May 31, 2024
Dear Interested Readers
Last Minute Edits Triggered By The Trump Verdict
Every day during the last seven weeks when the court was in session during Trump’s hush money trial my routine was to follow the comments from the reporters attending the trial for the New York Times. It was informative, but far from satisfactory. One wonders what the impact on the country might have been if like the O.J. Simpson trial television cameras could have provided continuous coverage.
I am not a lawyer, but I was impressed by how Justice Juan Merchan was able to maintain order in his court during this volatile case with a defendant who had little respect for normal legal processes. Many experienced lawyers and pundits had predicted a longer and more tumultuous process. I hope that Justice Merchan’s conduct of the proceedings will be lauded when Trump’s lawyers file appeals accusing him of errors that may or may not have been obvious to the eyes more accustomed to normal trials.
As it was, there was a tremendous amount of redundancy in the reporting as the reporters tried to adapt their minute-to-minute coverage to the schedule and normal delays in the course of any trial. Alternatively, it is probably true that there would have been many more boring minutes if the trial had been televised. Boring or not, I would have been “glued to the tube.” As it was, I could check the feed from the Times every half hour or so and be productive between checks.
I feel that during the trial, and especially in the Republican responses to the verdict, one fact that is important to remember seems to be forgotten, and that is by paying off Stormy Danials, Donald Trump may well have stolen the 2016 election. The question that will never be answered is whether or not Trump would have been elected if voters had known of his clumsy trist with Daniels or his much longer relationship with Playboy model Karen McDougal.
The “Access Hollywood” exposé was explained as typical “locker room talk” between cool guys, Would the revelation of Daniel’s story of a brutal one nighter a few days before the election or McDougal’s longer relationship with the candidate have added to the concerns of some voters who without that knowledge held their noses and voted for Trump? We will never know, but for me the possibility that the payoff of Daniels may have created the nightmare we have had for the last eight years is what made this crime more than most MAGA Republicans who claim the 2020 election was stolen will ever admit. The “what if” of the story is an uncomfortable question.
Many of us remember where we were when we learned that President Kennedy had been shot in Dallas in 1963. More people can remember where they were when they heard of the first plane to hit the World Trade Center on September 11, 2001. I suspect that many of us will remember where we were when we heard around 5 PM yesterday that the jury had reached a verdict.
I had just had my hair cut. I got into my car just as the 5 PM news report from New Hampshire Public Radio aired. The report was that the verdict would be announced as soon as the paperwork was completed and the jury returned to the courtroom. I expected a guilty verdict on one or some of the thirty-four charges since it seemed too early for a “hung jury” which would not be a “verdict” but the lack of a verdict, and I could not believe that twelve rational people could find a way to deny the well-constructed case of the prosecution.
As I turned into the road leading to my house, I was flabbergasted to hear that our former president was guilty on all thirty-four counts. We will read and hear a lot about the impact of the verdict on the election from the “talking heads” of the media between now and July 11 when Justice Merchan sentences Trump.
Near the end of the trial and during their summation, Mr.Trump’s lawyers called Michael Cohen the G.L.O.A.T., the greatest liar of all time. I think that they were stealing that accolade from their client. As soon as Mr Trump left the courtroom he began again to spew lies, or perhaps more charitably speaking, expressing a self-serving analysis of the trial and the supposed involvement of President Biden in the “perversion of justice” that he believed had just occurred. I was quite surprised that as he concluded his remarks I was forced to admit to myself that for once I agreed with him when he said that the only verdict that would count would be the one delivered on November 5.
It is my personal opinion that the four years of Mr. Trump’s presidency were some of the most distressing years I can remember. I felt like he had desecrated his office. There is no court other than the ballot box where he can be “tried” for his contribution to the destruction of the political and social norms upon which our society rests.
We have had other presidents who were dishonest. We have had other presidents who were not competent to effectively perform the duties of the president’s office. We have never had a president in my memory who was so blatantly illiberal or more obviously inclined to put personal interest above the rule of law.
