Tag Archives: Obamacare

Diehard Trumpites Have “Special Needs”

 

At a campaign rally in January, 2016, in reference to the blind loyalty of his followers, Trump said, “I could go out on 5th Avenue and shoot someone and I would not lose any votes.” The media (even Fox News) scoffed at his exaggeration, but it turns out that Trump was not that far off. After a tempestuous campaign, an erratic transition period and two months of an administration that could best be compared to bareback bull riding, Trump followers are, if anything, even more hypnotic in their support for him. Even when Trump makes things up from the vapors of his own peripatetic mind, his followers accept them as gospel.

Before we go further, let me acknowledge that I voted for Trump. I did so out of the belief that the establishment status quo was in need of some uncomfortable disruption and Trump was the only “disrupter” in the field of candidates. What I did not vote for was what Trump’s alter ego, Steve Bannon, described as the “deconstruction” of the pillars and institutions of the American government. You make a sick patient better by curing him, not killing him.

Even the most casual observer can see that the early days of the Trump administration have been a full-frontal assault on the fundamental institutions of government – the judicial, legislative and executive branches. At the same time, there has been a concerted effort to consolidate the levers and power of government within the walls of the White House (via Executive Order); much like role model Putin has done in the Kremlin. This attitude was vividly postulated by the wannabe Nazi Youth Leader Steve Miller, the White House advisor and Bannon buddy, who said in a television interview, “that the powers of the president to protect our country are very substantial and will not be questioned.”

And now of course, there is the broken promise to “replace and repeal” Obamacare. After seven years of repeated blood-promises by Republican Congressional leaders and multiple campaign pledges by Trump that if elected, Obamacare would be immediately “repealed and replaced,” that has not happened. After a cartoonish effort failed to fulfill the promise, we are now told, “Obamacare is the law of the land for the foreseeable future.” A lot of excuses have been offered up to explain the failure of the Republican AHC plan, but the bottom line is that this is a failure of leadership and inability to “make a deal.” Leadership and deal making starts at the top.

Then there is the blinding sandstorm of the “Trump-Russian affair.” There may be nothing to the suspected improper contacts – and maybe even collusion – between the Trump campaign and elements of the Russian government, but the circumstantial evidence that has emerged, combined with Watergate-like actions to obfuscate this activity, raises high suspicion. When was the last time so many American officials had so many behind the scenes contact with so many Russian officials?

Under normal circumstances this type of stumbling, bumbling, incoherent start to leadership, would spell doom for any leader at any level, let alone one who is president of the United States, but these are not normal times. The reality is that while Trump’s already low approval rating has declined further, his popularity among the vast majority of those who voted for him is even higher. Indeed, Trump backers want to believe that all of these issues are nothing but a wide conspiracy launched by those in the “deep government” that is intended to besmirch Trump and his agenda.

So what is it that blinds Trump’s die-hard followers to any of his foibles, fabrications and failures? The reality is that Trump followers have “special needs” and he is the only one who has promised to respond to them.

The Lost Generation

The core backers of Trump are part of what could be called the “lost generation.” For virtually their entire lives they have experienced a steady erosion of what has been generically referred to as the “American Dream.” The ideal of the American Dream was that everyone had an equal opportunity to achieve success and financial security through hard work, determination and individual initiative.

From the perspective of the Trump voter they have seen and felt the impact of the American Dream being dismantled step by step. They have seen “globalization” siphon jobs overseas; jobs being lost to immigrants (legal and illegal), their own wages have stagnated or even declined. They have witnessed vast amounts of wealth concentrated in the hands of the few and have suffered from the destruction of the great American middle-class. Not only has the core Trump supporter felt the loss of opportunity, but, even more important, they feel powerless and voiceless against a government that seems designed to work against them and the elite wealthy who do not care about them. Is it any wonder they are frustrated and distrustful of the establishment?

Then along comes Trump      

Give Donald Trump credit. Of the 20-plus individuals who ran for president in 2016, Trump was the only one to recognize, understand, enumerate and connect with the frustration, pain and special needs of millions of Americans. He not only promised to give these individuals a voice, but that he would, “Make America Great Again.” That was a “code phrase” signaling that he would take the country back to the way things were when the American Dream was alive and well. It was, for these people, an irresistible clarion call.  

This was like someone who had never been loved, being told that someone loved them. When someone is starved for love and believes they have found it, little else matters. The one being offered love is willing to blindly ignore any flaws, foibles, fabrications or even the insincerity of the one offering love. This is the case with the die-hard Trump supports.

Unapologetic Trump supporters do not care if he is impulsive, off-the-cuff, an admitted misogynist or one who plays fast and loose with facts and the truth. Trump’s core supporters couldn’t care less if Russia attempted to influence the election or if members of his staff (most likely with his knowledge) colluded with the Russians to fix the election. Even when Trump blames the Democrats for blocking the repeal of Obamacare – even though they had no power to do so – his followers believe him. The bottom line is that Trump has promised those who are frustrated and disenfranchised from the establishment that he will make right the wrongs they have suffered; and that is all they care about. And you really can’t blame them.

