Trump gets civic lessons from failed health bill

The defeat of the House of Representatives attempt to repeal and replace the Affordable Care Act provided great civics lessons.

Its most important student turned out to be President Trump. “We learned a lot about the vote-getting process,” he said. “Certainly, for me, it was a very interesting experience.”

The first lesson is there’s a big gap between promise and performance. Many voters believe politicians lie. That’s because they overpromise and then cannot produce.

Candidate Trump promised his health care reform would do more than the ACA but cost less. Yet the White House offered no specific proposal. The president simply endorsed Speaker Paul Ryan’s bill as if it were what he had promised. When it failed, he failed.

The second civics lesson is that on major issues, the president proposes and Congress disposes. That’s called the separation of powers.

Trump expected that, because he won the presidential election, congressional Republicans would fall in line behind him. This time, it did not work that way. As much as he wanted to dominate the process and paste the Trump name on it, he depended on an independent Congress.

This piece of legislation had to begin in the House, because the Constitution requires “money” bills to start there. While passage of the ACA, done with only Democratic votes, had taken more than a year, Ryan allowed his bill only 18 days.

The president made a series of assumptions about the House. He made no effort to attract Democratic votes, expecting virtually all of the majority Republicans, out of loyalty to him, would support the bill.

But the bill ran into the Freedom Caucus, an extreme conservative GOP group, which wanted outright ACA repeal without replacement. Desperate to pass the bill, Trump and Ryan agreed to delete coverage for such essential services as emergency and maternity coverage, trying to reduce costs to gain conservative votes.

By cutting health services and Planned Parenthood funding, Trump and Ryan lost the support of some moderate Republicans, who risked election defeat if they opposed their constituents’ interests on these matters. And the leaders still could not pick up some Freedom Caucus members.

Maine Second District Rep. Bruce Poliquin, while worrying about Ryan’s rushed efforts at passage, was not among the bill’s GOP opponents.

Ryan could not afford to lose more than 21 GOP votes, but 33 opposed his modified bill. Trump, always the salesman, urged them to change, but they refused. The president was learning that loyalty to him does not overcome the separation of powers.

Here is another civics lesson. The bigger a party’s legislative majority, the less unified it will be. More members means more diversity of outlook. That explains the GOP opposition.

Even if the House passed the bill, the matter would not be settled, despite the impression Trump gave. The key part of this civics lesson ignored by Trump was the independent role of the Senate. It would not have simply accepted whatever the House passed.

Affecting previously approved spending, the bill needed only 51 senators, avoiding the 60-vote threshold to end a filibuster. But, with just 52 Republican senators, only a handful of opponents were needed to block the bill. A sufficient number of conservatives and moderates had already made clear their opposition.

While the ACA may not be “collapsing,” as Trump and the Republicans claim, it needs to be fixed. Competition is lacking in some markets and costs are rising. It cannot work indefinitely under its current rules or management by Health and Human Services Secretary Tom Price, who would abolish it if he could.

The lesson is that ACA reform, which must come eventually, should be the result of negotiations between Republicans and Democrats. Ryan worries about cooperating with Democrats, because he will lose some Republicans simply for doing that.

Ryan and Trump should try to get enough votes for a bipartisan deal and worry less about inevitable Republican defectors. And they should drop the idea of using health care reform to cut taxes on the wealthiest, the real conservative strategy.

If the Democrats accept the need for changes in ACA operation including markets, while insisting on preserving ACA coverage, they should get off the sidelines if invited by Trump or Ryan.

To win votes, Trump overpromises. Trump needs to be less of a salesman and more of a statesman. Is that possible?

A friend of Trump’s has said: “On future legislation, he won’t make the same mistakes.” If so, he must better understand Congress and be more realistic about making promises he can’t keep.

GOP right, moderates make ACA reform unlikely; bring on the Dems

The Affordable Care Act and its reform are causing confusion. Here’s what we know.

It covers more people than did the free market system and changes some of the terms of insurance policies, but it does not abolish the market.

Conservatives dislike it because they believe it substitutes government for the free market, costs too much and requires participation.

Progressives like it because it partly substitutes government for the free market, which did not cover millions of people.

Everybody agrees it needs to be fixed.

There are fundamentally only two ways to provide health care insurance to people.

In the U.S., the traditional approach was insurance sold by private carriers. People could choose among policies the companies offered, choose not to be insured, or simply couldn’t afford insurance. Competition among insurers would supposedly control prices. The system was mainly financed by insurance premiums.

