Tuesday, July 25, 2017

Trump Report Card after 6 Months

Six months have passed since the inauguration of President Donald Trump.  That represents nearly 13% of a presidential term.  They should have been able to legislate with little interference considering the Republican Party maintains majorities in the House and the Senate.  What does Trump and his administration have to show?  Well, not much.

The inability to pass any significant legislation in the first six months of Trump’s term represents his biggest failure as president.  Trump’s administration has control of both houses of Congress, yet efforts to create healthcare legislation augmenting the Affordable Care Act (ACA) have consumed too much time and the process has been haphazard.  

The White House seems absent in the actual process of crafting a replacement bill for the ACA.  Trump’s team appears to have ceded its power to Congressional leadership, which has twice stumbled in presenting the American Health Care Act of 2017 to the nation.  The bill failed so magnificently that Senate Majority Leader Mitch McConnell (R-KY) would not allow a floor vote (presumably to avoid further humiliation by watching many Republican senators vote against it).  When the AHCA experienced a painful death in the Senate, GOP leadership sought to vote on a repeal only bill of the ACA.  Like the AHCA, it never came to the floor.  

During the 2016 campaign, Trump created a “Contract with the American Voter,” a slate of issues to tackle within his first 100 days in office.  Here’s where the nation stands with the promises of Trump:

  • The White House is expected to create some sort of tax overhaul program for consideration by Congress, but no one seems to know when that will arrive on Capitol Hill.  
  • During his campaign, Trump promised to work on a spending bill that would improve existing infrastructure in the nation.  This isn’t on anyone’s radar right now.  
  • The proposed End Offshoring Act concept was a promise to levy tariffs against corporations who outsource and bring products back to the country.   This also included promises of returning manufacturing to the nation. Still no progress there.
  • The Trump administration also promised changes to education policy that would allow more educational options, such as devoting more funding for private schools and a voucher system.  Congress is said to be working on a bill, but nothing has been officially introduced.
  • Any type of immigration bill has escaped the attention of the White House, though the president’s budget included a request for billions of dollars to construct the now infamous ‘wall’ on the southern border of the nation.

Trump’s grade on his legislative agendaF, these issues have not been addressed in any significant way, nor is his team actively working with Congress to make them happen.

Beyond the legislative suggestions a president makes to Congress, the chief executive does have additional power to issue executive orders.  These are orders which direct a specific enforcement of an already existing law.  They can be overridden by a law passed through Congress or ruled unconstitutional by the Supreme Court.  Until that occurs, though, these orders have the force of law.

Hampered by the inability to pass legislation at the moment, Trump turned to executive orders to change some policies, but most of the 40-something orders he has issued thus far are rhetoric with little action.  Here’s a rundown of the significant orders thus far:

  • EO 13771 - This order requires that any government agency which issues a new rule or regulation must repeal two already existing rules.
  • EO 13780 - Undoubtedly the most well-known of the president’s executive orders, this particular statement directed that a travel ban be imposed on anyone coming from Somalia, Iran, Yemen, Syria, Sudan, and Libya.  Critics have contested this in the federal court system and the Supreme Court is expected to take up the issue during its next session.  
  • EO 13784 - This enabled the president to establish a commission on combating drug addiction and the opioid crisis.  It requires that a commission be established and they provide a report within 90 days whereby they advise the president about how to best fight the ongoing drug problem in the country.

Those these three executive orders help advance the president’s agenda, most of the orders are benign and don’t do much to change actual policy.  For instance, EO 13783 promotes energy independence and exploration of all forms of energy.  EO 13800 mandates that the president holds cabinet officers accountable for the cyber security of their respective departments.  

Trump’s grade on executive orders I, this can’t really be graded until we know the final result of the contested travel ban.  It represents one of the main priorities from the campaign trail and so far, it’s the only order to receive real scrutiny.  Many of the other orders create commissions or compel departments to create reports about various issues, which have not yet been issued.

What about President Trump’s foreign policy?  Trump deserves some credit for a few of his appointments to key foreign policy positions.  General James “Mad Dog” Mattis received bipartisan support as Secretary of Defense.  Secretary of State Rex Tillerson and United Nations Ambassador Nikki Haley are also highly regarded and have performed well in difficult roles.

The president’s ability to conduct foreign affairs is far greater than acting to push domestic legislation.  One of the nagging problems in the world pertains to the development of nuclear weapons and ballistic missiles in North Korea.  Trump has done little other than offer threats towards Kim Jong Un, while China has done little to curtail the activities of their quirky neighbor.  North Korea has tested nuclear weapons, and the Trump team has moved forward with an already existing plan to implement an anti-missile defense system in South Korea.  

President Trump has also backed off some of the campaign rhetoric directed at China and Japan, whom he claimed were currency manipulators, and he would instruct his administration to label them as much.  Moreover, the administration claimed they would work to adjust the trade deficits with these two nations, but that is largely connected to the ability of this administration to return manufacturing to the area.  The administration has implemented some tariffs on steel and lumber, but the long term results cannot be predicted at this point.

In the Middle East, Trump offered harsh words towards Iran during his campaign, but stated he will not cancel the executive agreement limiting Iran’s nuclear program.  Moreover, Trump admitted that Iran was complying with the agreement, though he lamented they were not “honoring the spirit” of the agreement.  President Trump declined to offer specifics on what that meant, but did claim his administration was reviewing the agreement “very, very carefully.”

