Where were you at 11:30 AM last Saturday? I was sitting bleary eyed in front of my television watching John King and Wolf Blitzer on CNN. Outside the weather was glorious, and I knew that there were many “productive” things that I could be doing that would be a more rational use of my time than sitting mesmerized in front of the TV waiting for the announcement that Joe Biden was the projected winner of the election. The temperature outside was approaching 70. I could have been out in my kayak enjoying the gift of a late fall day that felt like early September. I was definitely conflicted as I continued my vigil which had begun at 8PM on Tuesday evening when the East Coast polls closed. By 11:30 on Saturday morning, I into the eighty eighth hour of my wait. I had slept fitfully for a few hours each of the nights, but was up at the crack of dawn to resume my vigil. I was tired of hearing John King’s explanation for why CNN had not called the election for Joe Biden. I was saying just do it! Biden was leading in Pennsylvania by over 28,000 votes. He was leading in Nevada by 22,000, and he was still ahead in Arizona by at least 20,000. Perhaps the most amazing indicator of Biden’s dominance was that he was ahead in Georgia! I was saying to myself, “Pick any two, or pick Pennsylvania. Just call it.”

Then it happened. A few thousand more votes came in from the Philadelphia area, and CNN called the election for Biden. At that moment I did not know that at the same time the AP, ABC, CBS, PBS, and NBC had simultaneously found the courage to tell Donald Trump that he was a loser. 

What happened next was another surprise. In cities across the land bells began to ring. People flooded the streets and began to dance and shout as an expression of relief and joy. It was right out of the Wizard of OZ when the Munchkins, the little people, celebrated the death of the “wicked witch.” The joy people expressed could not have been greater had their hometown teams just won the World Series, The Super Bowl, The NBA Championship, and the Stanley Cup all on the same day. The header for this post is a screen shot from a video that my son captured in Grand Army Plaza in Brooklyn near where he and his wife live. Unlike me, they were out on a walk to enjoy the day when the call of the election came. 

Was the reluctance of the networks to call the election yet another example of how Donald Trump has traumatized the nation? As I write to you, now a week after the election, and three days since the election was called, the president refuses to accept the outcome. Ironically, when the final results are in, he may lose by exactly the same electoral college vote that was Hillary Clinton’s measure of defeat. The difference was that she accepted the vote less than twelve hours after the polls closed. The president’s lack of acceptance suggests that he continues to think that nothing is real unless he says it is. As Catie Edmondson has written in the New York Times today, the president’s grip on the Republican Party makes it unlikely that he will lose the control that bends his party to his will. His dominance makes it possible that he will never acknowledge his defeat and there will be a huge number of people who will support him in his contention that he won. I expect that on January20, 2021 he will still be saying that he is the rightful president, and that the election was stolen. There will also still be millions of Americans who will believe against all reason that he is right. The power and extent of his narcissism and his hold on his party is so great that he will continue to act as if he has dominion over reality.  Ms. Edmondson writes:

I am delighted with the outpouring of enthusiasm for Biden/Harris that we saw in the celebrations in the cities last Saturday. It is hard to imagine putting all that joy “back in the box.” Perhaps Trump is right and there is a far flung conspiracy that included the Republican Governor of Arizona, the Republican legislature of Pennsylvania, and the Republican Governor and Secretary of State of Georgia, but reason denies the possibility. One great defense against the possibility of a conspiracy to steal a national election is the fact that the result of the election is the sum of fifty independently managed processes. His Republican faithful know that the only way you can really control the outcome of an election is by limiting the access to the vote, or by using lies in the social media before the election.

Yesterday, in an article in The Atlantic entitled “What to Expect Next From Donald Trump: There is nothing about him that goes gently into the night,” Peter Nicholas wrote:

Presidents who leave office in the modern era recede from public life, often happily so. They write memoirs, plan their library, and pick up new hobbies. As a courtesy, they give the sitting president space to govern without catapulting themselves into the national conversation. Donald Trump will be different: He isn’t going anywhere.

Even after his defeat, the soon-to-be-former president, who feeds on attention, will make sure that he’s not deprived of any of it. From his exile at Mar-a-Lago, he’ll phone in to favored TV anchors and radio hosts to carp about the election results. If he’s not banned from the platform, he’ll use Twitter to keep up a running commentary on incoming President Joe Biden. He might start a new media venture or tease his base by vowing to run again in 2024. Whatever he does, he’ll remind a nation that rejected him after one exhausting term that it can’t easily forget him. “There is nothing about him that goes gently into the night,” Douglas Brinkley, a history professor at Rice University and a presidential historian, told me. “He has bathed in the fountain of real power, and he’s going to want to again. He doesn’t want to become a third-rate, has-been figure.”

Or an even bigger target for prosecutors…

I can understand the angst and disappointment of those who believed in the promise of Donald Trump. In my letter last Friday, I tried to describe the affection for the president that I saw on my trip through white rural America. The election results are an obvious demonstration of the size of his following. The future that this election favors is not one where we will see Democrats dominating the government and forcing through new laws that fundamentally change the character of America. There are Democrats, myself included, who hold on to the faint hope that Democrats will gain control of the Senate on January 5th by winning both of the runoff elections in Georgia, but that outcome is not likely, and even with the slimmest possible control of the Senate there is no guarantee that Democrats will hang together to pass progressive laws the way Republicans bend to the whip of Mitch McConnell to push a conservative, right leaning  agenda.

