27 September 2109
Dear Interested Readers,
It’s Been An Interesting Week
At four o’clock on Tuesday afternoon I was sitting at a table in the ballroom of the Boston Seaport Hotel at the 6th ATLAS (Annual Thought Leadership Symposium). This year’s conference title was “Expanding Boundaries. Removing Barriers.” I have attended all of the ATLAS conferences as a member of the Clinical Advisory Board of Kyruus, the company that sponsors the event, and I have written about several of them. The speaker at that moment, David Shore, an authority on change management and innovation, was the last of several exceptional speakers that included the famous former CEO of the Cleveland Clinic and ground breaking cardiovascular surgeon, Dr. Toby Cosgrove. Dr. Shore’s subject was “Leading Change With Actionable Strategies.” There had also been demonstrations, break out groups, and panel discussions that were focused on timely subjects that centered around effectively capturing the benefits of technology to transform care delivery. I had been at a banquet of ideas. I was trying to figure out how I was going to weave all of the ideas that I had heard into a meaningful presentation for you to read.
While listening to Professor Shore, I heard the faint tone from my cell phone that occurs when there is a “notification” of some kind. I glanced at the screen and read the banner from the Washington Post that announced that Nancy Pelosi would be giving a press conference at five o’clock to explain why she was initiating impeachment proceedings in the House against President Trump.
I can tell you where I was when I heard that President Kennedy had been shot in Dallas. I vividly remember my visceral response on hearing that Dr. Martin Luther King. Jr had been shot. I know exactly where I was standing the moment I heard that Robert Kennedy had been assassinated. I remember the moment that my medical assistant lead both me and the patient that I had been seeing to the “break room” where staff and patients together were incredulously looking at the looping image of smoke coming from the North Tower of the World Trade Center as a second airplane crashed into the South Tower. To that list of indelible memories I now add this stunning new event. I should have expected it when I heard over the weekend about a suppressed whistleblower complaint against the president, but it just didn’t occur to me that this would be “the smoking gun” that would finally make the defense of democracy and the rule of law important enough to House Democrats to do away with the fear that a failed effort to remove the president from office would assure his reelection.
Yesterday I was scheduled to drive to Pennsylvania for a board meeting of the Guthrie Clinic. I always look forward to the trip that takes me through the heart of Vermont and then down scenic I 88 to Binghamton and the “Southern Tier” of New York before heading west toward Elmira, on my way to Sayre, Pennsylvania in the “Northern Tier” of Pennsylvania. Guthrie has five hospitals and about thirty outpatient offices across the large area known as the “Twin Tiers.” It’s a six or seven hour drive. Normally I listen to NPR, audio books, and music. I just relax and enjoy the journey. Yesterday, while driving, I spent the morning listening to Joseph Maguire, acting director of national intelligence, give his testimony about the delays in delivering the “whistleblowers” report to the House Intelligence Committee. During the afternoon I was listening to endless analysis of the hearings and the evolving impeachment process on various Sirius XM channels. I am old enough to have watched much of the Watergate hearings and to have suffered through the Clinton impeachment process. So, as Yogi Berra would have said, it was “deja vu all over again.”
It’s not clear to me what happens next since Congress is scheduled for a two week recess, but appartently the “whistleblower” wants to testify, and the House Intelligence committee has indicated that it wants to interview the people who informed the whistleblower. At the moment there is an emerging battle between the president and the House Committee leaders who are telling the president to stop his attempts at witness intimidation by saying that the whistleblower is a traitor who should get a traitor’s punishment.
By now you may be asking, “What does this have to do with healthcare, the future of healthcare, and the Triple Aim?” My answer would be that it adds to the difficulty of the moment by further increasing our uncertainty and distracting the public’s attention away from the many issues that challenge us as a society. Where I come from there is an old saying that has strategic implications, “That’s a long run for a short slide!” That translates as a great effort for little or no benefit. Some commentators like David Brooks go so far as to point out the potential for huge losses associated with the effort, no matter how justified it might be. In an opinion piece entitled “Yes, Trump Is Guilty, but Impeachment Is a Mistake: This political brawl will leave Trump victorious,” Brooks makes the following points:
- Donald Trump committed an impeachable offense on that call with the Ukrainian president. But that doesn’t mean Democrats are right to start an impeachment process… impeachment is a political process, not a legal one.
- This will probably achieve nothing. To actually remove Trump from office, at least 20 Republican senators would have to vote to convict him. Usually when a leader takes a big risk, it’s because there’s a big upside. But Nancy Pelosi is taking a giant risk and there is little upside.
- This is completely elitist. We’re in the middle of an election campaign. If Democrats proceed with the impeachment process, it will happen amid candidate debates, primaries and caucuses. Elections give millions and millions of Americans a voice in selecting the president. This process gives 100 mostly millionaire senators a voice in selecting the president.
