If you are like me, you are wondering when the uncertainty over the election will end. I ask myself several times a day if there is really some path to a second Trump term. His supporters are in the streets proclaiming that they love him and repeating his claim that the election was stolen. There is no question in my mind that he lost, but I lack total confidence that something won’t happen that allows him to remain in office. Some people say that he is just getting over the surprise and trauma of being a loser. They say he “needs time.” I don’t buy that explanation for what I see. The events of the last four years allow me to imagine that through some uncertainty of the courts system including the Supreme Court where he now has placed three justices, or perhaps through a malfunction or malfeasance within the electoral college, we will wake up some day in late December or early January to discover that despite losing the popular vote by over five million votes, he will remain president for at least the next four years.
The experts continue to reassure us that his contention that the election was rigged and that he really won will eventually fade or be thrown out of court. A more plausible explanation for the president’s reluctance to concede the election might be that the money that he is collecting from his supporters to fight the fixed election in the courts will be used to retire campaign debts, provide cash flow for him and his family, and be seed money for whatever activities he has planned as continuing harassment of Joe Biden for the next four years.
…the four central motivations for President Trump’s actions that have followed the Nov. 3 elections.
These include:
- Trump maintaining his leadership of the Republican Party. He is determined to remain the kingmaker for primaries and state races, while at the same time being able to kill candidacies that have been disloyal to him. It would be shortsighted not to take seriously Trump’s musings about running again for president at age 78 in 2024. Even if he doesn’t run, just the suggestion he might would keep him at the center of national and international attention.
- Trump emerging from his electoral defeat with enough standing and authority to refinance his business and get new loans. By all accounts, he is under significant financial pressure, including a debt load of anywhere from $400 million to $1 billion. To maintain his brand, he’ll need to finance it, including the possibility, reported by Axios, that he’s planning to launch a digital media channel to compete with Fox.
- Achieving immunity from federal prosecution. President Trump believes law may allow him to even pardon himself, a concept that almost certainly would be tested, up to and including the Supreme Court. Trump also has other options: he could resign before Jan. 20 and have Vice President Mike Pence pardon him. President-elect Biden on the campaign trail has said he wouldn’t pardon Trump.
- Finally, Trump would want to protect his family members and ensure they could continue to pursue their business andis own personal agenda. political interests.
It would be naive to think that in “Trump world” the country’s need for a smooth transition would trump his personal concerns. It is already clear that if President-Elect Biden assumes office at noon on Tuesday January 20th, he will immediately face an enormous workload. He will need to solve the problems of the pandemic, healthcare, inequality, global warming, the challenges of Iran, Russia, China, and North Korea, immigration, and infrastructure while simultaneously swimming against a current of resistance from former President Trump and Mitch McConnell.
I do not want to be a downer, and I do cling to the hope for the eventual triumph of character, empathy, and political experience, but patience and lowered expectations are the realities that are called for given the strength of the Republican showing on election day. Paul Krugman expressed similar feelings in his column yesterday in a piece entitled “Why the 2020 Election Makes it Hard to be Optimistic About the Future: If we can’t face up to a pandemic, how can we avoid apocalypse?” He writes:
…OK, democracy also won, at least for now. By defeating Donald Trump, Joe Biden pulled us back from the brink of authoritarian rule.
But Trump paid less of a penalty than expected for his deadly failure to deal with Covid-19, and few down-ballot Republicans seem to have paid any penalty at all. As a headline in The Washington Post put it, “With pandemic raging, Republicans say election results validate their approach.”
And their approach, in case you missed it, has been denial and a refusal to take even the most basic, low-cost precautions — like requiring that people wear masks in public.
I can venture the grandiose thought that Krugman shares my sense that the next four years are shaping up to be a difficult uphill climb against a powerful head wind if there is to be any progress on the critical issues that many of us care about. Krugman is very concerned about what will happen with the pandemic even as people are waiting for relief from a vaccine, but his biggest concern is the environment.
…what worries me more is what our failed response says about prospects for dealing with a much bigger issue, one that poses an existential threat to civilization: climate change.
As many people have noted, climate change is an inherently difficult problem to tackle — not economically, but politically.
