GOP, Health Care, Medicaid, Trump

The Art of the Miscalculation

“Hello, Bob. So, we just pulled it.”

        Donald J. Trump phones Washington Post reporter Robert Costa to report on the art of his failed deal.

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Congressional Republicans spent seven years – and 60-plus repeal votes in the House of Representatives – promising their most fervent supporters that if they ever got all the political power in Washington, D.C. they would wipe away the hated Obamacare on Day One.

On Day Sixty-four they ran head long into an old political reality – don’t believe your own press releases.

What could go wrong?

In the end, the collapse of the Republican plan to “repeal and replace” Barack Obama’s signature legislative accomplishment – the Affordable Care Act – was based on a huge miscalculation, a miscalculation that is now the signature reality of the Grand Old Party. The politics of opposition met the realism of substance. Given seven years to come up with a genuine alternative to what virtually everyone concedes is a flawed national health policy, Republicans, particularly the vacuous leader of their party, punted on substance.

Just consider what President-elect Trump told the Washington Post a week before taking office. “We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law, he said, “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”

Perhaps even he can’t spin this one…

The Post’s Robert Costa and Amy Goldstein reported in that January interview that Trump – wait for it – declined to discuss specifics. Big surprise. There were no specifics short of a massive tax cut for the most well to do and a butchering of Medicaid.

The intellectual bankruptcy of Donald Trump’s GOP, the total triumph of puffy rhetoric over hard reality, was on full display during the Republican art of the fail. The empty suit in the Oval Office met the empty heads in Congress. Of course, Trump predictably blamed Democrats for failing to undo the legislation that they bled over and that cost the party many seats in Congress. It won’t wash. Democrats actually believe in what they have done, while Republicans now fully embrace the smoke and mirrors that surround Trump and the party he now owns, if cannot control. Not surprisingly the post mortem’s have been, and brutally so, all about Trump’s failure and that of the once and never again policy wonk Paul Ryan.

“It’s hard to overstate the magnitude of the Day 64 defeat,” wrote Axios’ Mike Allen, a D.C. access journalist who rarely misses a chance to curry favor with the powerful. “President Trump, who made repeal-and-replace a central theme of his campaign, and House Republicans, who made it the central theme of every campaign since 2010, lost in a publicly humiliating way despite controlling every branch of government and enjoying margins in the House rarely seen in the past century.”

The Miami Herald – Trump won Florida just four months ago you may recall – was just as critical. Republicans “made a huge political miscalculation,” the Herald’s editorial said. “They were vociferous. They were resolute. Ultimately, they were clueless. Well, their constituents, many getting preventive care for the first time, or prenatal care, or cancer treatments clued them in: Obamacare, for all its faults, was working for them.

“Ryan finally — finally — stated the obvious: ‘Doing big things is hard.’ (We’re suppressing a ‘Duh!’) And it’s especially difficult when you leave out preparation and inclusiveness to meet a long-touted promise.

And it hasn’t just been the “opposition” press delivering harsh judgments about the Republican debacle. Right wing websites savaged Congressional Republicans with The Drudge Report featuring a photo of the German airship Hindenburg bursting into flames over the headline: Republican Catastrophe.

Republican Catastrophe (Photo by Sam Shere/Getty Images)

Politico’s Tim Alberta relayed this little bit of color from a critical meeting Trump had last Thursday with the self-righteous egotists of the hard right House Freedom Caucus. “Forget about the little shit,” Trump told those who taught the new president his painful lesson about the art of the Washington deal. “Let’s focus on the big picture here,” the Closer-in-Chief opined. Trump’s message, of course, was that substance doesn’t matter. Don’t sweat the details. The art of the flim-flam got him elected, after all. Who would have thought governing could be so hard?

Trump’s constant use of shape shifting lies notwithstanding, Republicans own this colossal mess and for one principle reason: they have abandoned governing, which is to say substance, in favor of once again trotting out the old hackneyed rightwing clichés and policy inconsistency. Trump’s promise of “health care for all” that would lower costs was always nonsense and internally inconsistent, about as intellectually honest as a sales pitch for Trump University.

