One of the most remarkable events of the first week of the Trump presidency was his interview with David Muir from ABC. Muir asked questions that allowed the President to reveal both his focus on the trivial and his lack of understanding of the subtleties of the complex issues of our times. Jenna Johnson’s analysis in the Washington Post focused on his obsession with his popularity. To make sure that no “alternative facts” fooled you read another Washington Post article by Greg Sargent, “Trump just gave a remarkable new interview. Here’s a tally of all his lies.”
The most important part of the interview for me was the interchange about healthcare. I have bolded the parts that for me were most important. I have inserted some of my concerns in brackets:
DAVID MUIR: Let me ask you, Mr. President, about another promise involving Obamacare to repeal it. And you told The Washington Post that your plan to replace Obamacare will include insurance for everybody. That sounds an awful lot like universal coverage.
PRESIDENT TRUMP: It’s going to be — what my plan is is that I wanna take care of everybody. I’m not gonna leave the lower 20 percent that can’t afford insurance. Just so you understand people talk about Obamacare. And I told the Republicans this, the best thing we could do is nothing for two years, let it explode. And then we’ll go in and we’ll do a new plan and — and the Democrats will vote for it. Believe me.
Because this year you’ll have 150 percent increases. Last year in Arizona 116 percent increase, Minnesota 60 some-odd percent increase. And I told them, except for one problem, I wanna get it fixed. The best thing I could do as the leader of this country– but as wanting to get something approved with support of the Democrats, if I didn’t do anything for two years they’d be begging me to do something. But I don’t wanna do that. So just so you unders– Obamacare is a disaster.
It’s too expensive. It’s horrible health care. It doesn’t cover what you have to cover. It’s a disaster. You know it and I know it. And I said to the Republican folks– and they’re terrific folks, Mitch and Paul Ryan, I said, “Look, if you go fast — and I’m okay in doing it because it’s the right thing to do. We wanna get good coverage at much less cost.” I said, “If you go fast we then own Obamacare. They’re gonna put it on us. And Obamacare is a disaster waiting to explode. If you sit back and let it explode it’s gonna be much easier.” That’s the thing to do. But the right thing to do is to get something done now.
[As Mr. Obama pointed out in his recent New England Journal of Medicine article, the ACA needs to be improved, but the process should be one of consensus improvement and not repeal. It seems unlikely that President Trump has the will, the perspective, or the expertise to initiate such a process.]
DAVID MUIR: But you …
PRESIDENT TRUMP: So I wanna make sure that nobody’s dying on the streets when I’m president. Nobody’s gonna be dying on the streets. We will unleash something that’s gonna be terrific. And remember this, before Obamacare you had a lot of people that were very, very happy with their health care.
[“Nobody’s gonna be dying on the streets” elicits from me the same level of disgust as “Build the wall” and “Lock her up.” As I have facetiously noted in previous references, death without intervention has been made much less likely by the passage of EMTALA in 1986. The ACA represented the first step in the transformation of our expensive and inadequate system of fee for service medicine into a system that has the ability to improve the health of the nation and reduce the cost of care. As former President Obama noted in the NEJM and as Don Berwick described in the article that I quoted in this week’s posting, “Information for Responsible Resistance”, on strategyhealthcare.com, the ACA is now woven into every aspect of healthcare. Many experts have warned that removing it suddenly carries the risk of far reaching unintended damage to the health security of every American. The executive order signed on his first day in office has already introduced substantial confusion.]
And now those people in many cases don’t even have health care. They don’t even have anything that’s acceptable to them. Remember this, keep your doctor, keep your plan, 100 percent. Remember the $5 billion website? Remember the website fiasco. I mean, you do admit that I think, right? The website fiasco.
Obamacare is a disaster. We are going to come up with a new plan ideally not an amended plan because right now if you look at the pages they’re this high. We’re gonna come up with a new plan that’s going to be better health care for more people at a lesser cost.
DAVID MUIR: Last question because I know you’re gonna show me around the White House. Last question on this. You’ve seen the estimate that 18 million Americans could lose their health insurance if Obamacare is repealed and there is no replacement. Can you assure those Americans watching this right now that they will not lose their health insurance or end up with anything less?
[This is the key question. Just as we are discovering that it is highly unlikely that Mexico will pay for “the wall” , it is also highly unlikely that the President and his Republican colleagues in Congress can deliver on the claim of “something better for less.” The President and the Republican leadership in Congress have launched a disastrous and foolish journey. I am concerned that saying care will be “universally available for those who want it” is an empty offering that will be accompanied by a substantial withdrawal of public resources and the loss of what has been accomplished. I will join Barack Obama in promising that if a bill is produced that is a genuine improvement on the ACA, I would gladly embrace it. ]
PRESIDENT TRUMP: So nobody ever deducts all the people that have already lost their health insurance that liked it. You had millions of people that liked their health insurance and their health care and their doctor and where they went. You had millions of people that now aren’t insured anymore.