At this time, I have two thoughts. First, I would say to my Republican family members, Republican friends and acquaintances, and the millions of Republicans I never met, “I understand your sense of outrage and loss. I felt the same way in 2016.” Second, I would say to Democrats, if we want lasting change, especially on issues that improve the environment, secure an equal opportunity for everyone, and offer a path to the Triple Aim, or promote improvement of the social determinants of health, we must try to achieve those objectives through bipartisan processes. Executive orders may supply temporary relief, but they do not serve as the basis for lasting change and will be quickly negated by new executive orders when the control of the government changes, which it will surely do in time. 

The road ahead will be difficult. Just as Donald Trump still maintains that he won the popular vote in 2016 by reasoning that there were more than 3 million illegal votes, you can be sure that it would be a huge surprise if he ever concedes this election. As Nicholas suggests, I believe that he will seek to be a force that distorts the normal processes of government as long as he draws breath. That reality makes the work of extending access to healthcare to everyone much more difficult than many people who voted for Biden/Harris currently comprehend. 

Democrats, specifically Joe Biden, Kamala Harris, Nancy Pelosi, Chuck Schumer, and Democratic members of the House and Senate, must figure out how to govern in the context of a deeply divided government. As things are, a bipartisan strategy is the only logical way forward. We will not see a  bipartisan strategy produce “Medicare For All,” but we might see it solidify the ACA, drive the regulations that can promote quality, reinforce patient centeredness in the system, slow the growth of healthcare costs, reduce the out of pocket expenses of patients and families, make healthcare finance more transparent, and create a better market with more competition by adding a “public option to the exchanges.” Just as the arc of history bends toward justice, the arc of the future healthcare was enabled by this election to bend toward quality, safety, and equity through the effort to find the compromises necessary to offer universal access to care.

A few weeks ago, I expressed the hope that after the election the metaphors for Trump’s departure would be like the stain that was removed from a fine piece of fabric or the bad dream from which we awaken. That was wishful thinking. In reality, there will be a continuing reminder of his influence that will be manifested by his ability to maintain loyalty within the ranks of Republican lawmakers through his emotional hold on a base that is large enough to determine the outcome of the primary elections within the Republican Party at every level of governance. 

The result of the election reminds me of “good news/ bad news jokes.” A simple example of such a joke is that the good news is that there will be free beer at the local tavern today. The bad news is that they ran out of beer yesterday, and will not get a new delivery until next week. The good news from this election is that there will be a return to many of the norms of government that were violated during the tenure of Donald Trump. Joe Biden will be able to return America to the Paris climate accords. He will rebuild relationships with many of our allies. He will be able to use administrative measures to give relief to the worried DACA recipients. He will be able to support the ACA with administrative decisions, if it survives the challenge that will be heard today in the Supreme Court. The best of the good news is that we have leaders who care about improving the health and future of every American.

The bad news is that the way forward will be difficult. It will require all of the wisdom and experience of the president elect, and it will require that his outreach efforts generate a positive response from a party that is at this moment is very confused about whether its greatest responsibility is to itself and Donald Trump, or to the collective future of all Americans. 

It is good news that in a time of uncertainty, there is a change in leadership that will give many of us reason to hope that the change will be good for the health of the nation and all who live within its borders. What remains uncertain is whether the change will enable a movement away from our deep divisions toward a new attempt at progress through compromises that will benefit everyone. There is overwhelming evidence that our planet is at risk. Can we negotiate solutions to mitigate this threat? There is evidence that everyone will remain vulnerable to this pandemic . for some time, even as we roll out a new vaccine, and there is evidence to believe that other dangerous viruses may emerge in the future. Can we work together to end this pandemic and mitigate the risk for others? There is growing evidence that as a nation we want some path to better health that is available to everyone. Is there a way to blend our preferences into some program of care that protects everyone?

If we can not answer those and other critical questions affirmatively, the election will be just a small inflection in a downward spiral, and that would be bad. I hope that we are on the threshold of change that will be worthy of the enthusiasm of the celebrations that began last Saturday at 11:30. Donald Trump is letting us know that the he will make the difficult work ahead even more difficult for those who might want to be part of a bipartisan process. The ultimate push back and rejection of Donald Trump will not be manifested by some future dominance of the progressive wing of the Democratic. His most significant defeat will be when his trashing of norms and his attack on universal respect for other people and the planet ceases because people on both sides of the process have moved from “my way” to “our way.” Donald Trump will have no relevance in a new world that was created not through dominant force but through mutual understanding and compromise. To realize the promise of the election that so many people wanted to celebrate last Saturday morning, a super majority of Americans must stay engaged and continue to demand that we truly become what we have always said we are, a nation of long suffering souls who are willing to do the hard work of seeking to understand their neighbor’s concerns and then asking, “Neighbor, how do we find common ground that is a benefit to both of us.” That common ground will be a place where the promises of “these truths” apply to everyone.

It is reassuring for me to remember that there was a time when schools and the armed services were segregated. Major League Baseball was for whites only. Social Security, Medicare, and Medicaid were once as controversial as the ACA, Black Lives Matter, and the Green New Deal are now. In time all of these societal changes have moved from an environment of controversy to generalized acceptance. I know that at some moment in the future the control of government will change hands again. What I hope is that when that next change in leadership does occur, we will all accept the reality that leadership can change in a democracy, and that is good, but what does not change is that we are all mutually engaged in the search for solutions to the barriers that deny our greatness as a nation. I hope that what we are celebrating now is a beginning. With the election of Joe BIden we have made a significant step in the direction toward a less divided America. It would be bad news to realize in the future that the divisiveness of the last several decades persisted despite the fact that the majority of Americans, both red and blue, are dissatisfied with where America is today, and could not find the wisdom to reject divisive leaders and look together for a better forward.