- This is not what the country wants to talk about. Pelosi said she would not proceed with impeachment unless there was a bipartisan groundswell of support. There is no bipartisan groundswell, and yet she’s proceeding. According to a Quinnipiac University poll, only 37 percent of Americans support impeachment.
- The presidential candidates all report the same phenomenon. Voters are asking them about health care and jobs and climate change, not impeachment.
- Democrats are playing Trump’s game. Trump has no policy agenda. He’s incompetent at improving the lives of American citizens, even his own voters. But he’s good at one thing: waging reality TV personality wars against coastal elites. So now over the next few months he gets to have a personality war against Nancy Pelosi and Jerrold Nadler.
- The Democrats are having a pretty exciting and substantive presidential primary season. This is what democracy is supposed to look like. Why they would want to distract from that is beyond reason. Trump vs. Nadler is exactly the contrast Trump wants to elevate.
- This process will increase public cynicism. Impeachment would be an uplifting exercise if we had sober leaders who could put party affiliation aside and impartially weigh the evidence. It would be workable if Congress enjoyed broad public affection and legitimacy. We don’t live in that world. This process is already devolving into the sort of mindless partisan war that causes Americans to be disgusted with Washington.
- This could embed Trumpism within the G.O.P. If Trump suffers a withering loss in a straight-up election campaign, then his populist tendency might shrink and mainstream Republicans might regain primacy. An election defeat would mean the people don’t like Trumpism. But the impeachment process reinforces the core Trumpist deep-state message: The liberal elites screw people like us. If Trump’s most visible opponents are D.C. lawyers, Trumpism becomes permanent.
- This could distort the Democratic primary process. It’s already obvious that impeachment upstages the Democratic primaries….Democratic policy debates are going to be obscured.
All of those points are worth deep contemplation. Brooks finishes with practical advice:
Democrats are running against a man whose approval rating never gets above 45 percent. They just have to be normal to win. Instead, they’re rolling the dice in a very risky way. I get the need to remove this unfit man from office. But this process will not produce that outcome.
An election can save the country. An inside-the-Beltway political brawl will not.
I must be honest and say that I am disappointed to admit that there is a lot of logic in what Brooks says. It is easy to find many commentators who say that we must defend the constitution and hold the president accountable for his egregious behavior. There is no doubt that he is an embarrassment to a numerical majority of Americans, and an anathema to most of the world.
Brooks makes sense, but so does David Leonhardt in his opinion piece, “Why I Changed My Mind About Impeachment:Trump was always unfit, but that’s not enough.” Leonhardt, like Brooks, begins s by noting that impeachment is, by design, a political process, not a legal process. Impeachment provides a mechanism for the legislative branch to hold the executive and judicial branches of government accountable. As he says:
Impeachment is not like a criminal trial, in which a jury or judge is supposed to base a verdict only on what happens inside the courtroom. The Constitution’s standard for impeachment — “high crimes and misdemeanors” — is deliberately vague. The decisions about whether the House should impeach and whether the Senate should convict have always involved a mixture of law, politics and public opinion.
Leonhardt goes on to say that since impeachment is a political process he has thought that the Democrats would be making a mistake by starting impeachment proceedings even though he believed the president was unfit for office. He called the Mueller report disappointing and ineffective while blaming those realities mostly on the Attorney General. Then he points out the obvious risks of a failed attempt to remove a president, why it was wrong to try after the Mueller report, and why he thinks it is the right thing to do now.
If you impeach a president and fail to damage his political standing — if you’re just as likely to shore up his standing, as I think a post-Mueller impeachment would have — you’re doing it wrong. You are going to political war with the Constitution you want rather than the one the country has.
Many House Democrats understood this. They’ve certainly made mistakes since retaking House control this year — namely, failing to hold investigative hearings that might have shifted public opinion. But Democrats were right to reject calls for impeachment. Most House members who represent swing districts were right about this, and so was Nancy Pelosi.
And they are right to be changing their minds now.
Starting an impeachment inquiry is the proper move because of both what’s changed and what hasn’t. What has changed? In his dealings with Ukraine, the president committed a new and clearly understandable constitutional high crime: He put his own interests above the national interest by pressuring a foreign country to damage a political rival. He evidently misused taxpayer money in the process. He has shown he’s willing to do almost anything to win re-election.
What hasn’t changed? Trump is unfit for office.
That last link will take you to a column that Leonhardt wrote a few days ago where he wrote 40 sentences. Each sentence was a reason that the president is unfit for office. Some are crimes. Some are misdemeanors. Some are just behaviors unbefitting a president. It was like a bill of indictment that a prosecutor might present to a grand jury. In summary he concludes:
He has repeatedly violated his oath of office, to preserve, protect and defend the Constitution. He has weakened America’s national security. He has used the presidency for personal enrichment. He has broken the law more than once. He has tried to undermine American democracy.