In other developed countries, government is the insurer, providing coverage to virtually all people. Government, the “single payer,” pays the bills. As the only customer, the government can control prices and costs. The system is financed by taxes, which replace insurance premiums.

The American system includes elements of single payer: Medicare for older people and the Veterans Administration.

The traditional American system left too many people without coverage, but the single payer system approach was widely considered to give too much power to the government while destroying a key element of free enterprise – competition.

By 2010, Congress included enough Democrats and President Obama to move away from a pure market system, but not to a single payer. Congress would not allow government even to provide a nonprofit competitor in the market. The result was a compromise that shows the defects of a hybrid.

In 2017, Congress includes enough Republicans and President Trump to restore some or much of the market system, allowing competition to attract people to insurance rather than a government requirement. Some elements of the ACA might be allowed to survive.

The ACA imposed some new costs resulting from the inclusion of tens of millions of previously uninsured people and required additional features, like guaranteeing coverage for pre-existing conditions.

It does not control drug or hospital costs, which to continue to rise, though at a slower rate. The new ACA costs are financed by new taxes, mainly levied on the wealthiest taxpayers. Republicans would repeal those taxes.

Rising costs, accompanied by limits on what insurers can charge despite higher premiums, are causing insurers to leave some markets. Trump and GOP critics say that shows the coming collapse of the ACA.

Strong right-wingers don’t want reform; they want repeal. Outright repeal now may be impossible because the program is established, and many previously uninsured people are not only becoming accustomed to it, but find they like it.

Like Social Security, which was once similarly challenged, it may become an integral part of American life. If the ACA cannot be killed now, strong conservatives reckon, it will never be ended.

One element of the ACA that gets much attention is the financial aid offered to states, allowing them to expand Medicaid to include many more low-income people. States could turn this money down, but even many Republican-led states accepted it to provide help to their low-income uninsured.

In Maine, Gov. LePage has thus far successfully blocked the state from accepting more federal Medicaid funds. This year, a referendum could allow Maine voters to expand Medicaid, known as MaineCare, without the governor’s agreement.

As Congress considers the ACA, a conflict exists between those who favor repealing as much as possible and others whose constituents have come to rely on it. Sen. Susan Collins has tried to lead Republicans toward a state-by-state compromise that serves both sides, but it seems to have no chance.

Neither she nor Sen. Angus King is inclined to agree to a deal that strips Maine people of coverage.

Health care costs are increasing and with them insurance premiums from Medicare, the ACA and insurers. Unless costs are controlled, the health care tab will become impossible to pay under the free market, single payer, or anywhere in between.

As a start, when government gives drugs a monopoly, it should be possible for government to impose price controls on greedy pharmaceutical companies. That would be a huge reform in itself.

Whatever happens in Washington, states may adopt their own health care insurance programs. After all, Massachusetts adopted a program in 2006 that became the basis of the ACA. That state now has the lowest rate of uninsured in the country.

Immigrants, refugees face U.S., European nationalism

President Trump wants to build a wall with Mexico. The United Kingdom wants out of the European Union. The Netherlands blocks the Turkish Foreign Minister from campaigning. Gov. LePage wants to keep more refugees out of Maine.

What these policies have in common is a desire to keep a high degree of national identity alive in face of mounting immigration.

That’s “nationalism” and it’s sweeping much of the world. It is incorrectly labeled “populism,” which applies to policies, mostly economic, to support average people against the interests of the rich and powerful. The nearest politician to populism is Bernie Sanders not billionaire Trump.

Countries like Britain, the Netherlands and France have long had immigrant populations, usually supplied from their colonies abroad. Germany has imported Turkish workers to support its strong economic growth.

Under the EU, which aims at creating a single continental economy much like the American, workers are allowed to take up residence in any of its 28 countries. As in the U.S. system, the efficiency expected from a single market requires a single labor force.

Layered over the presence of foreigners in European countries, who may gradually assume citizenship where they live, is the influx of refugees.

In the U.S., refugees, mainly economic but sometimes political, may enter the country without permission. Seen as refugees, they are “undocumented immigrants.” Seen as lawbreakers, they are “illegal aliens.”

Some Americans oppose undocumented or illegal residents because they may threaten to take jobs that otherwise might go to long-time citizens or change the racial mix in which white men have dominated since the founding of the country.

This opposition has a long history. While Chinese were imported to build railroads, work that American did not want to do, they were blocked from immigration until the 1940s, when China was America’s wartime ally. Interestingly, denying votes to women until 1920 reflecting much the same sentiment.

