One Day at A Time Through The Uncertainty Ahead

 

Let me offer you an introductory warning and a rationalization. I have to admit that I can’t overcome my compulsion to write about what is on my mind. That lack of self control then forces me to hope that I can twist my obsession of the moment into something that might pass as an appropriate subject for a blog that is supposed to be focused on healthcare. I reason that almost anything that affects the political environment can eventually delay or accelerate our progress toward the distant goals of universal access to care, healthcare equity, and the Triple Aim. 

 

Progress on the road toward the Triple Aim, or even short of that, the lofty goal of building a bridge over the “quality chasm” are hardly topics that are front and center in the thinking of most Americans as they watch the bizarre spectacle of Donald Trump’s last days as president. What he is doing is substantially complicating chances for progress on any aspect of a progressive agenda. Perhaps that is the strategic thought behind the circus of the president’s norm defying behavior and the associated silence of over two hundred Republican Senators and members of the House of Representatives. 

 

The other reality that clouds the mind and obstructs a positive view of the future is our collective concern about surviving physically and economically between now and the moment mass vaccinations may end the COVID pandemic. As a more proximate issue, it is hard for most of us to be interested in thinking about improving the total experience of healthcare as we struggle to rationalize the loss of our usual holiday experience as a painful personal part of our collective struggle against the ever present danger of COVID-19. Most people are weary from worry and the need to be constantly monitoring and limiting their desire to reach out and embrace family and friends. With those thoughts and disclaimers in mind let me continue.

 

The four weeks between Thanksgiving Day and Christmas, the season that the church calls Advent which is the the time when the retail economy scores its margin for the year, have always been a difficult time for me. I was filled with hopes and expectations, not for the coming of a baby that would change the history and experience of humankind but for what I would find under the tree on Christmas morning. Relief from the anxiety and tedium of waiting always came on Christmas morning when my sibs and I assembled at the top of the stairs in our pajamas, and waited for our father to give us the signal that we could run down the stairs to the living room to see what Santa had left under the tree. 

 

By the time I realized that whether or not Santa existed I should act as if there was no question about the facts of the situation, I had learned that I could count on Santa fulfilling somewhere between 60 to 75% of my requests. If Santa was just a story, which was the opinion of the majority of my first grade friends as we discussed the issue on the playground at recess, or if he was real for reasons beyond my comprehension, I was smart enough to know that the real negotiation was with my parents. As soon as I realized that everything depended on how well my Dad was managing his chronic fears about the health of his bank account, I was able to evolve a strategy that was reasonably effective.  If my strategy didn’t produce a greater yield, it did reduce my anxiety. If I was to get 3 out of 4 of the things on my list then, I would probably get 4 out of 6 requests. Asking for more than I expected “Santa” to bring me led to many exciting Christmas mornings when I would run down to the living room not expecting to get every request from Santa, but excited to finally see which of my requests were fulfilled. 

 

Anticipation, expectations, and the possibility for satisfaction balanced against the possibility of disappointment make this time of the year both exciting and nerve racking for many. As an adult with four children, the mantle of responsibility for making Christmas a memorable experience was passed to me and my wife. I took my father’s role in the ongoing play. No longer were excitement and anticipation my dominant emotions of early and mid December. They had been replaced by the fatigue and tension of added activities and responsibilities to a schedule that was already crammed with too much to do in too short a time. The tension would culminate in a mad rush of overspending during the last 48 hours before Christmas. I was the flip of my father. If he tried to calculate what he didn’t need to deliver, I was frustrated if I could not fulfill the wish lists and add an unexpected surprise for each of my children and my wife. In truth, I could always count on my wife making sure everything came out as a positive experience. At the peak of my frenzy, I calmed myself by remembering that she would always pull it all together and everything would be fine on Christmas morning. 

 

This year I fear that my anxieties will persist past Advent. The moment of relief that I once experienced on Christmas morning won’t arrive until about a quarter past twelve noon on January 20th, almost a month longer than usual. One month of day to day uncertainty has yielded one certainty. Donald Trump is not going to wave goodbye as he climbs aboard a helicopter to fly away to the usual silence of a former president. Trump has let us know that he will not be a one term president who leaves with the grace of Gerald Ford, Jimmy Carter, or George H.W. Bush, nor will he be as observant of the norms for ex presidents as Richard Nixon was. Even Nixon attempted to be pleasant and honor norms as he boarded the helicopter that carried him away from the White House for the last time. He left with a big smile while waving his hands in the air with his first two fingers spread in the sign of “V” for victory, as you can see in today’s header. I can only imagine that if President Trump signals us as he climbs aboard the helicopter to begin his trip to Mar-a-Lago and into infamy, he will give us the sign with his middle finger. With each passing day I worry more and more, and offer up prayers of thanks for the contrasting apparent equanimity and grace of Joe Biden who is trying hard to make a good start by appointing a very diverse group of senior leaders. I also pray that the president elect will have the stamina he needs to endure what is likely to be four long years of Trump’s persistent ugliness. 

