Almost 100 million votes have been cast before election day. We are told that the turnout for this election will be huge. We are also told that Republicans know that anything that reduces turnout increases their chances of winning. I am OK with their enjoyment of a low turnout that arises from bad weather or voter apathy, but I am not OK with a lower vote count because of efforts in the courts to disallow the votes of many voters. The 2000 election stands as a warning that the courts can produce a winner who was not the choice of the majority of voters. George Bush won the presidency by a 5-4 majority in the Supreme Court. This election is important for several reasons, not the least of which is that it will determine the future of healthcare for several years to come. The outcome of this election will also impact the future of the planet. This election could accelerate the struggle for minority rights, or it could continue to protect the inherent advantage of the dominant white population which fears a future when they become a minority. 

 

As we have gotten closer and closer to the election, the president has become more and more outrageous with his lies about the possibility of voter fraud. What really is happening is that there is a concerted effort on the part of Republican officials in many of the states where they have control to limit the number of votes counted, no matter how many votes are cast, or how many people might vote if the barriers to voting were reduced. The efforts include decrees to limit the number of polling places, limit or eliminate ballot collection boxes, and prevent the counting of ballots postmarked before the election, but delivered after the 3rd of November. There have been attempts at the Federal level limit the efficiency of the post office. All the while, the president continues to try to seed the idea that the election will be flawed, and not produce a legitimate outcome unless he wins. There is the threat that some Trump supporters will attempt to intimidate voters as they approach the polls much like their harassment of a Biden campaign bus in Texas. Intimidation works. My wife is afraid to put a Biden sticker on our RV for fear that something bad might happen to us when we are passing through “red states.” 

 

An astounding fact revealed by researchers from Cornell is that the president himself is the origin of much of the misinformation on the Internet. He has launched 38% of the false information about the COVID-19 pandemic.  The Atlantic published an article this week by Kaitlyn Tiffany entitled “The Internet Won’t Be the Same After Trump: How the president changed life online—for better and for worse.” The article catalogues how the president has used, misused, abused, and perhaps permanently altered the Internet and social media as reliable sources of factual information. In the article she outlines four basic ways that Trump has changed our political online experience. After her points, she writes:

 

Trump is the “poster child” of bad information, Renee Hobbs, a communication professor at the University of Rhode Island, says. “He doesn’t value experts, he doesn’t value evidence, he goes with his gut, and he demonstrates the appeal of that.” He undermines the press, fuels conspiracy theories, and lies about basic information.

 

If vote limiting tactics including misinformation and lies on the Internet, and the multitude of lies that Trump spouts at his rallies don’t work prior to the election, Trump and the Republican Party are preparing to continue their attacks on the electoral process in the courts where many of the judges were nominated by Donald Trump. We are told in the “fake news” that Republicans are in the process of spending 20 million dollars to initiate 300 court actions in their attempt to limit the number of votes that will be counted.  

 

The president has said on many occasions that he hates losing and disrespects “losers.” He questioned whether John McCain was really a war hero because he was captured. This summer we learned that he considers soldiers who died in action to be losers. I have come to  believe over the last four years that his loathing for losers, and fear of being a loser himself, may be a justification in his mind for his lying. Observing his behavior, we must conclude that he considers lying to be just another tool to use in his effort to win. Finally, the most startling assertion that the president has made is that he may not accept the results of the election. He is busily trying to build the case before the election that votes should not be counted after election day, and that the results will be flawed by mail in votes, and that the results in key states will be illegitimate. No presidential candidate has ever used this line in an attempt to not lose. Denying that you have lost and inciting others to react to that assertion must represent the ultimate effort to win at any cost to the nation. There was a time when the candidates presented platforms about what they would do for the country if they were elected. President Trump talks about what he may do if he is not elected. 

 

I am tired of writing about President Trump and his many inadequacies, and his lack of the basic moral prerequisites for the office that he holds. His many attacks on the ACA through the courts and through administrative abuse without presenting a plausible replacement is a threat to the health of millions of  Americans. Once the election is behind us, and if the outcome is that Biden wins despite Trump and his party’s efforts to use any tool that might allow him to steal the election and remain in office despite the fact that more than 50% of Americans prefer Biden, I will let Trump fade out of these notes like an effectively removed stain from a fine piece of clothing. I want to let go of Trump like the quickly fading terror of a dream from which you might awaken and realize that there is no ongoing horror. I want to return to writing about the creative work to advance quality and move toward the Triple Aim that is being done by healthcare professionals around the country. I want to return to the anticipation of better things to come that existed prior to the surprise of November 2016. I want to imagine the emergence of a positive future for those who are disadvantaged by the social determinants of health. I would like to imagine a leader who can assure the health of the nation from future pandemics. I want to imagine again the possibilities offered by Dr. Martin Luther King, Jr in his “I have a Dream” speech that is now 57 years old. I want to believe that Joe Biden can lead America to Build Back Better, and enjoy having the opportunity to make comments about the process.  