Unlike Europe, the U.S. had a long traditional of allowing, even inviting, immigration as a way of taking control of vast territory. But implicit in this policy was the understanding that the immigrants should look like those already in the country. In short, they should come from Europe.

In Maine, there was once a movement called KPOOM – Keep People Out of Maine. Now, LePage seems to agree with that movement if the newcomers are refugees, who are different from the majority in the least racially mixed state in the Union.

The big exception to U.S. open immigration was Africans, who did not ask to come, but were brought by force. They were not recognized as being eligible to be Americans. It took the Civil War plus a hundred years to change that view.

Today’s anti-immigrant policy promotes the survival of a mentality that does not welcome people who don’t look like the majority. The reason is that the majority can see itself becoming the minority.

In Europe, nationalism based on color and culture has deeper roots. That creates a problem of divided loyalty. For example, the Turks in the Netherlands may have Dutch passports, but they can also vote in Turkish elections. That’s why a Turkish official wanted to campaign in the Netherlands.

The same dual nationality problem, maintaining divided loyalties, arises in other European countries like Germany.

Then there’s the EU. In Britain, an island country, people have become uneasy with what seemed like an invasion of people from eastern Europe. While ex-colonials might not be white, they behaved like the British. But Poles and Rumanians obviously bring their own culture.

The prime force behind Brexit is keeping different Europeans out. The prime cost to Britain may be losing the benefits flowing from open economic links with the Continent.

Add the refugees to all this. As the result of devastating conflict in the Arab Middle East, partly caused by the policies of the U.S. and its European friends, millions of people have lost their homes and their livelihoods. They fled to the nearest area where they could find economic stability and shelter – Europe.

Europe as a whole was not ready for them and had no policy, leaving it up to individual countries. Germany, still overcoming its Hitler legacy, opened its doors, at considerable risk to Chancellor Angela Merkel. Other countries, through which a flood of refugees had to pass, could not handle the influx.

Simple nationalism, dual nationality or open-ended refugee status are not the answer. Workers and refugees moving across borders are no longer unusual. They are the new normal.

National policies are needed that are clear, understandable and possibly uniform across the world.

It's time to expose five recent political myths

Every so often, the political news gets so rich in misinformation or distorted facts, that it becomes time to expose some myths.

Myth 1: President Trump deserves our respect, because he was elected president.

In fact, it’s the presidency that merits our respect. The U.S. is unusual in combining the head of state, the person representing the entire country, with the head of government, the leader of a political party. For example, in the United Kingdom, the queen is the head of state and the prime minister is the head of government.

As for Trump or any president, he or she must earn our respect. But we also respect the presidency. The officeholder has the responsibility of conducting the office to maintain that respect. The American people can then easily rally to support a unifying president in time of crisis.

If the president’s conduct is disrespectful of the office by ignoring his or her responsibility as chief of state, our unusual American approach to government is threatened.

Myth 2:  The American president runs the government. 

Unlike a corporation run by a single person, who may give orders to subordinates and fire them at will, government agencies have powers independent of management by the president.

To protect the administration of justice from political manipulation, laws have been passed by Congress and signed by presidents that shield many Justice Department functions from political control.

Presidents propose laws and carry out policies consistent with the law. They also appoint people to head government agencies. By their broad policies and appointments, they set the course of government and must take responsibility for it, but they cannot run the agencies or instruct agency heads on carrying out their jobs.

For one thing, government, even if it were trimmed down, would be too large to manage centrally. A president may order military action, but he or she will not designate the specific unit assigned to the job. That’s up to the Defense Department.

President Trump appears to have thought he could control Attorney General Jeff Session’s decision to take himself out of Russian election tampering investigations. He was reportedly angry when Sessions did just that. But, in fact, he has no control over such a decision.

In the end, if there is a real conflict, the subordinate may have to leave office. But too many firings or heated resignations could undermine the president’s authority in other matters. Richard Nixon learned that in the Watergate scandal.

Myth 3: Oaths matter. 

 In his confirmation hearing, Sessions swore he would tell “the truth, whole truth, and nothing but the truth.” The term “the whole truth” ought to mean he left nothing out.

But in denying he had talked with Russians during the presidential campaign, he omitted two meetings with the Russian ambassador. Later, he said those meetings had nothing to do with the campaign but only with his job as senator. Fair enough, if true, but still his answer was not “the whole truth.”

He might have avoided subsequent controversy if instead of telling “the truth,” he had revealed “the whole truth.” As a lawyer, he should have known better.

Myth 4: The majority seeks bipartisanship. 