This defeat was so big and so obvious that perhaps even Donald Trump can’t spin it away. And Congressional Republicans are going to have difficulty escaping the reality that they fumed against Obamacare for seven politically productive years, but when given a real chance to change the law – or repeal it outright – the GOP quarterbacks took a knee.

Stipulate the obvious: Obamacare has problems. Premiums are too high for many working poor, some states have opted out of the Medicaid portion of the program and the whole scheme remains complicated and confusing. Blame Democrats for some of the confusion. They have never been able to articulate a consistent message about the benefits and there have been real benefits, including insurance coverage for millions of Americans who had not been covered before. Also blame Republicans for the confusion because they have repeatedly misrepresented the negatives impacts of a program that impacts less than 10% of the entire health care marketplace.

Still, Obamacare needs work just like the defense budget or Trump’s golf game needs work, but the constant GOP mantra that the Affordable Care Act is imploding or cratering the economy is just as nonsensical as the tweets from the West Wing. But having ridden the “Obamacare is killing America” hobby horse to electoral success Republicans, as the New York Times pointed out, went searching for a solution to a problem they invented. The problem was invented, of course, because of a burning desire to continue to exploit the issue politically rather than actually work to improve health care. The approach clearly worked. What was missing, as the Times noted, was a “coherent idea or shared vision of what [Republicans] want to achieve and what problem they mean to solve.”

The one and never again policy wonk. (AP Photo/J. Scott Applewhite)

As one wag noted Republicans might have had a better chance to push their plan if they could have pointed to any place in the world were their ideas about enhancing “competition” in health care is working. Americans pay more, have worse outcomes and see more of their fellow citizen’s uninsured than any other major industrialized country. And no country does health care the way we do. The Republican approach wasn’t in any way a fix for a still fractured American approach to health care, but instead would have doubled down on the only strategy the GOP has known in the last two decades: cut taxes for the wealthiest and tell the poor to get a job.

Obama, in pushing the legislation in 2009, sought to reduce the number of uninsured and encourage more preventive care. He succeeded and would have succeeded even more broadly had Republicans not spent every day of both his terms attempting to delegitimize his presidency and with it his legislation. When Republicans got their chance to show the country what they value – should I mention they have more control over the government than they have enjoyed since the 1920s – they opted to advance a plan that would have ended coverage for 24 million Americans over the next decade and gutted the Medicaid safety net for many of the same working class Americans who, against their own best interests, put Donald Trump in the White House.

To the moral bankruptcy that has accompanied the Congressional Republican embrace of the very idea of Donald Trump as their leader, now you may add the intellectual bankruptcy of treating actual governance the way Trump treats the presidency – with contempt and arrogance.

The Atlantic’s Russell Berman had one of the best summaries of the Republican health care fiasco and one of the best quotes. “I’ve been in this job eight years,” Republican Representative Tom Rooney of Florida told Berman, “and I’m wracking my brain to think of one thing our party has done that’s been something positive, that’s been something other than stopping something else from happening. We need to start having victories as a party. And if we can’t, then it’s hard to justify why we should be back here.”

Now, that is a perceptive politician.

Cenarrusa, Idaho, Journalism, Medicaid

Sorry, Wrong Number…Many, Many Times

My Dad used to smile when telling his story about the young fellow who had just seen the classic 1962 World War II movie – The Longest Day – about the D-Day invasion of France in 1944 and was, in turn, telling his own father about the film.

The old man listens patiently and then off-handedly tells his son, “I haven’t seen the movie, but I was there for the play.”

In the same spirit as that old story, I have not seen the 1948 Barbara Stanwyck/Burt Lancaster movie – Sorry, Wrong Number – but I have definitely been living the play. My play is called: Trying to Reach Health and Welfare? Sorry, Wrong Number.