I am not a trained historian, and I have my biases, but it is my opinion that Trump is not the only person who should be held accountable for the destruction of our political norms. I think the process began with Ronald Reagan’s well-executed “dog whistles” about “welfare queens.” Newt Gingrich made huge contributions to the destruction of political norms. The “Tea Party” made disrupting Congress “business as usual” that is carried on now by Matt Gaetz, Marjorie Taylor Greene, Lauren Boebert, and a host of other members of Congress who like to call themselves “The Freedom Caucus.”
The sum total of these events has been to undermine the delicate acceptance and compliance with “norms” that allow earnest people of opposite opinions to find the compromises that allow progress to occur. A good example of the lack of adherence to norms was the sudden Republican opposition on command from Trump to a negotiated agreement on a new compromise immigration law to control the southern border. Trump initiated the objection to the law which likely had enough bipartisan support to become law because he wanted to preserve immigration as an issue in the election. Then there was the crafty way that Senator McConnell denied Obama a Supreme Court nomination when he still had almost a year in office and gave Donald Trump the ability to nominate and confirm Justice Amy Coney Barrett with less than two months before the 2020 election.
Except for the first two years of Biden’s term when Democrats briefly controlled the House, Senate, and presidency, the period between the inauguration of Donald Trump in January 2017 and this moment has been a disaster in the journey toward the Triple Aim and policies that promote improvement in the social determinants of health. It’s hard for me to think about our deficient healthcare system and not be angry amid the aftermath of Trump’s trial.
I have said before that current events have displaced healthcare as a top political concern. We have not heard presidential candidates debate the problems in our healthcare system and potential solutions to those problems since Joe Biden won the South Carolina Democratic Presidential Primary in March of 2020. If you can remember, after Biden won in South Carolina, the other candidates that might have had a chance including Amy Klobuchar, Elizabeth Warren, Pete Buttigieg, Kamala Harris. and probably others that I can’t remember, withdrew from the race and pledged their support to President Biden.
As the 2020 election turned toward a referendum on Trump’s threat to Democracy, phrases like “Medicare for All” and “Medicare for those who want it” quickly faded from discussion. All of these potential policies that had been debated early in Democratic primary offered a non-Medicaid public option that probably would have been sold for less than commercial insurance.
Before the verdict in Trump’s hush money trial was announced yesterday, I had planned to review where the healthcare discussion had stalled after the early Democratic Presidential Primaries of 2020. My plan was to then present a few of my own biases about what would be a good policy direction for some day in the future when we might get back on track toward healthcare equity and the Triple Aim. What follows from this point is what I had written before the verdict, assuming that there would be no verdict this week.
You will read that I found an excellent review that presented where we were in October 2020, just before the last presidential election. I had hoped to continue by reviewing what the ACA has accomplished and what still needs to be done. Perhaps, next week I will complete the original plan by discussing my suggestions for getting back on the road for better healthcare. For now I will just focus on the differences in healthcare policy between Trump and Biden going into the 2020 election.
It is important to remember that there was significant resistance from the insurance industry to a public option during the run-up to the passage of the ACA. In 2009 the public option failed to make it into the ACA over the objections of Joe Lieberman from Connecticut, the home of Aetna and other insurance companies. Lieberman, an independent, caucused with Senate Democrats and his vote was necessary to override a Republican filibuster.
In 2020, Biden’s healthcare proposal was much less progressive than the ideas of an Elizabeth Warren, Kamala Harris, or Pete Buttigieg. He favored efforts to improve healthcare by tweaking the ACA, lowering the cost of medicines, and other activities at the margin like improving the care in the VA healthcare system. As the least “progressive” and most “mainstream” candidate in the Democratic Presidential Debates, he was still much closer to the ideals of universal access to healthcare than Donald Trump was. An article from the Commonwealth Fund in October 2020 contrasted what Vice President Biden proposed versus what the incumbent, President Trump proposed doing in a second term. The contrast was stark as you can read below.