Trump acted swiftly in response to the Syrian government’s use of chemical weapons against rebels by ordering a launch of 59 cruise missiles on a military air base.  Since that strike in April, the only other major action was the cancellation of a CIA program that armed the Syrian rebels.  This move has been viewed by many as an aid to Russia, who has supported Syria’s dictator, Bashar al-Assad.  These two actions appear to be a contradiction of sorts, and there does not appear to be any coherent policy pertaining to Syria.

Long-time ally Israel has welcomed President Trump’s administration.  The US has placed little pressure on the Israeli government for its expanded settlements in Jerusalem and the West Bank, areas that were once considered off-limits for expansion of Jewish populations.  Trump also noted that he would be satisfied with a one-state or two-state solution with respect to the Israeli-Palestinian conflict.  He is essentially offering President Benjamin Netanyahu carte blanche in the region.

Trump has wrangled several longstanding allies in Europe and North America, however.  Great Britain once considered banning Trump from entering the nation and mass protests occurred when the British government extended an invite.  Mexico is notably frustrated about Trump’s proposal of a wall on the shared border in the South (and more so with the idea that Mexico would pay for it) and the attempted renegotiation of the North American Free Trade Agreement (NAFTA).  Canada and France have also expressed annoyance with the bombastic comments Trump frequently makes.

The United States also made waves when it opted out of the Paris Climate Accords, a decision made by the president though many of his administrative team recommended staying, including his daughter, Ivanka, and Secretary of State Tillerson.  This made the United States only the third nation in the world to not participate in this widely popular agreement.

And finally, there’s Russia.  Currently, the relationship between the United States and Russia is somewhat frosty.  Intelligence agencies have stated the Russian government participated in illicit computer hacking in an attempt to sway the outcome of the 2016 Presidential Election (in Trump’s favor).  In December, outgoing President Barack Obama imposed certain sanctions against Russia and confiscated certain properties they held in the United States.  Trump has yet to reverse those actions, but numerous inquiries have been made about whether or not the president’s campaign team colluded with Russian officials for their assistance in the election.

Despite these allegations and concerns, Trump has been friendly with President Vladimir Putin and not taken him to task on his illegal occupation of Ukrainian territory in the Crimean Peninsula.  

Trump’s grade on foreign policyC-, The appointments of Tillerson, Haley, and especially Mattis earn Trump some credibility.  Yet, there is no cohesive policy about how the nation will handle specific issues.  Nations are left to wonder how their policies will be viewed by the United States.  Also, the friendly stance with Russia definitely deserves heightened scrutiny considering the circumstances.  Many Trump supporters remain puzzled because the candidate’s promises do not meet the president’s actions.

Communication might be the biggest problem facing the Trump administration.  President Trump uses Twitter as a platform to convey his thoughts, which are often confusing and misleading.  In several situations, he has focused on issues not relevant to his agenda, which only makes it more difficult to have the nation and Congress talk about anything other than trivial issues.

Trump created an issue just days into his presidency when he insisted his presidential inauguration had a larger crowd than former President Obama.  Despite evidence to the contrary, Trump kept perpetuating a false narrative, while the White House Staff labeled the president’s version as “alternative facts.”  

Though President Trump secured election victory by winning the vote in the Electoral College, he did not win the popular vote.  Hillary Clinton secured more overall votes, but Trump persisted that the final popular vote tally was incorrect because of millions of illegally cast votes.  He did not elaborate on this, nor could any proof substantiate such a claim.  

The Internet nearly broke after Trump rambled in a late night tweet, “Despite the constant negative press covfefe …” That was it.  Memes, random comments, and plenty of coverage trying to figure out what ‘covfefe’ is.  

The current administration is struggling to deal with the media who is becoming increasingly critical.  Trump’s response has been to label unfriendly reporters and media outlets as “fake news.”  This strained relationship between the White House and the media has led to scaled back briefings and cancelled credentials of veteran reporters.  Instead of using social media as a way to reach Americans, President Trump would rather tweet about how Morning Joe is an overrated show, and the New York Times is bad journalism.

Conservative news giant Fox News has even seen some of its journalists express frustration, including Shepard Smith, who vented of this administration, “Why is it lie after lie after lie? … The deception is mind-boggling and there are still people out there who believe we’re making it up.”

If the tweets and poor treatment of the media was not enough, Trump has also consistently contradicted subordinates on various issues, which makes apparent that the members of the administration are not on the same page.  

Ambassador Nikki Haley broke with the president on the Israeli-Palestinian conflict, noting the two-state solution was the intent of the United States.  Secretary of State Tillerson had to assuage Mexican officials who are still unhappy about the notion that they will pay for a border wall they do not want.  Tillerson was personally upended by the president on the issue of Qatar, a small Middle Eastern nation accused by the secretary of financing terror operations.  Less than two hours after Tillerson stated that the United States would not tolerate such actions, Trump contradicted his most important diplomat by reassuring Qatar had the support of the US.

Secretary of Homeland Security John Kelly had noted that Executive Order 13780, which temporarily halted immigration from several Muslim nations was not a “ban.”  Trump tweeted days later that he would call it a ban, which was precisely what it is in his view.  

Grade on Trump’s communicationF, There is no credible institution in the world who would think for a moment that Trump’s ranting tweets do anything but distract.  Additionally, the way Trump and his administration present a combative and insulting posture towards the media demonstrate they have no real message to deliver.  The slogan of “Make America Great Again” is their rallying cry, but the White House has yet to offer a cogent plan on how that will happen.  Allies and enemies alike have no clue what to expect from the US, and while Trump prides himself on unpredictability, this creates a far more unstable world.

