Mar 26

Donald Trump, working the media.

Who would have thought that after his first two months as president in daily public combat with big media over everything he said and did, at the end of the day of what was reportedly his biggest political setback, President Donald Trump would make a couple of spontaneous, surprise phone calls to reporters at the two biggest newspaper outlets perpetuating what he labeled “fake news”, to chat about it?

My first thought was ‘seems like what Pope Francis has been doing since he was elected pope‘, in February 2013. Really. Early. And often. And to popular media. It’s a way to control the message, even though both leaders have media handlers.

President Trump had to have thrown the New York Times off their footing when he phoned them to talk about the failure to get the GOP health care reform bill to a vote on Friday. ‘He’s blaming Democrats’, the Times said in this story about the call.

The House speaker, Paul D. Ryan, was preparing to tell the public that the health care bill was being withdrawn — a byproduct, Mr. Trump said, of Democratic partisanship. The president predicted that Democrats would return to him to make a deal in roughly a year.

“Look, we got no Democratic votes. We got none, zero,” Mr. Trump said in a telephone interview he initiated with The New York Times.

“The good news is they now own health care. They now own Obamacare.”

Mr. Trump insisted that the Affordable Care Act would collapse in the next year, which would then force Democrats to come to the bargaining table for a new bill.

“The best thing that can happen is that we let the Democrats, that we let Obamacare continue, they’ll have increases from 50 to 100 percent,” he said. “And when it explodes, they’ll come to me to make a deal. And I’m open to that.”

To some degree, this had to have flummoxed Trump’s most hostile detractors.

“I’m not disappointed,” he insisted. “If I were, I wouldn’t be calling you.”

The Washington Post had a great attention-grabbing headline: ‘Hello Bob’: President Trump called my cellphone to say that the health-care bill was dead‘. Well known journalist Robert Acosta recounted the moment the call came in, and the exchange he had with the president when he answered it.

At first I thought it was a reader with a complaint since it was a blocked number.

Instead, it was the president calling from the Oval Office. His voice was even, his tone muted. He did not bury the lead.

“Hello, Bob,” Trump began. “So, we just pulled it.”

Trump was speaking, of course, of the Republican plan to overhaul the Affordable Care Act, a plan that had been languishing for days amid unrest throughout the party as the president and his allies courted members and pushed for a vote.

Before I could ask a question, Trump plunged into his explanation of the politics of deciding to call off a vote on a bill he had been touting.

The Democrats, he said, were to blame.

“We couldn’t get one Democratic vote, and we were a little bit shy, very little, but it was still a little bit shy, so we pulled it,” Trump said.

Trump said he would not put the bill on the floor in the coming weeks. He is willing to wait and watch the current law continue and, in his view, encounter problems. And he believes that Democrats will eventually want to work with him on some kind of legislative fix to Obamacare, although he did not say when that would be.

I’m trying to picture Bob Costa at that moment, and those cold calls from Pope Francis kept coming to mind.

In sports, an artful move can result in ‘wrong footing’ an opponent. It means a player is lunging right when the ball goes left, or vice versa. You are thrown off your game. I thought of that, too.

These calls had to have thrown off two of the major media outlets Trump and Press Secretary Sean Spicer and other surrogates have targeted for perpetuating “fake news”. They and their entertainment media have played that up, to the point when Saturday Night Live’s string of opening skits satirized White House spokesman Spicer among others, and then Spicer refers to it in his daily press briefings, sometimes playing it up and using lines from the SNL skit, other times fitting right into that caricature. To the point where one TV news roundtable participant said he didn’t know whether it was ‘art imitating life, or life imitating art imitating life, or what’.

Which raises the real consideration of what is news, really. And Baudrillard’s Simulacra and Simulation. The chapter titled ‘The Implosion of Meaning in the Media’ opens with this quote:

We live in a world where there is more and more information, and less and less meaning.

Provocatively, he explores and analyzes basically what we’ve been seeing, experiencing and consuming in news media for decades.

What is news, and what is reality?

Politics right now seem to be operating more feverishly on perception becoming reality. Whether that played into President Trump’s calls to the Times and Washington Post, or to what degree it did, is hard to tell, he’s such a wild card.

But his call to Robert Costa at WaPo was certainly interesting. And lengthy. It’s a back and forth exchange on the politics of trying to get, or stop, health care reform done and who tried to stop it and what comes next, and later down the road, and what it would take to get anything done.