Vice President Joe Biden
Overall approach: Protect insurance for people with preexisting conditions by supporting and building on the ACA; expand insurance coverage and reduce consumers’ health care costs by enhancing the ACA’s marketplace subsidies, covering people currently eligible for Medicaid in nonexpansion states, and giving more people in employer plans the option to enroll in marketplace plans with subsidies.
Medicaid: Expand enrollment by allowing eligible people in 12 states without Medicaid expansion to enroll in a public plan through the marketplaces with no premiums; make enrollment easier with autoenrollment.
Individual market and marketplaces: Expand enrollment through enhanced subsidies, greater advertising and enrollment assistance: no one pays more than 8.5 percent of income on marketplace coverage; change the benchmark plan from silver to gold to reduce deductibles and cost-sharing.
Employer coverage: Allows anyone with employer coverage to enroll in a public plan through the marketplaces and be eligible for subsidies.
Medicare: Would allow people ages 60 to 65 to enroll in a Medicare-like heath plan.
President Trump was looking forward to a second chance of gutting the ACA.
President Donald Trump
Overall approach: Repeal the ACA and replace it with market-driven coverage options aimed at lowering premiums and increasing choice of plans tailored to individual preferences; give states more flexibility in designing coverage options; require more accountability for people with low incomes enrolled in public programs; protect preexisting conditions.
Medicaid: Repeal the ACA Medicaid expansion for adults; provide block grants to states to design their own programs; increase accountability through work requirements.
Individual market and marketplaces: Has promoted weaker regulations on plans that don’t comply with the ACA’s preexisting condition protections and other requirements; elimination of advertising and enrollment assistance during open enrollment; elimination of payments to insurers to offer lower-deductible plans.
Employer coverage: Has promoted weaker regulations on association health plans that don’t comply with the ACA and allowed employers to fund accounts for employees to buy health plans on their own, including products that don’t comply with the ACA.
At the end of the Commonwealth Fund paper, in a section entitled “Implications of the Candidates’ Approaches,” the authors expanded on the contrast between the two candidates by asking several question in a hypothetical interview of both candidates and then extrapolated the answers to their questions (which I have bolded) based on their campaign literature and public statements. I think their conclusions still hold four years later although neither candidate has very much to say about healthcare now.
I don’t have health insurance. Will the approaches provide me with new options?
Trump: The number of people without health insurance has increased under the president’s watch in part because of policies that have eliminated the promotion and advertising of marketplace open-enrollment periods, enrollment restrictions in Medicaid, and immigration policies that have had a chilling effect on enrollment of legal immigrants and their children. Trump supports a lawsuit now before the Supreme Court that argues for repeal of the ACA, which would eliminate coverage for as many as 20 million people. Says he will come up with a replacement but has yet to do so.
Biden: Has introduced proposals to build on the ACA by covering people in the 12 states that haven’t expanded Medicaid and enhance subsidies for marketplace plans. This would provide new options for people who are currently uninsured and increase coverage over time.
I have a preexisting health condition. Will the approach guarantee that I can always get covered?
Trump: The ACA currently provides this protection. Trump supports the lawsuit before the Supreme Court that argues for repeal of the ACA and its preexisting conditions provision. Trump issued an executive order that said preexisting conditions are protected, but without the ACA or new legislation the order has no effect and is purely symbolic.
Biden: The vice president pledges to support and build on the ACA, retaining its preexisting condition protections.
My premiums and deductibles are becoming less affordable; will the candidates’ approaches lower them?