No presidential administration can succeed unless the chief executive chooses the right personnel to carry out policies and solve problems.  Trump’s selections of Mattis, Tillerson, and Haley were widely seen as solid selections.  The president also receives high marks for filling the vacancy on the Supreme Court with Justice Neil Gorsuch, a reputable judge who withstood a great deal of angsty questioning from a Democratic Party who believed this seat was stolen (it remained unfilled for nearly the last year of Obama’s presidency). 

Though Trump has made a few wise decisions, the number of poor choices has become an exceedingly glaring problem.  First, there was Betsy DeVos for Secretary of Education.  She lacked any serious credentials in the field of education and has never attended a public school.  The fact that DeVos and her husband have donated hundreds of millions of dollars did not escape the attention of the Senate, who confirmed her by a 51-50 margin with Vice President Mike Pence having to cast the tie-breaking vote.

Rick Perry, former governor of Texas, was nominated to serve as the Secretary of Energy.  While he served in public office from a state known for energy production, there is an element of irony he received a nomination for this particular department.  In the 2012 presidential primary debates, Perry stated that if elected, he would eliminate four executive departments.  He named three of them, and forgot the fourth.  This, of course, was the Department of Energy.

Trump’s selection for Attorney General was former Senator Jeff Sessions from Alabama, a legislator with spotty record on civil rights issues.  The NAACP and ACLU strongly opposed his nomination, as they did in 1986, when his nomination for a federal judgeship was shot down.  Letters from the like of Coretta Scott King discussing Sessions’ poor record in supporting minority rights created a significant backlash.  Sessions was confirmed in a 52-47 vote along party lines.

Trump’s cabinet secretaries at least had to be confirmed by the Senate, which necessitated selecting individuals who would be questioned and vetted.  Members of the White House Staff, however, can be hired and fired at the discretion of the president.  This administrative team includes:
  • Kellyanne Conway - Special counsel to the president who coined the phrase “alternative facts” in the wake of the inauguration debacle.
  • Jared Kushner - Son-in-law of the president, who is facing a Senate Judiciary Committee hearing to determine his level of involvement in a meeting with a Russian attorney who offered the Trump campaign damaging information on Hillary Clinton.
  • Steve Bannon - Chief White House Strategist former boss of the Breitbart news outlet, which is the preferred medium of the “alt-right” extreme conservatism movement.  
  • Michael Flynn - the short lived National Security Advisor for the administration who lasted a scant 24 days before resigning when it became known he misled Vice President Pence about meetings with the Russian Ambassador to the United States.  
  • Sean Spicer - former White House Press Secretary who had the unenviable task of attempting to defend the president’s policies and strange actions.  Spicer left voluntarily after disagreeing with the administration on various issues, including the hiring of a new communications director.

After six months in office, Trump has made more terrible choices than some presidents do in a full four year term.  It doesn’t help matters that Trump has made threats to replace Attorney General Jeff Sessions and his Chief of Staff Reince Priebus.  Also, there are rumors swirling that Secretary Tillerson has already grown tired of Trump’s antics and is considering resigning.
Trump’s selections in hiring have been suspect, but one firing is drawing more attention away from his agenda than anything else.  Shortly after taking office, President Trump fired FBI Director James Comey, who was conducting an investigation into possible election tampering by Russian operatives.  
Comey had received high praise from Trump previously, for his investigation into Hillary Clinton’s e-mail servers and possible use of private e-mail for sending and receiving top secret information.  As late as January, Trump indicated he would retain Comey as head of the FBI, only to reverse course, claiming he lost confidence in Comey’s abilities to lead.

The firing of Comey set off alarm bells across the nation, as critics accused President Trump of attempting to cut off any investigation of his campaign’s collusion with Russian officials.  To look into the matter further, a special investigator was appointed by the Deputy Attorney General.  Jeff Sessions recused himself from involvement, citing his own involvement as a member of Trump’s campaign team.  

Trump quickly derided Sessions for his action, noting he probably would not have appointed Sessions if he was going to recuse himself in this action.  This only further fuels speculation about Trump’s campaign team and their meetings with various Russian officials.

Grade on Trump’s personnel choicesD-, The constant undercutting of his subordinates will chase off the good candidates and the ones who remain have proven to be sycophants who only seek to empower themselves.  The only reason this grade isn’t lower is due to the high level of respect garnered by Mattis, Tillerson, Haley, and Gorsuch. 

Overall grade for the Trump administration F,  The president has not been able to further his own legislative agenda because of the numerous distractions and the inability to focus his message.  The success or failure of his executive orders, including the travel ban, have yet to be determined, but his personnel decisions leave much to be desired.  

Trump seems unaware that government cannot be run like a business.  Power is greatly distributed and rightfully so.  In the case of the president, his power is largely based on his ability to persuade.  

Most incoming presidents have a certain amount of political capital they can use to leverage Congress into acting.  Trump did not win the popular vote, his approval ratings are low, and the Republican Party is unwilling to follow his lead.  When a president has this little capital at the beginning of the term, there is no margin for error.  

If Trump survives for an entire four year term (and that is anything but guaranteed), he will need to adapt to his surroundings and become more presidential.  Focus on solving problems, and responding to specific needs of the people rather than ranting on social media.

The Republican Party should be significantly worried about their immediate future.  Their majority in Congress could easily disappear in the 2018 midterm elections and the White House has shown no signs of following the party platform.  