If Love is Lost

This is all well and good. It is easy to empathize with those who have been left behind by a rapidly changing economy and world order. One can understand why they would gravitate to the promises of Trump. But what if he ultimately fails to deliver? In the end, even more serious problems and frustrations could arise if, for whatever reason, Trump is unable to deliver on the promises he has made to “Make America Great Again.”

Trump is Right: Healthcare is Complex, but it does not have to be

from “If You’re Not Making History, You Are History” by Bob MacDonald

 

No doubt about it, the healthcare system in America is a mess. Obamacare is not working as intended and the proposed Republican replacement is being castigated, even by Republicans, as potentially even worse. Democrats complain the American Health Care Act (ACA) takes too much away from people who need coverage the most. Republicans who oppose the ACA call it “Obamacare-lite” and complain it does not go far enough to repeal Obamacare; and that it creates an entirely new entitlement program.  

The reality is that resolving the healthcare challenge is simple, but it is made complex because Republicans and Democrats have diametrically divergent views on what the end result should be. In simple terms, the Republicans believe the answer lies in assuring that all Americans have “access” to healthcare coverage, while the Democrats believe the answer lies in assuring that all Americans actually have healthcare coverage. There is a big difference between having access to healthcare coverage that an individual needs but cannot afford and providing the needed coverage, regardless of the ability to pay.

This difference exists because the political leaders have failed to address and resolve the most fundamental healthcare question: Is basic healthcare a right or a privilege?

The Republicans believe that healthcare is a privilege, and thus, so long as there is universal access to healthcare coverage (no matter what form or price), the problem is solved. (It should be noted that prior to becoming president, Trump consistently argued that healthcare coverage is a right.) On the other hand, Democrats take the position that every American citizen, regardless of financial status, has a right to receive basic healthcare.

It is this philosophical difference that motivates the Republicans (believing healthcare is a privilege) to propose in the ACA that Medicaid (the state/federal plan that covers low income citizens) funding be slashed. (This is one of the chief reasons why the Congressional Budget Office estimated that as many as 24 million Americans will lose their coverage under the Republican plan.) Conversely, (believing that healthcare is a right) the Democrats used Obamacare to expand Medicaid that covered 15 million people who previously could not afford coverage of any type.

There can be no effective bipartisan agreement on the best form of a healthcare system, unless or until there is a debate and resolution of the question as to whether healthcare is a basic right of every American citizen or a privilege based on means to pay. If, as a society, we decide that healthcare is indeed a privilege, then the Republican ACA plan will work just fine. If, we as a society decide (as virtually every other industrialized nation has) that basic healthcare, like a basic education, is a natural right of every American citizen, then we can work together in a bipartisan way to find the best way to achieve that goal.

Repeal and Replace Obamacare

Ironically, if it is decided that healthcare is a basic right, it would call for the repeal and replacement of Obamacare, because it has failed to achieve the objective of covering all Americans. But such a replacement would be based on the rights of all, rather than the privilege of a few to have healthcare.

If this approach to repealing and replacing Obamacare is taken, the solution is right in front of us. It is a healthcare system already in operation. It has proven to be effective and efficient; it has high consumer satisfaction and acceptance. Maybe even more important, it is a plan that President Trump has endorsed and pledged to protect.

Taking the complexity out of the healthcare solution.

The simplest and most effective way to solve the healthcare crisis is to merge the Medicare and Medicaid systems into one program that, on a phased in basis, will provide basic health care services to every American citizen, regardless of age, social status or income.

There would be no need to create another bureaucracy. Both of these programs have processes and procedures in place and in point of fact are paying for the health services provided by clinics, hospitals and doctors for millions of Americans age 65 and over, along with millions more of low income citizens. Patients covered by Medicare are free to select any of the 95 percent of the doctors, clinics and hospitals that accept Medicare payments. This is not the government deciding or providing the healthcare, but simply being the “single payer” of the benefits provided.

Of course merging and expanding Medicare and Medicaid into a universal healthcare system can’t be done with a flip of a switch, but an organized phase-in of this system over time for those not currently covered under Medicare or Medicaid could smooth the way. This would allow for Obamacare, along with all other forms of healthcare such as individual and employer group plans, to be repealed and phased out at the same pace the new system is expanded.

Certainly there will be concerns about the cost of such a change, but a number of serious studies have concluded that diverting all expenditures on the current system (federal, state, individual and employer) toward this new system and combining this with premiums, deductibles and co-pays based on income, would create more efficiency and actually be less costly than the current system. President Trump has even made this point in interviews.