Trump: The president eliminated payments to insurers to reimburse them for offering lower-deductible plans in the ACA marketplaces to people with lower incomes, as required by the law. This had the effect of increasing premiums for people not eligible for subsidies. He has promoted the sale of non-ACA-compliant health plans, like short-term plans. These plans have lower premiums for healthy people but screen for preexisting conditions and often provide little cost protection if someone becomes sick. He has loosened regulations for association health plans, although that was turned back under legal challenge. The repeal of the ACA would mean the loss of marketplace subsidies and preexisting-condition protections, making coverage unavailable or unaffordable for people with low and moderate incomes and those with health problems.
Biden: The vice president’s proposal to enhance marketplace subsidies will cap the amount of premiums people pay at 8.5 percent of income, including people in employer plans who would have the option to enroll in the marketplaces. By linking subsidies to gold plans, deductibles would also fall for those who choose those plans.
I am worried about racial inequity in health care. Will the approach make health coverage more equitable?
Trump: Uninsured rates among Hispanic people have risen under the president’s watch. Repealing the ACA would further eliminate coverage gains made by Hispanics, as well as Black people and Asian Americans, widening racial disparities in coverage and access.
Biden: The vice president’s proposals to expand coverage under the ACA will particularly benefit people of color. This is because people living in the 12 states that have not yet expanded Medicaid are disproportionately Black and Hispanic.
The article does not end with an admonition to vote for Biden or for Trump. It just gives us a summary of the philosophy of each candidate and the predicted efforts that would be made during the next four years to improve our system of care. It seems to me that we are in a very similar position now except that healthcare will not be a significant discussion in this election. The most important question to be answered this November is whether we will choose a felon to continue the journey toward deeper political divisions and a possible autocracy.
It is good to remember that things never end well with a narcissist. That was the opinion expressed by Jeff Kluger in his 2014 book, The Narcissist Next Door. Ironically, in the book he presented Donald Trump as the perfect example of a narcissist who was a danger to others a year before Trump descended his escalator to announce that he was running for president to protect us from drug dealers and rapists coming from Mexico. Our journey with the dangers he represents is not over. I don’t think healthcare policy, healthcare equity, and the reforms we need will get the attention they deserve until we reset the process with another guilty verdict on November 5.
Earlier This Week, Before the Verdict
My wife and I drove to Maine on a rainy Memorial Day after two warm, clear, beautiful, early summer-like days on Saturday and Sunday. We were headed to help cover our new grandson in the transition from his parents’ parental leaves and his enrollment in daycare. Both parents work for organizations that offer generous benefits, and they had been able to arrange their leaves so that until this week at least one of them was always home with the baby for the past four months. It was an assignment that we were eager to accept.
Whenever I travel I am always challenged to get my exercise. My son has a new home as well as a new son. I was not sure what walking might be like in the semi-rural community where they live. I had never been to the end of their road. The road’s name is Summit, and from what I had seen on a few previous brief trips, was that the road was a pretty steep climb toward some summit, My son told me the road was not paved a few hundred feet after his drive. Tuesday was a gorgeous day. I decided to follow the road even if it was headed up a steep hill.
Today’s header was taken a few hundred yards past “where the hardtop turns to clay.” [That is a line from a Red Clay Rambler’s song.] After the pavement ended, there was still a gentle uphill slope, but the summit was not far ahead. The big surprise was the very step downhill that followed the summit. All runners know that the most painful part of running or walking is a knee jarring steep downhill. About a half mile ahead, the road and its descent ended in a trail that continued deeper into the woods. I did not continue for fear of ticks. The reverse trip was a challenge, but the walk, even with my two canes, along the beautiful country road was well worth the effort.
We should not waste the summer focusing on what will happen next in the Donald Trump saga. I plan just to wait for future surprises. Things are looking good for Trump at the Supreme Court where he already has the votes of Justices Alito and Thomas no matter what the question. I hear that he has valid options on which to base the appeal of his conviction. You can imagine how I will react to a Supreme Court decision that says a president can’t be tried for the crimes he committed while in office.
My suggestion for this weekend is to set aside the contemplation of Trump’s crimes and find some new place to discover what is at the end of the road.
Be well,
Gene