Wednesday, July 5, 2017

Get healthy America! The ACA and some changes ...

Can anyone explain how we arrived at this point in history?  You know, the one where the most powerful nation in the history of the world cannot put together an effective system ensuring affordable healthcare for its citizens.  This is where the United States finds itself at the moment.

Developing technologies, medicines, training personnel about complex issues, and administering an effective oversight of the health care system presents a financial and logistical nightmare.  We should be astonished our system functions as well as it does.  However, this nation must implement changes to the existing legislation and structures or millions of families will struggle to stay healthy and financially solvent.

Unpaid healthcare bills have contributed to the increase in healthcare costs for Americans.  Many individuals lacked health insurance and required medical attention.  By law, hospitals could not deny certain services, yet the patients could not pay for these services out of pocket.  Thus, hospitals did not receive compensation.

These medical facilities made decisions to increase costs for various services to make up for lost revenue.  The gradual increase of these costs affected the individuals who paid out of pocket for their health care and those who received health insurance in some capacity.  This was a particular problem for health insurance companies, who saw their own payments to hospitals increasing.  These companies, in turn, passed on these costs by increasing health insurance premiums.  

In 2010, President Barack Obama put together legislation in an attempt to correct this problem.  His signature piece of legislation, known as the Affordable Care Act (ACA), sought to reduce healthcare costs by requiring that every American have health insurance.  Of course, the issue is more complex.

The ACA operates under the principle that if all Americans have health insurance, the number of unpaid medical bills will decrease.  Medical facilities could then lower various prices for services, thereby easing the burden on health insurance companies and those who pay for the premiums.  Hospitals would be happy because they would receive their money and people would be happy because they received necessary care.  

Prior to the ACA, Americans received health insurance through a variety of ways:  workplace providers, personally purchased insurance, Medicare for seniors, and Medicaid for low-income or disabled Americans.  Despite these various ways of finding health insurance, some citizens slipped through the cracks.  What does the country do with Americans whose jobs do not provide health insurance, yet that same person makes too much money to qualify for government assistance?

These individuals lack the financial resources to pay for insurance on their own and they are often too young to enroll in Medicare.  Their recourse was to hope they would not face a major illness or not pay their medical bills.

The ACA sought to correct these problems with some serious policy changes, which included: 

  • An individual mandate that required a person have health insurance or they must pay a fine
  • A requirement that any business employing 50 or more full-time people must provide health insurance for those employees
  • A child could stay on a parent’s health insurance until the age of 26
  • Insurance companies could not place a cap on benefits
  • A person could not be denied health insurance based on a pre-existing health condition
  • An expansion of the poverty line to include more Americans to qualify for Medicaid
  • The creation of an online ‘exchanges’ where citizens could examine various health insurance plans from companies.  The Americans who still did not have health insurance would benefit from being able to look at all the options.  Also, the hope was that having these companies post their coverage plans in the same online marketplace would create competition, driving down health insurance premiums

Conservative citizens in the nation objected to many of these major components for a variety of reasons.  No business owner likes having the government place additional restrictions on their livelihood.  Requiring them to provide health insurance would create a financial burden that cuts into profit margins.  The individual mandate also amounts to the government requiring a citizen purchase a good or service, which runs counter to the freedom to choose how we spend our money.  The expansion of Medicaid also means taxpayers will further subsidize the health insurance of people who are technically above the poverty line.  These represent valid concerns of many Americans.  

The implementation of the ACA has produced mixed results (which is typically the case with most legislation).  These policies have undoubtedly assisted low-income Americans, providing more insurance options and a greater likelihood that they will be able to pay for healthcare.  The expansion of Medicaid provided immediate relief to citizens across the nation.  Young people remained insured under their parents’ plans while at the ages where they searched for jobs that provided their own health insurance.

The ACA’s passage and implementation also positively affected the cost per person of health care spending and slowed the growth of Medicaid expenditures over the long run.

Millions of Americans received health insurance who otherwise probably would not.  This surely saved lives and improved quality of life for so many individuals.  Yet, despite some successes, there is a problem which still exists.  The ACA remedied the healthcare issues of lower-income Americans, but created a problem for middle-class Americans.

States and the federal government created online health insurance exchanges where individuals who still did not have coverage could shop, but the competition between companies has yet to see a reduction in those premiums.  Unfortunately, these premiums have increased since the implementation of the ACA.

One of the reasons for increases in health insurance stemmed from changes in the minimum coverage that insurance companies were required to offer by law.  Many Americans had no choice but to choose a new healthcare plan because insurance companies could no longer offer those old plans.  These individuals experienced a level of frustration after President Obama had touted, “If you like your healthcare plan, you can keep it.”

These Americans faced the prospect of paying far more in premiums for a plan they did not want.  They also did not qualify for Medicaid or Medicare, and their job did not provide insurance.  That puts millions of people in a difficult position.

Insurance companies also contributed to the increases in premiums.  When the ACA became legislation, companies could no longer deny individuals a policy based on pre-existing conditions.  Americans who once could not access health insurance now had policies, which dramatically increased the money paid out to medical facilities by insurance companies.  