And then Trump said this:

“Well, look, you can say what you want,” Trump said. “But there are years of problems, great hatred and distrust, and, you know, I came into the middle of it.”

So Costa says he wanted to get some clarity before wrapping up the call. It”s easy to imagine how head spinning this was at that point.

As Trump tried to hang up the phone and get back to work, I asked him to reflect, if at all possible, on lessons learned. He’s a few months into his presidency, and he had to pull a bill that he had invested time and energy into passing.

What was on his mind?

“Just another day,” Trump said, flatly. “Just another day in paradise, okay?”

He paused.

“Take care.”

It’s all in how you take it.

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Nov 12

No one knows yet just how much worse this is going to get.

But the people the healthcare overhaul was supposed to help are mostly not being helped, and the people who were supposedly safe in the system they preferred have mostly lost that safe haven. President Obama was not able to deliver what he promised, and even when he was warned to stop promising it, he persisted.

He was the one who made it sharply and divisively political from the start, giving leadership of the Republican party  no voice at the table to negotiate necessary healthcare reform. Something as major as the redesign of health care in America should have been a joint effort, but alternative plans never got a hearing.

Wall Street Journal columnist Peggy Noonan summarizes it, to this point, here. She makes very good and important points, and particularly one I’ve focused on while so much attention in the early unraveling of Obamacare centered on the stunning website failures. That was misdirected focus, though that crash definitely occurred, definitely cost a ton of money and most definitely didn’t have to happen, with technology experts able to handle something like this with far less lead time and at far less cost with vastly more ease of use. That’s all true. But Noonan focuses on what I’ve wanted to see addressed, which is the main point.

So the program debuts and it’s a resounding, famous, fantastical flop. The first weeks of the news coverage are about how the websites don’t work, can you believe we paid for this, do you believe they had more than three years and produced this public joke of a program, this embarrassment?

But now it’s much more serious. No one’s thinking about the websites. They wish you were thinking about the websites! I bet America hopes the websites never work so they never have to enroll.

The problem now is not the delivery system of the program, it’s the program itself. Not the computer screen but what’s inside the program. This is something you can’t get the IT guy in to fix.

Yes, it’s the program itself. It was always that.

They said if you liked your insurance you could keep your insurance—but that’s not true. It was never true! They said if you liked your doctor you could keep your doctor—but that’s not true. It was never true! They said they would cover everyone who needed it, and instead people who had coverage are losing it—millions of them! They said they would make insurance less expensive—but it’s more expensive! Premium shock, deductible shock. They said don’t worry, your health information will be secure, but instead the whole setup looks like a hacker’s holiday. Bad guys are apparently already going for your private information.

Many people may have missed that, but HHS Secretary Kathleen Sebelius had to admit under oath in her testimony before a Senate Finance Committee hearing that healthcare ‘navigators’ hired by the federal government to help people sign up for healthcare online and thus take sensitive personal information from them just may be felons.

Sen. John Cornyn asked if federal background checks were a prerequisite for the hiring of the individuals tasked with walking people through ObamaCare enrollment.

“The president is in Dallas, Texas today touting the navigator program, which as you know are people who are hired to navigate the [Affordable Care Act], but I would just like to ask you this question,” Cornyn said to Sebelius. “Isn’t it true that there is no federal requirement for a navigator to undergo a criminal background check, even though they will receive sensitive personal information for people they help sign up for the Affordable Care Act?”

“That is true,” Sebelius responded. “States can add an additional background check and other features, but that is not part of the federal requirement.”

“So a convicted felon could be a navigator and could acquire sensitive personal information?” Cornyn asked.

“That is possible,” Sebelius said. “We have contracts with the organizations, and they have taken the responsibility to screen their navigators and make sure that they are sufficiently trained for the job, and there’s a self attestation, but it is possible.”

Noonan has a suggestion.

Maybe [oversight committees] could even call in some people from the White House and Congress, the ones who helped write and interpret this famous law that you had to pass before you could know what was in it, and ask: “Did you ever meet a normal human? Did you understand what you were doing when you produced this thing?”

Maybe they could even ask the president: “In your entire life, from community organizer to lawyer to politician, did you ever buy an insurance policy? Were you always on your wife’s plan, or immediately put on a plush government plan? Did you ever have to do anything like what you’re telling the people of your country to do?”

What are the odds those questions will be asked? Though the media are now, finally, asking questions and turning up information about pressure politics to avoid transparency on the healthcare overhaul.

We deserve transparency, the president and all elected officials deserve scrutiny by an informed electorate, because we’re all affected by it.