There is nothing special or particularly unique about my telephone number except that the first seven digits of my number match the first seven digits of a toll-free, helpline number – Medicaid Automated Customer Service – managed by the Idaho Department of Health and Welfare. I know this rather obscure fact because I have been averaging two or three “Health and Welfare calls” every weekday for the last two years or so. I long ago lost track of the number of calls, but it beyond hundreds and into the thousands. Thankfully, callers with questions about their Medicaid benefits must assume no state employee works on the weekend, so my phone tends to get the weekend off, as well.

Months ago I thought I had identified the answer to all these wayward calls, but alas it was a fix without a cure. On the state government website that promotes the toll-free number the “1” before the toll-free number had been, inexplicably, left off the rest of the number. So an unsuspecting caller, say from Weiser or Bonners Ferry – I’ve had calls from every corner of the big state of Idaho – would just dial the number shown (minus the “1”) and get me. I called a helpful state agent and asked if maybe, just maybe they could add the “1” and solve the problem of the call from Mrs. Jones from Caldwell, she needs to talk about her niece’s Medicaid needs, ending up on my voice mail. Problem solved, right? Not so fast. The wrong numbers declined a bit, but did not end. I have to assume regular callers to the toll-free number have made a note of the non-“1” toll-free number and were still calling, blissfully unaware that some public affairs consultant and part-time blogger was fielding their calls. The voice mail messages on my phone seemed to continue unabated.

So, believing that information is power, I changed the greeting on my phone. No longer was it, “You have reached me and I can’t take your call right now…” My message became much more Medicaid-centric: “If you are trying to reach the Department of Health and Welfare, you haven’t…hang up and dial a “1” before you call this number.” That’ll fix it, I happily proclaimed, as I began answering questions from people who were really trying to reach me and wondering why I had a Health and Welfare related message on my phone. You can inform some of the people some of the time, but…the calls continue.

I have genuine sympathy for my callers. They need answers to real questions. Judging by some of the hundreds of messages that have been left on my voice mail, many of the callers are confused and uncertain about benefits and responsibilities. If you have ever tried dialing into a government agency you know what an intimidating experience it can be. Imagine getting the wrong number and ending up in some civilian’s voice mail, while you worry and wait for a call back. It would be easy to conclude that government just doesn’t work.

My standard procedure now is to try and intercept as many of these calls as I can and re-direct them to a number that begins with that essential “1,” but it is not always possible. And, while I admit that I’ve been annoyed and frustrated by the calls that I get, wasted effort that doesn’t do the callers any good, the “sorry, wrong number” play I’ve been living has given me an entirely new appreciation of what one little glitch in a vast government program can do to create problems and frustrate users.

As Idaho contemplates a major expansion of Medicaid services under the Affordable Care Act – one estimate holds that 100,000 more Idahoans could be covered – and the state’s for profit Medicaid contractor continues to try to make the system work, here’s hoping, and not just for my sake, that they attend to all the details, small and large, involved in an expansion.

And, just for the record, I have equal amounts of sympathy for the state workers who, without much fanfare or appreciation, labor to make an essential program of our society work for people who really need the help. This is a vastly complicated government program, wrapped in layers of regulation and requiring immense levels of accountability. One little digit – that pesky “1” – can frustrate even the most essential government program.

And, yes, I could get a new phone number, but have ruled that out. If Barbara Stanwyck and Burt Lancaster can handle a wayward call, so can I. But, for future reference, do remember that “1” in front of a toll-free number. Given the vast proliferation of telephones these days, it is a given that someone has the number that is toll-free with a “1” and just some schmuck’s voice mail without.

 

 

Baseball, Cuba, Medicaid, Politics

Cuba

Isn’t it Time?

Former President Jimmy Carter and his wife Rosalynn recently made their second trip to Cuba. Carter also went in 2002. Both trips, undertaken as a private citizen (but no former president is really a private citizen), were designed to try and move U.S – Cuba relations in a more positive direction.