The decrease in profit margin, or outright losses, forced insurance providers to increase premiums.  In other instances, the companies singled out the specific insurance policies that lost money and eliminated them as options.  The loss of lower-tiered options put individual consumers in a difficult position because the remaining policies offered by insurance providers are typically too expensive.  Generally, this leaves families with two discomforting choices:

  1. Pay the higher premiums and reduce their expenses elsewhere
  2. Pay the fine and forego health insurance with the hope of not suffering a major illness

Americans who fall into this category do not have the financial assets necessary to access medical care, nor can they afford to pay a fine for not having health insurance.  Also, these same working Americans contribute tax dollars to a Medicaid program that pays for the health insurance of others.  This represents a problem that must be solved.  Shifting the problem of health insurance from one socioeconomic group to another is unacceptable.

Since the ACA became law, Republicans have campaigned that they would ‘repeal and replace’ this legislation.  After the 2016 elections, they have been given the opportunity to do that.  The GOP maintains a majority in the House, Senate, and they control the White House.  Republicans have proposed the American Health Care Act of 2017, dubbed 'Trumpcare' as a response, which would:

  • Roll back the Medicaid expansion introduced by the ACA
  • Repeal the individual mandate that requires a purchase of health insurance
  • Reduces the penalty to zero on businesses who do not provide insurance to employees 
  • Repeal numerous taxes implemented by the ACA
  • Keeping private market rules from the ACA (no denial of pre-existing conditions, no cap on benefits, etc.)
  • Retaining the health care exchanges established by states and the federal government
  • Retaining the 5:1 ratio on what insurance providers could charge the oldest customers compared to the youngest (seniors tend to incur more medical costs, thus have higher premiums)
  • Encourage the use of Health Savings Accounts by increasing the amount that can be contributed to these accounts with paying taxes
  • Add an option that allows individual states to mandate employment as a requirement to receive Medicaid funds for non-disabled, non-elderly, and non-pregnant adults.
  • Prevents federal Medicaid funds from being used on any services from Planned Parenthood
  • States that insurance policies offered by providers do not have to include abortion services 

The provisions in this GOP plan have not been well received by the public or on Capitol Hill.  According to the latest estimates from the Congressional Budget Office (CBO), the American Health Care Act would cause more than 23 millions Americans to lose insurance coverage.  Additionally, the repeal of the taxes from the ACA would benefit wealthier Americans and this would negate most of the savings from rolling back the Medicaid expansion.  Within 10 years, the rate of uninsured Americans would move from 10.4% to 18.6%.

The ACA has corrected problems for millions of Americans, particularly those with fewer financial resources.  Despite successes, health insurance premiums still continue to increase.  The problem shifted from one group to another, and the GOP response to the ACA is deficient, to say the least.  

Where does this leave us?  What realistic solutions exist for providing affordable and effective health insurance to all citizens?  

Open insurance competition across state lines. One issue neither the ACA or its replacement option have addressed is permitting insurance companies to operate nationwide.  Currently, insurance companies must actually be in a state to offer policies to those citizens.  A person living in Florida could not buy a health insurance policy from a company that is based only in California.  The prohibition of interstate activity means each state has fewer providers and thus, less competition for the best prices and policies.  

Allow for more customization of insurance plans.  The federal government now creates most of the regulations involving what insurance policies must include, they could scale back some of these regulations to allow an individual customer to decide which features they want in their insurance policy.  For instance, does a single man need a policy that covers fertility treatments and birth control?  

In this instance, scaling back some of these regulations would be beneficial to individual consumers.  If insurance companies were permitted to make a menu of options for coverage, it would allow individuals to create a plan they can afford which allows them to receive health insurance.  Additionally, these companies can tailor their plans to customers and compete nationwide for the best prices.  

The ACA provides minimum standards for every health insurance policy, and we value this particular facet of the law.  Plans must cover hospitalization, prescription drugs, emergency services, and laboratory services.  Most individuals will need this for themselves or for their family at some point.  Yet, some of these services are not necessary for all individuals.  Do couples who do not want children need maternity and newborn care, or pediatric services?  What about singles who neither need nor want this option?  If an individual's life circumstances change, they can alter their policy to meet those needs.

Create more incentives for preventative care.  Prevention is the key to good health, and good health translates to lower costs for insurance companies.  Providers already give consumers some incentives for good health, such as rate reductions for individuals who do not use tobacco.  Insurance providers could offer further discounts for preventive care or the federal government could create available tax credits for certain preventive care.

Reduce fraud and improper payments in Medicare and Medicaid.  A considerable amount of fraud occurs annually where theses two government programs are overcharged and scammed out of millions of taxpayers’ dollars.  In 2012, the FBI arrested more than 100 medical personnel, including doctors, who billed the federal government for more than $452 million in Medicare services that were not given.  Three years later, a group of 243 individuals were arrested by authorities for racking up more than $712 million in fraudulent charges to Medicare.  

Of course, these dollar amounts represent a pittance of the fraud occurring annually.  The Department of Health and Human Services estimates that potential fraud and improper payments make up as much as 10% of Medicare and Medicaid expenditures.  This translates to billions of dollars that could be funneled to any number of other programs or returned to taxpayers in some capacity.

Examine healthcare systems from other industrialized nations who offer the same services at significantly lower costs.  There is no shame in asking others for assistance in solving problems.  Specifically, European models might provide answers as to how to reduce prices for certain medical services.  Why does the same MRI cost three to five times more in the United States than it does in France or Great Britain?  Why does a hospital stay in the United States cost nearly three times as much as the same stay in a Japanese facility?  

Individuals in other nations visit the hospital far more frequently, receive comparable care, and use the same pharmaceuticals.  It would be wise to examine these systems and implement changes to alleviate some of the pricing problems.