The idea that “only” 3 percent of Americans will end up on the short end of a 2,700-page law remaking the nation’s health care system seems as fanciful as the President’s pledge that anyone who likes their current plan could keep it.

The facts are clear: Obamacare isn’t just unfair for a small percentage of Americans; it’s unfair for the entire country.

There were alternatives. Here are some that didn’t require policy wonks.

It didn’t have to be this way. The Affordable Care Act may have been designed to be a socialized monstrosity of health care displacement and governmental control, but it need not have been. Creating a means whereby people who wanted health insurance could purchase it (and younger people in good health could choose limited, catastrophic coverage, or none at all) needed only two things: a willingness to put common sense over politicization, and a genuine respect for the notion that people understand their individual needs better than anyone else.

Common sense, and respect for the people they have ostensibly been elected to serve, are currently in short supply in our nation’s capital. The Affordable Care Act was passed by one political party while it was in control of two branches of government and feeling disinclined toward discussing (or even acknowledging) design alternatives.

That’s a shame because creatively exploring and expanding upon just a few of these framework ideas might have solved the problems of the uninsured without severely disrupting much of anything:

A) Begin where you are: Why should all roads lead to Washington DC when local communities are best able to identify those in need and to reach out? In 2000, then-Mayor Rudy Giuliani, went to the New York City Council with the simplest of plans: Take a pro-active approach and reach out to the uninsured who are not even aware of what programs already exist, which helped to insure several hundred thousand in New York City alone. Before upending anyone, get the right people enrolled into the appropriate, existing programs.

B) Invite-in can still avoid federal intervention: Healthcare infrastructure is all about managing risk by spreading it. If the most economically efficient plan is the one covering as many people as possible, then why not create extensions that offer the uninsured the opportunity to buy into the very same insurance plans offered to any state’s government employees, which are usually excellent?

C) Open the markets: Perhaps because it is both the simplest and the most commercial of ideas, and the least political, there appears to have been no discussion of allowing insurance to be sold across state lines, which would have immediately broadened the market competition and thereby lowered costs for everyone, across the board. Rather than opening coverage availability, the ACA appears to narrow it.

Read the account there of cancer patient Edie Littlefield Sundby:

Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines. It would seem the ACA would have the effect of geographically trapping people, effectively keeping them from pursuing new in-state opportunities and adventures for fear of again losing insurance and having to re-start the research and purchasing process. It is another narrowing, rather than enlarging, effect of Obamacare.

The column concludes with a presumption that perhaps something may still be done, by people of common sense, before this gets much worse. Maybe that’s not possible, maybe it is. But there’s no telling right now.

As this unpopular policy we call Obamacare begins to crumble from the weight of its own incompetent over-reach and mendacity, the opportunity may soon arise for policy reform, but if other voices do not have alternative plans already designed, thought through and set for discussion when an urgent solution is called for, there will be no option left in the political imagination but a single-payer program—managed by these same incompetents—and a nation full of frightened, uninsured people willing to turn to it.

The latest political class punditry holds that there’s no turning back now from the inevitable impact of such a massive federal program already in place. We’ll see.

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Apr 11

Remember when Sen. Nancy Pelosi said they had to sign the healthcare bill to know what was in it? Well it has come to light, and some people are troubled by what it reveals.

Dr. Donalid Condit says it’s a big document loaded with sugar-coated rhetoric covering a bitter pill to swallow.

This ObamaCare prescription  threatens patients, the physicians who care for them, and the common good. The only clear winners are the consultants and lawyers busy trying to decipher this 429-page tome of acronyms and encrypted methodology that will compromise the doctor-patient relationship and is contrary to the principle of subsidiarity.

Very good point.

Medicare beneficiaries will be “assigned” to 5,000 patient-minimum organizations to coordinate their care. While HHS Secretary Kathleen Sebelius talks about improvement in care, the politically poisonous truth is that Medicare is going broke and ACOs are designed to save money. The words “rationing” or “treatment denial” or “withholding care” are not part of her press release, but reading the regulations reveals intentions to “share savings” with those who fulfill, or “penalize” others who fall short of, the administration’s objectives. The administration’s talking points include politically palatable words which emphasize quality improvement and care enhancement when the real objective is cost control by a utilitarian calculus.

Physicians and other health care providers will find themselves in conflict with the traditional ethos of duty to patient within ACOs.

Somebody has to point this out. The moral medicine we have taken for granted, that’s now under new threat.