President Trump received much credit for the restrained tone of his first speech to Congress. At times, he called for the two parties to work together. But his dismissive hand gestures toward the Democrats belied his words, indicating they simply ought to fall in line.

Both parties talk about a willingness to come up with a bipartisan approach. But the majority invariably means the minority should cave in and agree with it and, surely enough, we’d have a bipartisan approach.

If we ever see them sit down and negotiate with each side making concessions, that will be bipartisanship.

For Maine Gov. LePage there’s no spirit of compromise. He blames any lack of agreement on the “faulty ideology” of “liberals,” meaning Democrats. Fortunately, legislators of both parties still know how to compromise.

Myth 5: The people are sovereign. 

Under our system, all political power flows from the people. Every bill passed by the Maine Legislature begins with the words, “Be it enacted by the People of the State of Maine.”

Maine voters, like people in 22 other states, can pass laws on their own or veto laws passed by the Legislature. The laws they pass are unquestionably adopted by the sovereign people. But LePage and some legislators tinker with the just-passed minimum wage law, claiming they know better than the sovereign “People of the State of Maine.”

“Fake news” or “alternative facts” – Trump versus the media

Donald Trump is an honest man.

When the president says the traditional media, sometimes labeled “heritage,” “main stream.” or “lame steam,” is publishing “fake news,” he believes it.

How can he think that traditional media reports, backed by sound evidence, are fake, while his claims are accurate? The answer lies in the difference between the worldview of Trump and, say, the New York Times.

Take, for example, Trump’s views that Middle Eastern immigrants are causing unrest, even crime, in the Scandinavian paradise called Sweden. The traditional media immediately jumps to point out there has been no significant surge in crime there and certainly nothing big from immigrants.

Trump does not mean to be taken literally about Sweden. His point is that immigrants disrupt society. He uses crime as a way of describing that disruption. He believes that immigrants cause problems even in Sweden, and that is the clear message of his claim.

In short, he wants you to get his point and not worry about his facts. If the Times takes him to task because he got the facts about Sweden wrong, he slams the door on the Times, because it misses his point.

Some of his closest advisors maintain that his view should be given deference by the media, because he was elected president. If he says it, it must be true. That’s what I have described as “presidential facts” and Kellyanne Conway, one of his advisors, called “alternative facts.”

Beyond relying on his presidential standing, Trump may recall his New York days when he could influence tabloids to accept his version of celebrity gossip, according to a report by a columnist there. That changes when you are president and not merely a colorful real estate mogul.

Trump loves flattery and showers himself with it. When the media finds fault with him, he seems to regard that as “fake news.”

Political leaders sometimes say they “take responsibility” or others charge they should be “held accountable” for their miscues. In practice, with infrequent elections, the only way they can be held accountable occurs when the media highlights their errors.

Politicians do not feel positive about the press that holds them accountable, and Trump, who may deny his own responsibility, is like any other politician.

Many of his supporters continue to line up with him in this war over “fake news.” Their support may be explained by a couple of recent books showing that sound evidence might not change minds.

They report that if you have confidence in another person, you may well accept that person’s version of the facts on matters you do not fully understand. The link that gives some people blank-check confidence in Trump is their common desire to expel illegal immigrants.

From that agreement can flow support for Trump’s views on other issues like the Affordable Care Act and trade, about which supporters may have little or no knowledge. They may get to the point where they reject any facts that contradict Trump’s assertions.

At that point, Trump does not have to travel far to call the media, “the enemy of the people.” a phrase right out Joseph Stalin’s Soviet Union. “The people” consider illegal immigrants dangerous, and if the Times undermines that view, it becomes their enemy.

Some might call Trump’s view a reflection of living in an alternative reality. He sees events, countries, threats and success from a different perspective. Simply attacking his willingness to ignore objective evidence can prove to be frustrating and, even worse, counterproductive.

The media needs to pile up hard evidence and keep presenting it while avoiding what one writer has called “hyperventilating.” Less righteous fury and more explanatory journalism is needed. The traditional media should stop assuming readers and viewers know more than they really do.

If Trump is an honest man in an alternate world, it does not mean that any political statement without evidence is similarly motivated. Some of them are outright lies – when politicians tell you something they know to be untrue.

Take voting. In theory, some people may want to vote without eligibility or more than once. There is no evidence this happens beyond a handful of people across the entire country. Some Republicans admit the claim is untrue. Their efforts to tighten voting access are not about fraud but about turning away Democratic voters.

Deeply held false beliefs exist in the country, and it is difficult to see how they can be quickly corrected. No matter the challenge, the responsible media should provide more light than heat and keep at it.