Create nationalized standards for forms, computer software, and other administrative aspects of the health care industry to streamline the process and provide easier sharing of key information.

Keep most aspects of the ACA, particularly the expansion of Medicaid.  The current rules and regulations about health insurance corrected problems that hurt lower-income Americans, but premiums increased for a large number of Americans.  Changing legislation to shift the problem back to what it was does not represent a viable solution. 

An element of compromise can provide a solution that might have a positive effect.  With any public policy, the government should evaluate its effectiveness.  Specific legislation can then be crafted to refine that policy and correct problems.  In this case, scrapping the system is not the appropriate response.  

Yet, the health insurance issue has become a political pawn whereby Democrats do not want to give up any part of President Obama’s signature piece of legislation and Republicans refuse to publicly admit that the ACA has any good elements.  This policy area represents the current incarnation of the inability of our two major parties to do what is right and beneficial for American citizens.  When our two major political parties stop using policies as tools to gain power, perhaps they can become more cognizant of the fact that they are not the only group who has good ideas.

Require all sitting members of Congress to purchase health insurance on the market exchanges.  The men and women in our lawmaking body might have the ability to sympathize with Americans who face difficult choices, but unless it directly affects them, they will hesitate to change the status quo.  

Most members of Congress and the president will not face the prospect of not having adequate medical care because their net worth far exceeds the typical citizen.  If members of Congress were required to purchase health insurance on the individual market, at least they would have a small semblance of the impact of their votes.

Saturday, December 3, 2016

The "Arrival" of Jesus Christ

(Warning:  This post contains important movie spoilers!)

Typically, posts on this site pertain to the political, but the Christmas season and a recent film have prompted a change to my norms.  And, to be very candid, one cannot ignore the impact of Jesus Christ upon the world.  Yet, Christmas, the annual celebration of the birth of Jesus Christ, has taken on a secular meaning that attempts to rival the religious.

Despite the political arguments about a 'war' on Christmas, so many people miss the Christian parallels and allegories in popular culture.  During this Christmas season (or any season for that matter), would it not stand to reason to genuinely seek out the meaning of who Jesus Christ truly is?

Understanding Jesus Christ is not easy, and it requires study of the Bible, which most people find daunting.  The nature of Jesus Christ, though, is sometimes reflected in popular culture, particularly in film.  While more obvious examples exist, such as The Passion of the Christ (2004) and The Last Temptation of Christ (1988), more subtle movies exist with Christian undertones.  The Matrix (1999) was a popular allegory for Christianity embraced by churches throughout the country.  Man of Steel (2013) portrayed comic book legend Superman as a 'messiah' of sorts.  

This fall, the film Arrival has picked up the mantle of the latest movie to generate discussion of a religious theme.  The film's plot centers around the mysterious arrival of alien ships appearing above 12 random locations in the world.  The ships provide opportunities for humans to communicate with the aliens, and the American government calls in Dr. Louise Banks (Amy Adams), an expert linguist, to establish a connection.  Banks is joined in her mission by Dr. Ian Donnelly (Jeremy Renner), a scientist, who assists in the first contacts with the aliens, which are dubbed 'heptapods' (because they have seven legs).

Banks and Donnelly initially have little success with verbal language, but experience a breakthrough with demonstrating written language.  The heptapods respond in kind, which generates true progress.  In the written language of the heptapods, complex sentences and thoughts are communicated through what appears to be variations of a circular shape.  Banks becomes engrossed in her work, so much to the point where she has constant flashbacks and dreams to her own personal failures and pain, including a difficult divorce and the chronic illness of her daughter, which ultimately ended in the death of the child.  The flashbacks had been occurring before, but seem more frequent.

While the academics working to speak with the heptapods are genuinely curious, the government officials in charge of the expedition are more concerned with the security of the world and want to know precisely why the aliens have come to Earth.  Through tireless work and with the help of technology, Banks develops the ability to effectively communicate with the heptapods.

The daily message exchanges reveal key facts about the aliens, including their intent, which is to provide a gift to humanity — their language.  Of course, the obvious question to humans concerns how a language could be considered a gift.  Some nations even believe the aliens have created a ruse and have translated the gift to mean 'weapon.'  

Banks and her team also discover the aliens do not see or view time in the linear fashion that humans do.  They experience time differently, and they do not have an understanding of the linear, which explains why the creatures are puzzled by algebra (we've all been there).  This relates to the reason why the heptapods have arrived.  We learn that their gift to humanity is not entirely selfless, as they will need humanity's help thousands of years in the future.  By providing humanity with their gift of language now, the heptapods will equip us with the words we need to rescue them in some way during the future.

The revelations made to Banks greatly concern military figures who control access to the aliens, who are concerned about ulterior motives and potential conflict.  This is of great concern after the Chinese convey plans to attack the alien ship in their territory, which they are convinced is a  threat.  Banks makes one last attempt to communicate with the heptapods, who provide her with the stunning information that she already has the gift, and now, she need only use it.  

It is at this point, the viewers are treated to a nice plot twist.  Throughout the film, we are led to believe that Banks is remembering the past of her divorce and the death of her child.  However, the reality is that she has been seeing glimpses of the future.  Banks comes to the understanding that these visions are not so much visions, but her experiencing time and space in the way that the heptapods do.  Time is no longer a linear experience.

The exposure to the alien language has irrevocably altered the way in which Banks thinks (and there is a discussion of this concept earlier in the film).  She can experience time in the moment, and more significantly, in the future.  This is particularly significant when the Chinese are poised to attack the heptapods.  At this moment, Banks experiences the future, when she is attending a black tie event, and is introduced to General Shang, the Chinese leader who was prepared to order a strike against the aliens.  