Predictably, Carter was immediately denounced as a “shill for Castro” and an apologist for the Cuba government. Such criticism seems to roll of the former president’s back like water off a duck and Carter’s report on the visit, posted at the Carter Center website, paints a much different picture of what he did and said in Havana. Here’s the concluding paragraph of his trip summary:

“Both privately and publicly I continued to call for the end of our economic blockade against the Cuban people, the lifting of all travel, trade, and financial restraints, the release of Alan Gross [a jailed U.S. contractor] and the Cuban Five [Cuban dissidents], an end to U.S. policy that Cuba promotes terrorism, for freedom of speech, assembly, and travel in Cuba, and the establishment of full relations between our two countries. At the airport, Raul [Castro, the Cuba president] told the press, ‘I agree with everything that President Carter said.'”

For 50 years the United States has had an embargo against Cuba. During the Bush Administration and for most of that 50 years, it has been extremely difficult, even illegal, to travel to Cuba. Trade has been strictly banned. The Obama Administration has relaxed the travel rules some, but the chance that the two countries might actually get on a path to more normal relations remains wrapped around the axle of south Florida politics. The Cuba-American community there, largely Republican voters, remains a potent political force and last I checked Florida still played an outsized role in presidential politics. For years the political facts of life in one state have largely dictated the nation’s policy toward Cuba.

Nevertheless, by almost any measure our Cuban policy has run its course, and not just because I’d like to buy an extremely expensive Cuba cigar in the United States. At one time, post-Bay of Pigs and post-Cuban missile crisis it was easy to make the argument that Fidel Castro’s island regime was settling in to become a genuine threat to U.S. and Latin American security. Cuba did meddle in revolutions in far away places, like Angola, but today there is much reason to acknowledge that the Cuba-Soviet relationship was never as seamless as we feared nor was Castro, the socialist revolutionary, as effective as we might have thought. Cuba’s economy struggles today and the embargo, rather than bringing down Castro, has hurt the Cuban people and given the regime its anti-American reason d’etre.

Here’s the analogy that works for me. We’ve had 50 years of deadlock and non-engagement with Cuba, a country 90 miles from our shores, while halfway around the world, thanks originally to Nixon and Kissinger, we have engaged the Chinese and, I would argue, slowly, but steadily, helped bring a measure of the free market and openness in that communist country. We may have gone too far. The Chinese now threaten our economic leadership in the world. At the same time, we engage Vietnam, a country in which we fought a long and bloody war, with trade and diplomacy. We have an unsteady, but absolutely necessary relationship with Putin, the old KGB chief, in Russia. But nothing of any substance with Cuba.

Idaho and other Pacific Northwest conservatives, guys like Sen. Mike Crapo and Gov. Butch Otter, have long pushed for more trade opportunities with Cuba, the Castro brothers notwithstanding. In February 2008, Crapo signed a bipartisan letter to the Bush Administration, asking for a rethinking of U.S. policy in light of the resignation of Fidel Castro.

“Our current policy deprives the United States of influence in Cuba,” Crapo wrote, “including the opportunity to promote principles that advance democracy, human rights, and the rule of law.  By restricting the ability of Americans to travel freely to Cuba, we limit contact and communication on the part of families, civil society, and government.  Likewise, by restricting the ability of our farmers, ranchers, and businesses to trade with Cuba, the United States has made itself irrelevant in Cuba’s growing economy, allowing Cuba to build economic partnerships elsewhere.”

Cuba presents a “Nixon goes to China” moment. Relaxing trade restrictions and putting the countries on a path to more normal relations, requires conservative, trade-oriented Republicans, like Crapo, to keep pushing.

In a 2005 report, the libertarian-leaning CATO Institute, labeled our country’s Cuba policy “four decades of failure.” CATO’s trade policy director Daniel Griswold wrote: “The most powerful force for change in Cuba will not be more sanctions, but more daily interaction with free people bearing dollars and new ideas.” Indeed.