Using this approach to fixing the healthcare system could be a win-win for everyone. Trump and the Republicans could fulfill their campaign pledge to repeal and replace Obamacare; Trump could remain consistent in his call for universal healthcare and his pledge to protect Medicare and, most important, all Americans could finally join the millions of citizens of every other industrialized nation in the world for whom basic healthcare is a right of citizenship, not just a privilege for the wealthy.

Trump’s Actions Show that Change is Messy

 

The election of 2016 was billed as a “change election.” It is clear now that a large portion of the electorate had reached such a level of frustration and feeling of disconnect with the status quo that they were willing to vote for change – any change. Even though they came from different sides of the political spectrum, Donald Trump and Bernie Sanders were the only presidential candidates to recognize and tap into this powerful undercurrent of the desire for change.

Unfortunately for Sanders, his message of change was blunted by the Democratic National Committee that had effectively rigged the party nomination in favor of an establishment status quo candidate. On the other hand, Trump benefited from the fact that, while the Republican National Committee favored establishment candidates, a gaggle of 15 other candidates diffused the establishment support. This allowed disaffected Republican voters to coalesce around Trump’s message of change. Even though Trump never received a majority of Republican primary votes, the concentration of voters driven by the desire for change pushed him to the nomination.

The same phenomenon (plus a little help from Russia) also impacted the general election. Even though Trump and his message of change failed to garner a majority of the popular vote, he was able to cobble together enough disaffected voters to flip a number of traditionally establishment Democratic states in order to win the majority of Electoral College votes (the votes that really count) and win the presidency. Much to the chagrin of the bulwarks of the government establishment status quo – the mainstream Democratic and Republican parties and the national media.

Learning the Lessons of Change Management

As president, Trump is now challenged to live up to his promise to be a change agent. He is quickly learning the lesson that any person in a position of leadership who seeks to bring about change must understand: Change is not something that is simply announced, it has to be created.

Change has two natural enemies: Those who resist change and those are frustrated by the status quo, but fear what change will bring. Those who are comfortable with the way things are and view change as a threat to be resisted. For them, change is the answer to a question they never asked. Ironically, those who most vociferously call for real change can become fearful of change when the answer to what change means is not clearly answered. As a result, change, no matter how beneficial it may ultimately be, is always difficult to implement and accept. And change becomes downright messy and chaotic when what is to replace the status quo is muddled or nonexistent.

Real change is about being positive, not negative …

For a leader to be a successful change agent, it is critical for them to shift the focus off the desire for change itself and focus on the benefits that will be derived from change. In other words, for followers to accept change, the debate should not center on what they are losing, but on what they can gain from the change. If that does not happen, change will be stillborn.

A good example of this change dynamic at work is the current debate over Obamacare. From its inception, the majority of Americans have had a negative opinion of the program. The Republicans seized on the unpopularity of Obamacare to promise that if given the power to act, they would “repeal and replace” it. Likewise, during the campaign Trump railed against Obamacare and promised that his first act as president (right after tearing up the Iran nuclear agreement) would be to repeal and replace Obamacare.

But now with the Republicans in full control of the government, the effort to deliver on the promise of repealing and replacing Obamacare has become, at best, messy and chaotic. Even the Republicans are fighting among themselves as to how to implement this change. There is no clear, coordinated plan being offered by Trump or the Republicans; despite the fact that they have had years to develop one.

As a result of this befuddling Republican approach to change, even those who disapprove of Obamacare have begun to have second thoughts. For the first time in years, public opinion polls have shifted and more people approve of Obamacare, than oppose it.  

Why is it that even those who were demanding change (and voted for it) are now uneasy with change? The problem is – and this is a great lesson for any leader to learn – that by simply announcing the intent to repeal Obamacare and not coupling it with a clear plan for going forward, Trump and the Republican leaders have allowed people to focus on what they will be losing (as bad as it may be) rather than on what they will gain by a new approach to healthcare. 

What Trump and the Republican leaders are missing in their effort to implement the promised change (not only for Obamacare, but other issues as well) is the understanding that while people may be frustrated with the status quo and claim to want change, they are even more fearful of an uncertain future. As a result, there is nothing but confusion, frustration and fear of what the change will bring.

Again, the key to effective change management is for the leader to focus on where they are going, rather than where they have been. No matter how much people may protest against the status quo, unless they clearly understand the benefits of the proposed change, they will resist the change.

For example, Trump and the Republican leaders could have said something like, “We are going to repeal Obama care and replace it with an expanded Medicare system that would be available and cover all Americans.” By offering an alternative to the status quo, rather than simply attacking it, leaders can marshal support needed to make change positive.

Living with change …

There is a good lesson here for anyone who seeks to implement change in an organization. No matter how passionate people may be about seeking change and especially for those who do not recognize the need for change, the best approach for gaining acceptance of change is to debate the future, not the past. It is the duty of the leader to paint that future and explain the benefits to those who will live it. Only that way will real change come about.