Ever increasing numbers of doctors are leaving private practice and becoming employed by hospitals, due to a variety of challenges inherent in these uncertain times . The hospitals are the most likely recipient of bundled payments for caring for Medicare patients. Doctors will face agency conflicts between the time honored primary duty to patient, which may conflict with hospital administration, and ACO goals of fiscal savings. Medical care providers will receive incentives for controlling spending, and penalties if they do not. “No one can serve two masters” (Matthew 6:24). Not even physicians.

The physician’s ACO conundrum is illustrated in the language where these regulations proclaim that,  “Providers should be accountable for the cost of care, and be rewarded for reducing unnecessary expenditures and be responsible for excess expenditures.”

This is chilling.

Yet the very next sentence stipulates that, “In reducing excess expenditures, providers should continually improve the quality of care they deliver and must honor their commitment to do no harm to beneficiaries.” (page 14)

Doublespeak? Where is this leading?

The principle of subsidiarity guides policy makers to empower decision making and scarce health care resource allocation at the doctor-patient level. However, the Affordable Care Act moves in the opposite direction.

There is no question that significant – and scarce — health care resources are consumed in the Medicare population toward the end of life. ACOs intend to limit this spending — the government way. The Ethical and Religious Directives by the United States Conference of Catholic Bishops suggest a better path forward…

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Apr 14

Lots to talk about. I’ll be guest-hosting the Drew Mariani Show on Relevant Radio Thursday, and hope you can join in as much of it as you can, whether on dial or online, because we’ve got some great guests lined up!

Looking forward to talking with the founder of the Tea Party movement; Ambassador Alan Keyes; Heritage Foundation’s healthcare policy expert Dr. Robert Moffit; Acton Institute’s Fr. Robert Sirico’ Liturgical Institute’s Dr. Denis McNamara; and Fr. Frank Pavone, the legendary warrior behind Priests for Life.

Time flies, always. It’s going to be a particularly fast three hours. Take time to join the conversation. Open forum!

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Mar 23

Seems like the prolonged and fractious battle over healthcare reform in America has been the political and social war of our times. Turns out, it may have been only one raging national conflict that preceded what’s to come.

And, says Michael Goodwin in the New York Post, we’d best get ready for the sequel, and what follows that.

That’s because the battle over health care is merely a front in a larger war. Thanks to President Obama’s statist agenda, America’s new civil war is, at heart, the mother of all culture wars.

It’s the showdown between Americans who want bigger government and those who want smaller government. And it won’t be over anytime soon.

Not only does it encompass and include other wedge issues, such as abortion, taxing and spending, but the war over the size of government goes to the heart of the concept of American exceptionalism.

And there’s been quite a cultural battle over that in the short tenure so far of this president and his administration.

His health-care obsession, with industry tentacles reaching 17 percent of the economy, reveals his vision. There is little dispute the industry has big flaws, yet Obama passed up a bipartisan chance to fix most of them.

He opted for a sweeping expansion and takeover that would put Washington in charge of every aspect, from levels of care, to cost, to mandates, to jobs and taxes.

Ultimately, no American will be able to escape its centralizing impact, which is why opponents are so ferocious and frightened. While Obama tries to blame Republicans, most of the country, especially independent voters, is running away from his plan even though some components are popular.

It’s the sheer size — the expensive big government grab — that is stoking anti-takeover passion.

Pass or fail, the issue will move off center stage. But there will be no rest for a weary nation.

Goodwin predicts that a lineup of issues will successively try the identity of America as a representative republic in which the majority will of the people determines government, and replace that traditional model with one that subordinates the individual to the state, “with the feds aiming to run everything…” in every aspect of society.

Their vision is to gradually erode local control and shift power to Washington.

As with health care, parts of each issue make practical sense. Reducing our reliance on foreign oil, for example, is a goal most Americans share.

But what they object to, and will continue to resist, is the animating impulse that gives Washington more control over our daily lives. That is the definition of a statist, and it’s what Obama is.

But he believes that if he can just explain his vision better, the people will fall in line behind him, and he has plenty of reason to believe that.

Not surprisingly, he refuses to grasp why a clear majority of America now opposes his health care takeover.

“People have lost faith in government,” he said at a recent rally in St. Louis. “They had lost faith in government before I ran, and it has been getting worse.”

Actually, people haven’t lost faith in government. They just don’t think bigger is better. And the bigger he wants to make it, the less faith they have in him.

But with his healthcare victory this week, don’t expect him to get that anytime soon.

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