes into a Conference Committee.  This will put the House of Representatives into a showdown with the Senate and pushes us closer to a deadline which will result in the stoppage of essential government services.  Think Social Security checks, Military paychecks, the Centers for Disease Control and Prevention (CDC) which is gearing up for flu season!

 

For the sake of argument, let us say that the amendment does become a part of the final Bill that is presented to the President.  It is extremely likely the President the President would return the Bill to Congress with a bright VETO stamp across the top.  Republicans do not have the votes to overturn a veto and would be left holding the bag on a smelly collection of dog excrement when the deadline for government operational funding passes.  American citizens do not like when there is no one answering the telephone at the Social Security Office!  I personally would be quite pissed off if I found that our Military service members were not getting paid!!

 

Let’s enter the world of a Republican wet dream for a moment.  The amendment that defunds the ACA is passed through both chambers of Congress and the President accidentally signs this wrong-headed piece of legislative bovine-manure.  The Republican Party collectively orgasms all over themselves and claims they have achieved a monumental victory!  Orthopedic surgeons in the Beltway will be extremely happy for with all of the folks patting themselves on the back there are sure to be a few Rotator Cuff tears to deal with.

 

What happens next?

 

This amendment does not repeal the Affordable Care Act.  It does not block the implementation of any of the rules and regulations promulgated by the ACA.  It only does one thing.  It eliminates funding for any of the provisions of the Affordable Care Act.  So, what?

 

Hospitals have begun to implement Electronic Health Records (EHR’s) using money provided under the ACA.  Study after study has demonstrated that EHR’s reduce medical errors and have the potential to reduce costs.  The ACA requires that hospitals and physicians adopt the EHR as part of a goal to improve patient safety.  Doctors and hospitals are now left solely on the hook for the expense of this technology.  Failure to comply will result in a loss of eligibility for Medicare and Medicaid reimbursement.  The hospital I work at receives more than 40% of its reimbursement from these two programs.  Fortunately, we have already completed adoption of an EHR system.  I do not know about all of our affiliate physician groups and individual practice physicians, however.  If our surgeons cannot operate on Medicare patients, a huge piece of our revenue stream disappears.  Hospitals generally operate on extremely thin operating margins (gross revenue over expenses), typically 1 to 3%.  Many hospitals have a much higher percentage of Medicare and/or Medicaid patients and would be impacted even more by a loss of access to these revenue streams.  Loss of Medicare funding will mean the demise of a number of independent hospitals and loss of funding for EHR technology will mean that most independent practice physicians and many physician groups will cease to exist.

 

States are required to begin enrolling individuals in Health Insurance Exchanges (HIE’s) beginning on October 1.  Funding to set up these exchanges was allocated through provisions of the Affordable Care Act.  In a number of Republican-led states, the legislature and executive refused to participate in an HIE.  In these states, the Federal government is operating the exchange.  The money to administer these programs is eliminated as a result of the defunding amendment.  Insurance companies are participating in these exchanges anticipating a new influx of customers seeking health insurance.  From a business standpoint, health insurance companies know that having a broad base of customers allows them to spread risk among a broad base of payers.  This means that insurance rates can be maintained at an affordable rate for all consumers.  In a number of states that have already started operating these exchanges, insurance rates, including premiums and deductibles have been lower than suggested by certain folks on the right of the political spectrum.  Many of the folks enrolling are doing so in anticipation of subsidies available as part of the ACA.  Those subsidies are gone as a result of the amendment.

 

Under the Affordable Care Act, which, by the way, remains the law, insurance companies cannot deny coverage or charge exaggerated rates to individuals based on health status.  With the defunding amendment, Health Insurance Exchanges have been hobbled and not able to reach out to customers.  Since they will not be able to obtain, potentially 30 million additional customers, insurance companies will be forced to drastically raise the cost of premiums for all of their customers.  Except for the wealthiest among us, individuals will find they are unable to afford monthly premiums and will be forced to drop their coverage.  Businesses will find it increasingly difficult to afford the cost of health insurance for their employees and will begin to drop insurance coverage.  Instead of stable, affordable premiums, I would anticipate much more expensive premiums.  The result, millions more uninsured Americans!

 

This wrong-headed amendment to defund the Affordable Care Act would be dangerous for patient safety, health insurance companies, hospitals, doctors, taxpayers, and businesses.  The proponents of this legislation have failed to grasp the tremendous negative consequences of such a thing happening.

 

I am absolutely certain the Republican leadership in Congress is fully aware that they are playing political gimmickry with this amendment to defund the Affordable Care Act.  They know, completely, that this amendment will not make it to the President’s desk.  Speaker-of-the-House John Boehner knows this as does every member of the US Senate.  The absolute worst possible outcome for Speaker Boehner, and every Republican member of Congress would be for this to land on the President’s desk as part of a Continuing Resolution and actually be approved by President Obama.  The resulting collapse of the Affordable Care Act will lead to a collapse of the health insurance industry, hospitals and physician practices, and culminate in the establishment of a universal, single-payer healthcare system in the United States.  Speaker Boehner would be credited, single-handedly, with bringing Socialized medicine to the United States of America!



President Obama and the Glass of Water

Tuesday is Election Day, or if you are Dr. Ruth, “Erection Day.”  I for one will be relieved that this campaign season will be over.  The campaigns this year have been particularly over-the-top and there has been more negative campaign advertising thanks to a flurry of unaccountable money that allowed nearly a billion dollars to be spent on the Presidential campaigns alone!

 

When I look at the state of our nation, and of the economy in particular, I look at a glass that is half full.  Of course, I tend to be an optimistic person by nature.  When I listen to Republicans, the message I hear is this:  President Obama has been in office for four years and the glass is still half empty.  The President has failed to fill the glass completely.

 

Think about this.  When the President took office in January of 2009, the glass was completely empty because it had been shattered and all of the water had poured out.  Since 2009, the President repaired the broken glass and began to refill it.  The President repeatedly asked for a fire hose so the glass could be filled faster but Congress would only permit him to have a garden hose to use.

 

Remember to vote on Tuesday, November 6, 2012.  The nation is counting on you!!