 

Too much of the journalism around the election has been about Trump. This election has become a referendum on him, and the way he has destroyed the future of so many people for the benefit of a few. I wish it had been more clearly about the opportunities we should enjoy because of our many capabilities, and our internal harmony. My guess is that the majority of the readers of this note will have voted before reading these thoughts. It may be too late to shift the focus from the divisiveness of Trump to the positive presence that Joe Biden offers.

 

I was delighted this week to read three pieces in the Washington Post by Jennifer Rubin who did speak to the good judgement and thoughtfulness that Biden has exercised and that so many people have ignored as they continue to pay attention to the trainwreck of Trump that captures our attention. Rubin published three columns yesterday! The first one was entitled “Seven big things Biden got right.” The second column is entitled “Trump can declare whatever he wants, but it doesn’t make it so.” The third column is a very positive piece entitled “How Joe Biden can signal the return of a dignified presidency.” My sense that it is time to stop writing about Donald Trump, and that it is far past the time to direct more attention to Joe Biden, came to me as I was reading these columns. 

 

In the first piece, Rubin begins by acknowledging the malady that grips us:

 

Rational or not, those who fear four more years of President Trump are scared out of their wits. They recall the horror and the feeling in the pit of their stomachs when they realized that Hillary Clinton was going to lose the electoral college. Naturally, Election Day 2020 triggers memories of all that and a worry that because things went awry in 2016 they could go awry in 2020. Rather than analyze each poll (which never alleviates anxiety since there is always another poll, and then another), let’s look at what former vice president Joe Biden did right to put him in position for a commanding win.

 

Her list of the seven positive things Joe Biden has done deserve your attention as you suffer through the anxiety that will surely grip you as the events of the next few days evolve. They are:

 

• For starters, the Biden team never bought into the view that the Democratic Party had shifted far to the left, never confused Twitter with reality, and never gave way to the temptation to chase Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) to the most progressive end of the spectrum.

• Biden understands that the far left of his party is overwhelmingly White; his base of support and the bedrock of the Democratic Party are not. He understands that African American voters in South Carolina and elsewhere are more moderate than the flank of super-progressive White college-educated voters and that they did not feel like they had the luxury to pick a candidate with pie-in-the-sky progressive aspirations.

• Biden went out of his way after sealing the nomination to be gracious to Sanders and to include him in policy discussions, as well as to solicit advice from Warren and put forth a Build Back Better agenda that included many items in the progressive wish list (e.g., child care, minimum-wage increase, aggressive investment in green technology).

• Biden’s team took advantage of negative stereotypes that he was a gaffe-ridden, unfocused campaigner. The time “in his basement” helped as well, allowing him to sharpen his focus, control media exposure and allow Trump to self-destruct.

• Biden bet that he did not need to be a charismatic, exciting and fresh face…Biden grasped what political reporters did not: Primary voters did not care about that, and virtually none of them see entire speeches day after day. They wanted steady, safe and electable…primary voters [were] desperate to get rid of President Trump.

• Biden chose Sen. Kamala D. Harris (D-Calif.) as his running mate (not a bland figure like Clinton’s pick, Sen. Tim Kaine of Virginia). Harris injected a burst of enthusiasm, unleashed a torrent of fundraising and gave the media the telegenic, high-energy candidate they like to cover.

• Biden understood that voters would be more impressed with adherence to safety protocols than with big rallies. Big rallies, as many a candidate has learned, are like lawn signs — indicative of virtually nothing.

 

Joe may not be a flash, but he is nobody’s fool. Rubin is balanced in her analysis and recognized that one big advantage that Joe had was that he was not Hilary Clinton who, whether deserved or not, was loathed and mistrusted by many people who were willing to hold their nose and vote for Trump. Her conclusion gives me hope:

 

Biden has done everything he could to make it really hard for rational, sane and decent people to vote against him. And that is how you win — and win big.

