March 28, 2025
Dear Interesed Readers,
Weird, Confusing, and Ultimately Very Problematic
“You can’t make this stuff up” is one of the most overused and tired clichés in our language, but it has popped into my mind almost every day during the first two months of Donald Trump’s second administration. Most of the time when I am shaking my head in amazement, I am trying to understand how such a flawed individual could have the support of so many people when his ideas and actions will eventually harm our country and all of its citizens in very significant ways that may change our outlook for decades to come.
It feels as if there has been a convergence of unlikely events to produce this moment. There is no doubt that the Democratic Party is in disarray, but that is not enough to explain this moment. It is also true that historically, the electorate holds the party in power responsible, so perhaps Kamala Harris never had a chance. There may be other contributing factors to the election of a felon who more closely resembles a sideshow carny or a mob boss than a statesman. Why Trump won when so many of the people who voted for him were most likely voting against their own best interest will probably be a matter of conjecture for years to come. Did a combination of the economy, the lack of political awareness within the Democratic Party, working class animus toward “elites,” plus the delays and confusion in the prosecution of the president for his previous crimes converge as contributing factors that explain his re-election?
One longtime contention of the right-wingers who have thrown away political norms and captured what was once “The Grand Old Party” is that there is a far-left “deep state” that operates as a criminal cabal. Ironically, the authors of this theory are themselves “elitist,” albeit conservative elitist, and they are quite capable of strategic thinking in service of policies that serve their interest. Perhaps the most convincing evidence of these conservative theorists is the creation of Project 2025.
Whether Donald Trump understood the document or had ever read it doesn’t make much difference because with each passing day and its executive orders it is clear that the foundational document of this administration is Project 2025. Perhaps his disclaimers and sworn ignorance of Project 2025 before the election are not more of his lies. Maybe he was ignorant of what his handlers were planning. Whether he commissioned Project 2025 or not, it was written by those smarter than him in preparation for the possibility of taking maximum advantage of his election. What he knew or commissioned doesn’t make any difference because a comparison of the document to the events and executive orders of the last two months reveals a remarkable alignment of ideas and proposed policies for this presidency.
I apologize for going to ChatGPT once again, but it is very capable of giving a higher level review of the more than 900 pages of the document than I can easily construct. I know what is in Project 2025, but I must admit I am lazy. Why not take advantage of the aid AI can give me? So my question to the Chatbot was:
Please give an overview of the policies and actions called for in Project 2025.
A new wrinkle to ChatGPT is that the bot will often give you two answers to the same question. It then asks you to choose the one that you prefer. Either answer would have met my objective, but the one that most appealed to me had a little more edge and depth than the one I rejected. My answer to my question would have put even more emphasis on the expansion of the presidency over the courts and Congress. That concept is embedded in the bot’s answer, and it is obvious in the speech and actions of the president during his first two months in office.
In an interview before the election, Trumo said that he would be a dictator on day one. Many people assumed that he was implying that on “day two,” he would conform to the concept of separation of powers between the three branches of government that has been in place for most of the 236 years since the Constitution was ratified. We now know that day one would be followed by many more days. We know the president has a long history of twisting the truth. Most voters should have realized that any violation of norms he got away with on day one were likely to be standard operating procedure going forward.
There is no objective evidence that what the president has done so far has moved us closer to greatness, but it sure feels like we are much closer to living in an authoritarian state where freedom of speech no longer exists. If you don’t believe it ask Columbia University, ABC, or the once liberal leaning law firm, Paul Weiss. Whether busting norms and undermining the courts while violating the rights of many federal employees while ignoring democratic processes is a step toward authoritarianism, only time will tell.
Back to the Chatbot:
ChatGPT said:
Project 2025, officially known as the Presidential Transition Project, is a comprehensive policy framework developed by The Heritage Foundation in collaboration with over 100 conservative organizations. Released in 2022, it serves as a strategic blueprint for a future conservative administration, outlining extensive plans to restructure the executive branch and implement a wide array of policy changes across various sectors.