 

I continue to be concerned that while Joe Biden is calmly preparing to try to lead us into a period of progress toward universal coverage and closer to healthcare equity, the president is obsessed with concocting ways that he can undermine every attempt to restore what he has methodically disassembled over the past four years. Each day we hear of yet another court ruling against the president’s attempts to prove that the election was stolen, but he has not given up the effort. Perhaps the president keeps claiming that he won because it allows him to continue what has been a very successful fundraising effort. With the hundreds of millions of dollars he has raised he can continue to employ a staff to promote his efforts to control the Republican party and prepare for another run for the presidency in 2024. To position himself  for 2024, and to continue to enjoy the adoration of his faithful base, he probably wants be a visible influence for a Republican take over of the House in 2022 while financially benefiting himself and his family. 

 

He is not crazy. He has a strategy, and his strategy will ensure that he will remain a rock in the shoe of Joe Biden as Biden attempts to return us to a path that leads us toward the progressive goals of healthcare equity, reversal of climate change, pandemic recovery and prevention, and the resumption of our role as leader of the free world and away from the pursuit of an agenda of isolation. Peter Baker gave us a dark view of the possibilities of the next few weeks and the next few years in a New York Times piece earlier this week entitled “Trump’s Final Days of Rage and Denial: The last act of the Trump presidency has taken on the stormy elements of a drama more common to history or literature than a modern White House. In the piece Baker compares Trump to other desperate despots from literature. He writes:

 

Moody and by accounts of his advisers sometimes depressed, the president barely shows up to work, ignoring the health and economic crises afflicting the nation and largely clearing his public schedule of meetings unrelated to his desperate bid to rewrite the election results. He has fixated on rewarding friends, purging the disloyal and punishing a growing list of perceived enemies that now includes Republican governors, his own attorney general and even Fox News.

The final days of the Trump presidency have taken on the stormy elements of a drama more common to history or literature than a modern White House. His rage and detached-from-reality refusal to concede defeat evoke images of a besieged overlord in some distant land defiantly clinging to power rather than going into exile or an erratic English monarch imposing his version of reality on his cowed court.

And while he will leave office in 46 days, the last few weeks may only foreshadow what he will be like after he departs. Mr. Trump will almost certainly try to shape the national conversation from his Mar-a-Lago estate in Florida and his relentless campaign to discredit the election could undercut his successor, President-elect Joseph R. Biden Jr. Although many Republicans would like to move on, he appears intent on forcing them to remain in thrall to his need for vindication and vilification even after his term expires.

 

I think Baker is saying that the future is uncertain only to the degree of how difficult it will be. A CNN piece this week includes an picture of what lies ahead. Jim Jordan and other Republican congressmen plan to continue the attack on the election even after the Electoral College meets next week and confirms Joe Biden as the next president. The article flows from an interview with Jordan:

 

(CNN)President Donald Trump‘s staunchest defenders on Capitol Hill are urging him not to concede even after President-elect Joe Biden wins the Electoral College vote next week, calling on their party’s leader to battle it out all the way to the House floor in January as he makes unsubstantiated claims of widespread election fraud…

…Asked if Trump should concede next Monday, Rep. Jim Jordan of Ohio said bluntly: “No. No way, no way, no way. We should still try to figure out exactly what took place here. And as I said that includes, I think, debates on the House floor — potentially on January 6,” Jordan, a trusted Trump confidant, told CNN.

It is not unusual for a losing candidate’s most fervent supporters to take their case to the House floor — something that occurred after the 2016, 2004 and 2000 presidential races. But it is unusual for the losing candidate to mount a weeks-long public campaign aimed at sowing discord and distrust over a pillar of democracy, something that Trump has done relentlessly since losing the race.

 

You and I are in the audience for this drama. The part of the play where there was a chance for legitimate audience participation is over unless you live in Georgia. Dad always made sure that I got what I wanted and perhaps needed on Christmas morning. In the real world where the struggle is between what is best for the community and the planet versus the narcissistic desires of a wannabe autocrat and his supporters, the Advent expectation of “peace of earth and good will to all” is far from certain. Joe Biden is setting an example for us to follow as he trudges forward against resistance. I once wished for trains and bikes on Christmas morning. There was a time when I could relate to “All I Want For Christmas Is My Two Front Teeth”. Now I can truthfully say that all I want for Christmas, but don’t expect to get, is for Trump to quietly go away and give Joe a chance to find some path toward a bipartisan repair of healthcare..