Trump has handed Democrats a new opportunity to persuade the country that his presidency needs to end, on Jan. 20, 2021, if not sooner. Democrats should seize that opportunity. Even if they can’t persuade Republican senators to remove him from office, they can focus voters’ attention on his egregious misbehavior.
It’s time to start an impeachment inquiry and see where it leads.
It is hard to think about the issues in the face of all of the uncertainty that looms before us. If Watergate is a guide for what we might expect to be ahead of us, it is very likely that we are in for a long process. The Senate Watergate hearings began on May 17,1973. The House Judiciary Committee passed a recommendation for Articles of Impeachment on July 30, 1974. The House never voted on them because President Nixon resigned from office on August 8, 1974 after key Republican senators told him that he would be convicted if impeached. If that sort of process plays out now the election might occur before the hearings. Clinton’s impeachment and trial were “fast tracked” by Watergate standards but still took over five months.
There is no doubt that we will all be distracted by what happens in the House over the next several months. It is sobering to realize that we have no effective way to express an opinion about whether or not the process is an appropriate defense of the Constitution, or a strategic blunder of the Democrats. We all are captive to a process where the outcome will be determined by our elected leaders. Whether we want it or not, whether we think it is prudent or not, it appears that it will happen. Whatever our personal opinions might be, and despite how good David Brooks’ reasoning may seem to you, we will be forced to live through this process.
I have mentioned it before, but ever since President Trump descended the escalator in Trump Tower in 2015 to announce that he was a candidate for president, I have had dread based on a statement by Jeffrey Kruger in his 2014 book, The Narcissist Next Door: Understanding the Monster in Your Family, in Your Office, in Your Bed – in Your World. Kruger described the process of a relationship with a narcissist. He actually used Donald Trump as an example as he made his points. What I remember most was his assertion that a relationship with a narcissist might start as an exciting experience, but it was always in decline, and inevitably ended badly.
My advise and mind set will be to adopt the sort of strategy that is appropriate for an approaching hurricane. It may not hit, but you better be ready. I fear that there will be damage. We should try to carry on, but it may be a reality that many things will be put on hold. It will be important for us to continue to focus on the professional responsibilities that we have, and continue to focus on the objectives of the Triple Aim.
There is no doubt in my mind that if the predictions of David Brooks turn out to be true much will be lost. David Leonhardt describes good reasons to try to endure the storm. Our job will be to accept the uncertainty as something that is beyond our control, but not an excuse for forgetting our professional obligation to excellent patient care and continue to search for solutions that improve the experience of care for everyone, improves the health of the community through the reduction of the inequities that are the reason for the poor health of so many Americans, and continue efforts to lower the cost of care to sustainable levels that preserve resources that allow us to address the other concerns of our communities. We will be tested.
Come back on Tuesday and I will tell you what I learned from Toby Cosgrove and David Shore at the ATLAS conference before my phone started to buzz.
I Am Embracing Fall!
Today’s header is yet another “lift” from a drone video taken by a neighbor of mine. He is very gifted with his drone photography, and we have many wonderful places nearby for him to test his skills. All photographers know that the light of the late afternoon sun on a very clear day creates dazzling effects. If you click on the link you can take a three minute tour of McDaniel’s Marsh in Springfield. One end of my lake is in Springfield, and McDaniel’s Marsh is not far away. Our environment is an area of forested hills, low mountains, lakes, marshes, wetlands, and even a bog. All seasons offer spectacular experiences for anyone who enjoys being outdoors. No season is more spectacular than fall.
It will be a week or so before our area is in full color. Fall can be a very short experience. There is nothing better than cool nights, warm days, clear skies, and fall colors, and that is the prediction for this weekend. The video from which this picture was lifted was taken this past week just as color was becoming obvious. The changes occur by the hour so full enjoyment requires focus and diligence. It’s like a rainbow. If you look away, you might miss it. A great way to get a spectacular fall experience is to climb one of our “modest mountains.” I have mentioned “52 with a view” before. Mount Kearsarge, which is about 85 miles from downtown Boston, has a short route to the top when approached from the Rollins State Park entrance that a three year old can climb in about a half an hour. That is not an exaggeration. I have seen many little children on the mountain. Click on Rollins State Park to get a sense of what you will see from the top of the mountain. Kearsarge has had a clear granite top since a fire in the late 1790s. With no trees, there is a great 360 degree view of wonderful color late in September and in early October. If you are an “Interested Reader” from Eastern Massachusetts, it would be a rewarding day trip.
Be well, take good care of yourself, let me hear from you often, and don’t let anything keep you from doing the good that you can do every day,
Gene