Key Objectives and Proposed Actions of Project 2025:
- Restructuring the Federal Government:
- Personnel Overhaul: The initiative advocates for replacing a significant number of federal civil service employees with individuals who are politically aligned with conservative principles. This move aims to ensure that executive agencies are staffed by personnel committed to the administration’s agenda.
Wikipedia
- Agency Reorganization: Proposals include dismantling certain federal agencies, notably the Department of Education, and privatizing others, such as the Transportation Security Administration (TSA). The Department of Homeland Security (DHS) is also targeted for potential dissolution.
ABC7 Chicago
- Social Policies:
- Abortion and Reproductive Rights: Project 2025 seeks to revive the Comstock Act, a 19th-century law, to ban the distribution of abortion-related materials and medications via the U.S. Postal Service. It also recommends reversing the FDA’s approval of mifepristone, a medication used for abortions.
American Civil Liberties Union
- LGBTQ+ Rights: The plan calls for removing legal protections against anti-LGBTQ+ discrimination and eliminating terms like “gender” and “diversity, equity, and inclusion” from federal regulations and programs. Wikipedia+1ABC7 Chicago+1
- Immigration:
- Border Security and Enforcement: The project advocates for the immediate deportation of unaccompanied minors, increased funding for border wall construction, and the use of military resources to detain and deport individuals residing in the U.S. without legal authorization. ABC7 Chicago+1The Washington Post+1
- Environmental and Energy Policies:
- Climate Change and Energy Production: Project 2025 proposes reducing environmental regulations to favor fossil fuel industries, cutting federal funding for renewable energy research, and withdrawing from international climate agreements. It also suggests dismantling agencies like the National Oceanic and Atmospheric Administration (NOAA), labeling it a driver of “climate change alarmism.” Wikipedia
- Economic and Labor Policies:
- Taxation and Social Programs: The framework includes plans to reduce corporate taxes, implement a flat income tax, and cut funding for social safety net programs such as Medicare and Medicaid. It also aims to eliminate initiatives like the Head Start early education program. Democracy Forward+1Wikipedia+1
- Labor Regulations: Recommendations involve cutting overtime protections for millions of workers and relaxing workplace safety regulations, potentially impacting wages and working conditions.
Democracy Forward
- Justice and Law Enforcement:
- Department of Justice (DOJ) and Federal Bureau of Investigation (FBI): The plan calls for bringing the DOJ and its law enforcement arms, including the FBI, directly under presidential control, which would significantly alter the independence of federal law enforcement agencies.
The Washington Post
It’s important to note that while Project 2025 outlines these proposals, their implementation would depend on various factors, including legislative approval, judicial review, and public support. The project has sparked considerable debate, with supporters viewing it as a necessary realignment of government functions, while critics argue that it poses significant risks to civil liberties and established democratic norms.
As a metaphor, I would suggest that we look at Project 2025 as if it were the script of a very controversial Broadway play. There are some interesting points buried within it. There are bipartisan voices that agree that the federal bureaucracy is inefficient. Medicaid and Medicare fraud and abuse exist, and the Social Security and the IRS processes could be made more efficient. Ezra Klein and his co-author Derrek Thompson have just published a book, Abundance which points out how excessive government regulations have crippled our ability to respond to housing, transportation, and infrastructure needs.
The issue is how to transform and improve the processes without significantly injuring individuals and critical institutions. It seems unlikely that we will protect the health of Americans by stimulating global warming and withdrawing from monitoring infectious diseases and emerging health threats around the world. I applaud the idea of removing toxins from our food supply and increasing our focus on the management of chronic diseases, but not at the expense of critical advances in medical science or the sudden diregard for global warming which is increasingly a threat to human health and wellbeing. How will reducing the workforce of HHS by 20,000 (down from 80,000) without clarity about what is to follow improve the function of its agencies or improve it the health of the nation?
Returning to my metaphor of Project 2025 being comparable to a Broadway play, how a play turns out is dependent on more than its script. Two huge factors in the success of a play are the cast and the director. With the drama or comedy of Project 2025, we don’t have either an innovative director or a star-studded cast. I doubt that we will ever see Marco Rubio listed as one of our ten best Secretaries of State. He is not and never will be a Henry Kissinger or a George Marshall. Can you imagine FDR choosing Pete Hegseth as his Secretary of Defense?