World-class cigars aside, Cuba can’t have much to sell to us. They import most of their food and manufactured goods. By contrast, we have everything the Cubans need from automobiles to high rise resort hotels, from Idaho potatoes to Washington apples. Continuing sanctions is simply a huge missed opportunity.

Jimmy Carter left office in 1981 with a 34% approval rating. His tenure remains controversial, but his standing in the history books aside, Carter has quietly and effectively been a model “ex-president.” His selfless work in Africa to end disease, his election monitoring around the world and his advocacy for women continue to be impressive. As one of the few Americans to engage at the highest levels with Cuba’s political elite, with dissidents, artists and religious leaders, he deserves a fair hearing on Cuba.

Pure south Florida politics aside, when Jimmy Carter and Mike Crapo are on the same page about Cuba, everyone should be listening.

 

Egan, Idaho Politics, Journalism, Medicaid

The Moral Test

medicaidHard Cases

“The moral test of government is how that government treats those who are in the dawn of life; the children, those who are in the twilight of life; the elderly, and those who are in the shadows of life, the sick, the needy and the handicapped.”

The quote is most often attributed to the liberal icon Hubert Humphrey and dates to a time when there was a broad consensus in American life that government had a very precise role to play in trying to improve the plight of those fellow citizens “in the shadows of life.” The lingering Great Recession more than ever has called that role of government into question and, at the same time, made Hubert’s eloquent quote more relevant than ever.

A massive human hurt is unfolding in nearly every state as governors and state legislators contemplate unprecedented reductions in spending on various services paid for at the state level by Medicaid. In states like Idaho, all the easy stuff has been cut. Now the real pain begins, as illustrated by the estimated 1,000 Idahoans who showed up on Friday, some in wheelchairs, to show state legislators, more eloquently than words ever could, just what the American social safety net really means to real people.

With the 50 states collectively facing a budget gap estimated at $125 billion, the New York Times reports today that Medicaid is “ripe for the slashing” from New York to California, from Idaho to Texas. The times are tough – very tough – but I doubt that even tough-minded, fiscally conservative legislators can live with the implications of ending services for a guy in a wheelchair or an 8th grader with autism.

In Idaho, 20 lawmakers, the members of the powerful Joint Finance-Appropriations Committee (JFAC), make most every spending decision for the rest of the 85 members of the legislature. It is an awesome power and responsibility. The committee has co-chairs, Sen. Dean Cameron and Rep. Maxine Bell, and no one has ever credibly accused these experienced lawmakers of being big spenders. They run a tidy ship and one has to be impressed with the diligence they and their committee have lavished on the hard choices the state faces with both Medicaid and education. Cameron and Bell deserve a lot of praise for showing the political courage to open up the committee to those thousand people who came calling on Friday. It had to have been a sobering experience for anyone paying attention.

Here’s a fearless prediction. Arguably the most conservative legislature in the nation won’t be able to make the $25 million in Medicaid cuts that Idaho’s governor has proposed. It will take a while yet for the reality to sink in, its still early in the legislative process, but Friday was an important day. Not only did the thousand show up, but the budget numbers that have been in dispute since the first day of the 2011 session just gained some clarity and not in a good way.

All this will eventually lead to a frantic search for some barely acceptable source of new revenue to help plug the budget holes. The legislature will come to embrace, in tried and true fashion, the method of patch and scratch tax policy making. Some how, some way, Idaho’s very conservative legislature will “find” some new revenue to avoid these awful choices.

It won’t be easy, and people elected never to raise taxes will anguish over the choices, but it will happen I think. Idaho’s lawmakers have come face-to-face with their fellow citizens who really do, through no fault of their own, live in the shadows. In the end, it will not really be much of a political test. No one is likely to lose an election by making a vote to preserve home care services for an elderly, wheelchair bound neighbor. It will be quite a moral test, however, for lawmakers who infrequently see so clearly the impact of their votes.