I share Krugman’s concerns about the environment. It is my feeling that the environment and healthcare are our twin peaks of future concern. The two concerns are connected. We can’t be healthy in a collapsing environment. We can’t improve the social determinants of health when the leading edge of the deteriorating environment damages the poorest members of our society sooner and with more force than those whose wealth provides them some protection. Moving away from an economy built on fossil fuels offers the poorest among us the benefit of new jobs as it reduces their exposures to agents that threaten their health. The outcome of the election may have protected our democracy from an immediate descent into an authoritarian morass, but it has not paved the way toward progress against the threats to the planet or the Triple Aim.
Thoughtful pundits like David Brooks are suggesting that the president-elect lower his sites, avoid the overuse of executive orders and score bipartisan victories where he can find them. He expresses a hopeful outlook in his most recent column entitled “How Biden Could Steer a Divided Government: A pathway to a successful presidency.” He begins with an ugly prospect:
It’s easy to imagine ways Joe Biden’s presidency might open very badly. Covid-19 may still be spiking. The economy could slip back into recession. Mitch McConnell might still control the Senate, blocking every major Biden proposal. Donald Trump will be unleashed as National Narrator blasting everything that happens.
He implies that the problems that Barack Obama faced once the Democrats lost the Senate will be a garden party compared with where Joe Biden and Kamala Harris will start their attempt to clean up the carnage of the Trump presidency. He continues by asking how Biden can deal with the challenge and then immediately suggests that he not follow the advice of Elizabeth Warren and seek to create change through the use of executive orders:
One way was proposed by Senator Elizabeth Warren in a Washington Post op-ed this week: Use executive orders. She suggested some obvious moves Biden absolutely should make on Day 1 — like re-entering the Paris climate accord — but also suggested some big and expensive unilateral policy changes: raising the minimum wage for federal contractors to $15, canceling billions of dollars in student debt.
With all due respect to Warren, opening the Biden era by stiff-arming Congress and ordering all sorts of big policy changes by presidential diktat could knock the legs out from the Biden presidency.
That warning may make sense for many of the big issues that are associated with societal transformation. Legislation is definitely preferable over an executive order that might be challenged in court or reversed in four years if the presidency reverts to Trump or some other Republican presidential wannabe. What does Brooks suggest?
A better approach would, next, be about finding policy measures that can win 60 Senate votes. This is actually not that hard. I spoke to Senator Mitt Romney this week and he ticked off a series of areas where he was optimistic the parties could work together: fix prescription drug pricing and end surprise billing; an immigration measure that helps the Dreamers and includes E-Verify; an expanded child tax credit; green energy measures.
There is no question that fixing drug pricing and ending surprise billing would be positive moves, but they are incremental and not the sort of expansion of access to care that we know that the majority of Americans favor and would be beneficial to many of the people who voted for president Trump against their own interests when it comes to personal earnings, employment opportunity, and healthcare.
I was not enthusiastic about Brooks’s suggestion that Biden reach for the doable and resist the aspirational. Embracing that incremental approach is the acceptance of the reality that trying to focus on bipartisan activities and small but meaningful joint victories is a plausible strategy as we patiently wait at least two more years, when Democrats will have another shot of regaining the Senate with a commanding majority, for an opportunity to pass legislation that will give access to care to all Americans and insure healthcare as a human right. The reality and disappointment of the moment is settling in. The Democrats have displaced a very dangerous president, and possibly averted the collapse of our democracy, but the voters did not give them the ability to lead the country to immediate and lasting change. We are out of the ICU, but we have a long time ahead of us in rehab, or as Brooks says:
Given the likely division of power, Biden is not going to lead an F.D.R.-style New Deal administration. But there is a path for him to pass a series of important pieces of legislation that would help millions of Americans. More than that, he has a chance to take a dysfunctional system of government and turn it into a humane and functioning one. That in itself would be a miracle.
I am tired of waiting. I know that there is wisdom in patience and I remember that Dr. Martin Luther King, Jr. reassured us that the arc of history bends toward justice, but it seems that the arc is very long and justice and equity in healthcare will remain a work in progress for a while. I agree that there are many incremental things that we can do. What I wish is that healthcare providers and their leadership would more vigorously engage in leading the changes that we have known for almost twenty years, since Crossing the Quality Chasm was published, are within our control. We have lost ground over the last four years. It is up to us to regain some of that ground through our professional commitment to quality through efforts to be more patient centered, efficient, effective, and timely in offering care that is delivered with the greatest attention to safety and equity. Anything that Joe can accomplish can be added to the things we could choose to make happen.