Whether or not the collection of cabinet members and high-ranking administration officials who participated in the sophamoric conversation on Signal that somehow included Jeff Goldberg, the editor of The Atlantic, was a violation or not of classification protocols that was a security risk for the nation and our military, it did reveal a pitiful group process that more resembled a junior high school group chat than the work of a capable group that is responsible for the peace and prosperity of our nation. The Nation published an article entitled “Dumbest Fascist Timeline Ever” in the aftermath of the fiasco that underlines how dangerous it is to be led by incompetents. Not to be lost in the conversation is J.D. Vance’s casual off-hand suggestion that the president was clueless about the impact the action would have on Europe.
If you have not read Goldsmith’s account of this bizarre event, I urge you to click here and read the actual comments of our collection of “community theater” level actors who will be playing the key parts in the ongoing tragedy of the Washington production of Project 2025,
My bias since he was chosen by Trump as his running mate has been that J.D. Vance is a greater long-term risk to our democracy we once thought was secure, than our “bull in the china shop” president. He is young, smart, glib, deceptive, and manipulative. He seems authoritarian by inclination. I pray for the president’s health and safety because I would hate to see Vance suddenly elevated to the presidency.
Once again, the events of the week leave me wondering about the long-term prospects for our healthcare. The president has reassured us again and again that he will preserve Medicare and Medicaid, but he has already dealt crippling blows to medical research, public health, the environment, and regulatory attempts to improve diversity, equity, and inclusion that would have promoted health equity and improved the social determinants of health. I am sure there are more disappointments to come, and I fear that the safety of Medicare and particularly Medicaid are just another Trump lie.
I hope that as Trump’s term moves on toward the further implementation of Project 2025, many Republicans will fear a backlash from their constituents more than they fear being “primaried” and will not allow him to make a direct attack on either program. Nevertheless, I expect deep changes to occur while Republicans claim that they are only introducing efficiencies and rooting out waste and fraud. There is no plausible way to create the tax cuts for the rich that Trump promises and reduce federal spending to the degree that many on the right demand without huge cuts in Medicaid in particular.
The cuts will likely be created by barriers to obtaining benefits, work requirements, and changing the way states are reimbursed for the federal share of Medicaid costs. It is hard to avoid the conclusion that the interstate inequities that exist now in life expectancy will be enhanced when more control and a fixed sum is given to the states. Currently, the range in life expectancy from birth by state, as last confirmed a couple of years ago by the CDC, varied from about 81 years in Hawaii, which scored the highest in life expectancy, to about 72 years in Mississippi, which was the lowest. One can only imagine that as states must close the gap between the cost of care in our flawed and wasteful system and shrinking federal dollars, the variations in the access and quality of care from state to state will enhance and not diminish the inequities we now have in healthcare.
This week, the Kaiser Family Foundation Health News published a similar opinion in an article that was meant to “out” the lies that a Republican Congressman from Long Island was presenting to his constituency. The piece was entitled “Bill That Congressman Says Protects Medicaid Doesn’t — And Would Likely Require Cutting It.” I would encourage you to read the whole article because it clarifies the process going forward from the continuing budget resolution that Chuck Shummer facilitated passing in the Senate to the downstream consequences that the continuing resolution will probably create.
Explaining the Basics
Budget resolutions are not law, but rather blueprints that guide lawmakers on budget-related legislation…
As written, the resolution seeks broad spending reductions across a range of areas overseen by various committees…
It does not say it would protect Medicaid. The word Medicaid is nowhere in the document. It does not prescribe any specific action on the program, such as instituting work requirements for recipients. Lawmakers separately draft legislation to make program adjustments to achieve the spending cut targets.
A little background: Medicaid is a state-federal program that provides medical coverage to lower-income residents, as well as payments to nursing homes for caring for seniors and disabled residents. Medicaid and the closely related Children’s Health Insurance Program cover more than 79 million people…
Medicare is the federal program that provides health insurance for some disabled people and most people over age 65. More than 68 million people are enrolled.