DAVID MUIR: I’m just asking about the people …
PRESIDENT TRUMP: No, no.
DAVID MUIR: … who are nervous and watching …
PRESIDENT TRUMP: We …
DAVID MUIR: … you for reassurance.
PRESIDENT TRUMP: … here’s what I can assure you, we are going to have a better plan, much better health care, much better service treatment, a plan where you can have access to the doctor that you want and the plan that you want. We’re gonna have a much better health care plan at much less money.
And remember Obamacare is ready to explode. And you interviewed me a couple of years ago. I said ’17 — right now, this year, “’17 is going to be a disaster.” I’m very good at this stuff. “’17 is going to be a disaster cost-wise for Obamacare. It’s going to explode in ’17.”
[He can make his “prediction” come true. By undermining the mandate and the exchanges with his executive orders, and by appointing Tom Price and Seema Verma to head up HHS and CMS to lead reversals of programs in Medicare and Medicaid that have begun to make a difference, he has aggressively begun the process of making his prediction of the “failure” of Obamacare in 2017 a reality.]
And why not? Obama’s a smart guy. So let it all come do because that’s what’s happening. It’s all coming do in ’17. We’re gonna have an explosion. And to do it right, sit back, let it explode and let the Democrats come begging us to help them because it’s on them. But I don’t wanna do that. I wanna give great health care at a much lower cost.
DAVID MUIR: So, no one who has this health insurance through Obamacare will lose it or end up …
PRESIDENT TRUMP: You know, when you …
DAVID MUIR: … with anything less?
(OVERTALK)
PRESIDENT TRUMP: … say no one I think no one. Ideally, in the real world, you’re talking about millions of people. Will no one. And then, you know, knowing ABC, you’ll have this one person on television saying how they were hurt. Okay. We want no one. We want the answer to be no one.
But I will say millions of people will be happy. Right now you have millions and millions and millions of people that are unhappy. It’s too expensive and it’s no good. And the governor of Minnesota who unfortunately had a very, very sad incident yesterday ’cause he’s a very nice guy but — a couple of months ago he said that the Affordable Care Act is no longer affordable.
He’s a staunch Democrat. Very strong Democrat. He said it’s no longer affordable. He made that statement. And Bill Clinton on the campaign trail — and he probably had a bad night that night when he went home — but he said, “Obamacare is crazy. It’s crazy.” And you know what, they were both right.
DAVID MUIR: Mr. President, thank you.
(OVERTALK)
PRESIDENT TRUMP: Thank you very much. Appreciate it.
The President’s wilful presentation of his naked narcissism was breathtaking in its demonstration of a lack of self awareness. As the program ended I reminded myself of what I learned a couple of years ago (2014) when I read Jeffrey Kluger’s remarkable book, The Narcissist Next Door. In the book Kluger presented our new President, even before he was a candidate, as the archetypical narcissist. You can view him speaking about narcissism in a short YouTube clip. He warns us that things never end well in a relationship with a pathological narcissist.
Jane Brody offered a similar description of narcissism and warnings to those engaged with narcissists in her NYT article with the same title as Kluger’s book, “The Narcissist Next Door.” Perhaps Mike Pence and others close to the President are following advice that she offered in her article which she based on common characteristics of extreme narcissists from the work of Dr. Joseph Burgo, a clinical psychologist who wrote, The Narcissist You Know; Defending Yourself Against Extreme Narcissists in an All-About-Me Age.
“The best defense for employees who choose to stay is to protect the bosses’ egos and avoid challenging them,” …His general advice to those running up against extreme narcissists is to “remain sane and reasonable” rather than engaging them in “battles they’ll always win.”
Brody writes:
The disorder can be treated, though therapy is neither quick nor easy. It can take an insurmountable life crisis for those with the disorder to seek treatment. “They have to hit rock bottom, having ruined all their important relationships with their destructive behavior,” Dr. Burgo said. “However, this doesn’t happen very often.”
I don’t look forward to the moment when the President hits “rock bottom” and is ready for therapy!
Where does this leave us when it appears that we are in a struggle with a man who is more than an employer, more than a narcissistic spouse, and not as easily ignored as a blowhard bully who is our narcissistic neighbor? He holds all of the power of a sitting President and has many ways to use that power to fulfill his narcissistic needs first and consider the consequences later. The question is whether or not members of his party who think that they can control him and use him to support an agenda they have had for many years, can keep him within the bounds of propriety. We are still scheduled for elections in 2018 and 2020. Assuming things do not change, our efforts must be very strategic and like David Muir did in the interview, keep asking questions, keep refuting what is untrue undeterred by the volume and the mendacity of his responses.