Through her conversation with Shang in the future, Banks is able to use that information in past events to prevent him from ordering an attack.  Of course, this presents an interesting paradox.  Banks' future is only successful because of the information she received in the future.  Which event caused the other?  How could a past event be caused by a future only possible through the past which it must cause? 

The paradoxical event aside, there exists a much more interesting subplot.  Banks becomes aware that her future husband is Donnelly, the scientist she has worked closely with in communicating with the heptapods.  She has a difficult decision to consider.  Would the joy of the experiences be legitimately worth the degree of pain we would endure during the process? 

At its root, this could be viewed as a cost-benefit analysis — no different than any other economic choice.  If we look at this from an intellectual level, we should probably avoid the pain of a divorce, and not have a child who will die at a young age.  Perhaps it would be better to not have it happen, so that we could be spared the suffering, and prevent our own child from experiencing such a life.  

However, we know that the emotion of our humanity does not bend to the rules of economic decision making like other issues.  Love motivates people to override their instincts, logic, and sound decision making.  There is no cost-benefit here.  Banks chooses the life laden with suffering because of the joy coupled with it.

This is where we begin to see the parallels to Jesus Christ.   In terms of decision making, Jesus Christ saw his own future and experienced the rejection, pain, suffering, and sin of humanity for a brief moment in the Garden of Gethsemane.  Faced with the possibility of dying for the sins of humanity and experiencing ultimate suffering in their place, Jesus could have easily walked away and left us with a fate we rightfully earned. Yet, Jesus saw the agony that awaited humans and the wrath God intended to pour out on them, and Jesus chose to take that punishment for them.

For Jesus Christ, the pain he endured was worth it.  And for those who would follow, Christ bids us to make a similar choice with our own lives.  He asks for his disciples to take up their cross and follow him.  Take heart when you encounter suffering, because the end result is worthwhile for the Christian.  It would be easier to avoid difficult situations and pain, but there is something greater in the selflessness.

For Louise Banks, the experience of connecting with the language of the heptapods left her changed forever.  She began to experience the world in a way that would not allow her to return to her old life.  An encounter with Jesus Christ will produce the same result.  It leaves you transformed, and there is no going back.  No so coincidentally, the "word" of God is a language unto itself that will change how a person lives, permeating through every aspect of their life.

Additionally, the arrival of the alien ships causes an upheaval in humanity, which leaves an indelible mark on society.  Jesus' time on Earth radically reshaped humanity in such a way that his impact is still echoing through the world.  More than a billion people throughout the world claim to be followers of Jesus Christ and acknowledge him as God.  That, in itself, is astonishing.

Jesus was also able to alter the way people think about the world around him.  He demonstrated that we all have deeper flaws than we could have seen, yet are more loved than we could have hoped.  Jesus' message was also radically more inclusive than any religion or worldview.  He included the rich and the poor, men and women, Jews and Gentiles, the sick, the lepers, and tax collectors, and even sat down to eat meals with the very people who would later be instrumental in his crucifixion.

In Arrival, when the alien ships appear, there are no signs of hostility from the Earth's visitors, yet the world's powers are threatened by the existence of a power greater than themselves, so they plot in vain to strike against the heptapods.  This is akin to the reaction of the Pharisees and other individual powers in first century Judea, who were terrified at the power Jesus held over people that diminished their own authority.  Their response was to plot to kill Jesus.  Humanity seems to have a default setting that leads us to want to destroy anything that we cannot control or understand.

There are smaller nuances about the film that point towards a Christian theme.  The heptapods have seven legs, and they land in 12 different locations above the Earth.  Both numbers are featured throughout the Bible.  The aliens experience time differently than us, where they are not bound by a linear perspective.  This is how we imagine God would view time, not bound by its constraints and freely moving back and forth.  When the aliens have taught us what we need to know, they fade away out of existence.

Despite being a well-made film, every analogy breaks down at some point.  Arrival is no different in this regard, and it is assuredly not an adequate substitute for studying the gospels.  However, it points us to something greater than ourselves, and should push us to further examine who Jesus Christ is.

The strange irony of modern society is that we love the trappings of Christmas.  Buying and wrapping presents, decorating, and work Christmas parties are part of what we do, yet we toddle along through the season without paying that much attention for whom the holiday was named.  Since Christmas is coming, would it not be a wise choice to consider the truthfulness of Jesus' claims that he is God?
The world applauds us when we seek out the truth, yet demonstrates a terrible disdain for anyone who asserts that they have found the truth.  Jesus himself stated that he is the truth.  This Christmas, I hope that you would see the truth and proclaim the coming of a savior.  Merry Christmas!

Friday, November 11, 2016

In defense of the Electoral College ...

Every presidential election brings about a fresh round of criticisms of the Electoral College and 2016 was no different.  President-elect Donald Trump garnered 306 electoral votes to Hillary Clinton's 232, securing him the biggest upset in presidential history.  That fact, however, was not the most painful blow to the Democrats' wounded pride.  Despite winning the presidency, Trump lost the popular vote by approximately 200,000 votes.  That sticks in the craw of the liberal segment of society.  Most elections work on the principle of a plurality vote -- the most votes wins the race. 

In 21st century America, people want to immediately call to question why we would not have a direct election for the presidency.