The resolution directs the committee to draft legislative language that would cut spending from areas under its jurisdiction, which include Medicaid and about half of Medicare…
Policy experts and the Congressional Budget Office have said that, after removing Medicare from consideration, there’s not enough under the committee’s jurisdiction to cut $880 billion without substantially reducing Medicaid spending. (Medicare is generally considered a third rail because its beneficiaries are a powerful voting bloc.)…
“Even if the committee eliminated all of non-Medicare and non-Medicaid spending, they would still have to cut Medicaid by well over $700 billion,” said Alice Burns, an associate director of KFF’s Program on Medicaid and the Uninsured.
Adding work requirements — most Medicaid recipients already have jobs — would not yield that level of savings and could increase state costs. Other cuts suggested by Republicans, including capping federal spending per enrollee, reducing federal matching dollars, and eliminating the use of provider taxes, which states use to pay for their share of Medicaid spending, could force states to cut spending or find new revenue sources.
“Cuts to Medicaid could mean eliminating coverage for children, parents, working adults or those who might need long term care; limiting benefits; or cutting payment rates for health plans or providers. These choices could come at a time when state revenue growth is slowing, and most states face requirements to pass balanced budgets,” according to an analysis by Robin Rudowitz, vice president of the KFF Program on Medicaid and the Uninsured…
“Ultimately, the problem is you can’t take that much out of Medicaid,” Antos said…
It is hard to imagine the changes that will occur in the institutions that deliver healthcare and in the lives of those who depend on state and federal dollars for their health. Simultaneously, it is possible that the virtual abolition of the Department of Education will put even more stress on states, particularly those states where taxes are already high. Did you know that several of the states that have the highest sales tax burdens, taxes that disproportionately hit the poor very hard, are “red-states” in the south like Louisiana and Alabama? Sales taxes are also high in New York and California, where the social services safety net is a higher priority than in most states.
Looking forward, I don’t relish sitting through the whole production of “Project 2025” with its amateur cast and reality show producer-director. I summoned the courage to ask the Chatbot to predict what the conclusion of the play might be. My question was complicated. I asked:
In light of the stipulations in the continuing budget resolution recently passed, the executive orders signed during the first two months of President Trump’s second term in office, his choices to lead HHS, CMS, NIH, and other health related agencies, plus the outline of objectives in Project 2025, what can we expect to see as their combined impact on the future of American healthcare over the next 4 years?
The bot gave me a long answer with a conclusion that essentially said we are changing directions. My writing may suggest that the “sky is falling.” The bot is a little more balanced and gives notice to the philosophy behind the strategy.
Conclusion (from the bot)
The combined effect of these initiatives suggests a move toward deregulation, reduced federal involvement in healthcare, and increased reliance on market-driven solutions. While proponents argue this approach enhances efficiency and patient choice, critics warn of potential risks to public health infrastructure, increased costs, and reduced access to care, particularly for vulnerable populations. Stakeholders should closely monitor these developments to understand and navigate the evolving healthcare landscape.
The word “deregulation” sends a chill down my spine and seems incompatible with the guarantee of healthcare quality and progress toward healthcare equity or any aspect of the Triple Aim, patient satisfaction, or professional satisfaction. I want to say caveat emptor, buyer beware, or perhaps it should be voter beware. Should healthcare be more like a public utility or a Tesla dealership?
Winter Redux
Last Monday, winter did an encore in New Hampshire. We got three or four inches of wet, gloppy snow. Today’s header is proof of the encore. Before the temp dropped and the snow fell, our lake was beginning to thaw a little, as you can see by the darker spots on its ice cover. In places near the shore and in the sun, you could see water. We are expecting more snow this Saturday and Sunday.
Baseball season starts earlier and earlier. I was pleased that the Red Sox won their first game in Texas. It is a little confusing to think about baseball and snow at the same time, but the start of the season is a reminder that eventually, all our snow will be gone. What is true this time of year is that there is a reprieve of a day or two between winter weather events. When the sun does come out, you can believe that a warming change will eventually take hold and stay for a while. I wish I had the same confidence in our political future. I would love to write about “Democracy Redux.” Wherever you are, whatever your weather might be, enjoy the weekend as a brief intermission in a miserable performance by a cast of untalented nobodies.
Be well,
Gene