 

Her second column, “Trump can declare whatever he wants, but it doesn’t make it so” deals with Trump’s dance with the truth. It is both a complaint and a warning. The president is a master of maximizing what is vague to his advantage. He has also spent the last four years putting judges on the benches of thee lower federal courts and on the Supreme Court who are “political.” The piece begins:

 

Team Trump, which can never manage to avoid tipping its hand, let on that President Trump would declare victory prematurely Tuesday night even if the race had not been called. It doesn’t matter what he says. Trump declared himself a “stable genius,” but that didn’t make it so. The same is true for elections; self-declaration of a phony victory would signal Trump believes his only avenue — if it exists at all — is to try to delegitimize votes counted after midnight. (For this reason, networks should seriously consider not covering Trump’s intentionally false declaration live.)

 

Rubin goes on to implicate Justice Kavanaugh in the evolution of this strategy. It is built on the idea that a winner should be declared on election day or the integrity of the process becomes uncertain. Many of our elections have not been decided during the few hours after the election. The most recent sad example of this reality is the election of 2000 when it took 37 days for us to learn that the Supreme Court had elected George Bush, and that Al Gore put the stability of our process above his desire to be president and conceded to Bush who held all the cards including a conservative majority on the Supreme Court, and his brother was the governor of Florida, the state that held the deciding votes in the electoral college. 

 

In our very strange process of electing our leader, each state is entitled to determine its own process. What is true in Pennsylvania is not true in New hampshire. What is true in all states is that counting the votes by the local rules, whatever they are, does not need to be completed on Tuesday evening. The state where all of this conjecture may play out this year is Pennsylvania. Rubin ends the article with an ominous statement about the possibility of disaster arising from the ambiguities that exist. Her recommendations will not help us this time around.

 

A significant group of right-wing judges no longer cares about consistency or originalist meaning. These judges seem hellbent on making sure “their side” wins. They might hope to delegitimize a Democratic victory, but they risk delegitimizing the courts, instead. It is a perfect example of why we need radical reform of the federal courts either to expand the Supreme Court, institute term limits for justices or curb its appellate jurisdiction.

 

The final piece in the trio gets back to a positive outlook. Again, she begins with a “hook” that grabs us:

 

We know the big things a Biden administration would need to tackle — covid-19, economic recession, climate change — and the big changes required to address them (e.g., competent advisers, reliance on data). However, small things can matter, too, especially when they signal a change in outlook and values.

 

More people complain about the president’s conduct in office than complain about his tax policies, or his threat to healthcare. She has a few suggestions:

 

• Joe Biden should hold bimonthly news conferences. Take the hard questions. Show he is on top of his game. Admit errors. Instead of a lying, filibustering president who takes only softball interviews from the likes of Sean Hannity, Biden could exude candor, directness and responsiveness in engaging with the White House press corps.

• [No] more whining. President Trump complains about the media, the Democrats, doctors, scientists, elites, Black Lives Matter protests, blue states, unfavorable polls, his predecessor and even White House plumbing. Biden would inherit a mess, but the name “Trump” should not escape from his lips. He should neither complain about Trump dumping problems on him nor mention any current criticism. He should ignore Trump, Trumpist conspiracy theories and right-wing media.

• Biden should cease the strictly partisan use of the White House.

• Biden should invite any nonpolitical civilian or military personnel who quit during the Trump years to return without a break in seniority. He will need all the institutional knowledge and experience he can find to repair the institutional damage wrought by Trump.

• Biden should make State of the Union addresses shorter and more entertaining. Think about how the Democratic National Convention kept our attention with visuals from all over the country and with panels featuring Biden talking to real voters.

 

• [Less] is more. Biden should not appear at briefings on covid-19 unless he is announcing some political initiative or policy change. Let the scientists talk science. Fewer tweets, if there are any at all, would be much appreciated. The White House should refrain from responding to every crackpot assertion and accusation from the ex-president and the MAGA crowd; Biden personally should not deign to respond. 

 

Rubin’s advice makes sense. I certainly agree with her final statement:

 

Biden must first win the White House. But it’s hard not to think of the many ways he could signal the return of a normal, civil, dignified and trustworthy presidency. The bottom line is it’s time to forget Trump and move on. 

 

I sure hope that it the final result of what happens today will allow me to forget Trump and move on. We have too many problems to solve, and too much work to do to spend any more time gawking at the biggest loser ever to become president. I want to forget the nightmare. My fingers are crossed. I have cast my vote. I am ready to move on. I hope that tomorrow will be the beginning of a new era when America takes it first step to get back on in its journey toward “these truths” that will enable “the dream.” The Triple Aim is the medical expression of the principles of equity and opportunity for everyone that has always been the hope, if not the reality, of the American experience. It’s time to get back to work making these principles realities that improve every life.