Inflamed passion and a mob mentality are the preeminent reasons the Framers of the Constitution sought to implement a republic rather than a direct democracy.  James Madison, one of the key individuals in writing the Constitution, addressed this issue in his classic Federalist #10.  Madison wrote that a serious concern in our then new nation was how to deal with what he referred to as 'factions.'

The individuals behind these groups could easily sway a popular vote.  Madison warned, "Men of factious tempers, of local prejudices, or of sinister designs, may, by intrigue, by corruption, or by other means, first obtain the suffrages, and then betray the interests of the people."  It would not be difficult for a charismatic individual to capture the hearts and minds of the American people, thus the Framers believed a republican form of government (note the little 'r') would be the most ideal.

Madison and other Framers understood that a direct democracy was dangerous and untenable.  He continued, "... such [direct] democracies have ever been spectacles of turbulence and contention; have ever been found incompatible with with personal security or the rights of property; and have in general been as short in their lives as they have been violent in their deaths."  When citizens have direct control over governmental issues, they are prone to making terrible choices that break down a society.

The remedy, according to Madison, was to use a chosen group of representatives,
... whose wisdom may best discern the true interest of their country and whose patriotism and love of justice will be least likely to sacrifice it to temporary or partial considerations.  Under such a regulation it may well happen that the public voice, pronounced by the representatives of the people, will be more consonant to the public good than if pronounced by the people themselves ...
A small, deliberative body will be far more likely to make a solid choice than the general public.  This notion is reflected thoroughly in the Constitution, which created four key institutions -- the House of Representatives, the Senate, the presidency, and the Supreme Court.  Of these, only the House was directly elected by the people.  Senators were chosen by their respective state legislatures, and the members of the Supreme Court were chosen by the president (with approval from the Senate).

How to best choose a chief executive was a point of contention at the Constitution Convention in 1787.  At the Convention, one of the more popular ideas was to mimic British policy, whereby their Parliament selects a prime minister.  The sentiment at the Convention was to have Congress select a president in a similar capacity.

Americans should also be cognizant of the fact that our Constitution grants more power to a chief executive than most other democracies.  The presidency combines the roles of head of state and head of government into one office.  This type of power vested into one person should make us leery of entrusting the people to select this individual.

This notion was asserted by Alexander Hamilton in Federalist #68, where he wrote, "It was desirable that the sense of the people should operate in the choice of the person to whom so important a trust was to be confided. ... It was equally desirable that the immediate election should be made by men most capable of analyzing the qualities adapted to the station ..." 

Though a popular vote was never seriously considered for selecting the president, the Framers believed that the nation would best be served if the body of representatives who chose the president be convened only for that specific purpose.  Thus, the Constitution included a clause that forbade members of Congress from being members of the Electoral College.  Such an impetus further guarantees the principle of separation of powers found within the Constitution.

The means of selecting the president through the Electoral College still permits the people to retain influence, just not direct influence.  The Constitution provides that each state will have a number of electors who may be chosen however that state deems fit.  This provides the people of each state the opportunity to place men and women of character in the position to choose the single most powerful individual in the nation.

Moreover, Americans do not realize that they have absolutely no Constitutional right to vote for president.  States merely choose to allow their citizens to vote for president.  The practice varies from state to state, but in many instances, both major parties select a slate of delegates to be the members of the Electoral College should their preferred candidate win.  However, there is no guarantee that citizens would be permitted to vote, nor is there any promise that slate of delegates will cast their electoral vote for the candidate prescribed by the state's citizens.

In the early years of the republic, many states did not bother having a popular vote for president.  And why should they?    The very purpose of the Electoral College is to prevent a direct influence from the public on the presidential election, while still retaining the overarching principle that the people have the ultimate authority in our system of government.

Even with the current incarnation of the Electoral College, the members have no obligation to cast a vote in line with the popular vote of their state.  Several states have created laws that impose a fine if one of its electors does not vote with their state, but such fines are minimal and small contrivances when compared to acting as they see fit.

Critics of the Electoral College call this method undemocratic and arcane.  Maybe some truth exists to those charges.  Yet, these critiques only make sense within the lens of modern American political culture, which has somehow coalesced into the notion that we should have a right to choose everything.  Upon what do the opponents of the Electoral College base this idea?  Why should modern America entrust its citizenry with the important task of selecting the most powerful single official in the country?

Americans pay lip service to respecting the Founding Fathers and invoke the ghosts of great leaders like Washington, Hamilton, and Franklin.  It appears that the heaps of praise for those men is only relevant when it is politically convenient.  Politicians and ordinary citizens love these patriotic leaders until they actually see what they created. 

Instead of abandoning the Electoral College, I believe America should abandon the popular vote instead.  Return the Electoral College to its rightful place as a unique body with the sole purpose of choosing a chief executive for the nation.  Let each state carefully choose electors who will consider the options and make selections accordingly.

Does this sound like an insane idea?  This occurs at the federal, state, and local levels of government.  We already trust people and government agencies to make important decisions for us constantly, which is the entire point of a republic. 

Incidentally, a national popular vote to decide the presidency is problematic and impractical for many reasons.  Candidates seeking election would focus their campaigns on major urban centers, and abandon the rural parts of America.  Changing the system would also require the Constitution to be amended to eliminate the Electoral College.

Amending the Constitution (typically) requires 2/3rd of both houses of Congress to officially propose an amendment and then 3/4th of the states to ratify an amendment.  Given that small states benefit from the Electoral College, it is highly unlikely that an amendment proposal would gain any traction.