Surviving America’s Political Meltdown


August 17, 2017

Surviving America’s Political Meltdown

by Jeffrey D. Sachs*

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*Jeffrey D. Sachs, Professor of Sustainable Development and Professor of Health Policy and Management at Columbia University, is Director of Columbia’s Center for Sustainable Development and of the UN Sustainable Development Solutions Network. His books include The End of Poverty, Common Wealth, The Age of Sustainable Development, and, most recently, Building the New American Economy.

The US is in the midst of a political meltdown, unable to manage a domestic economic agenda or a coherent foreign policy. The White House is in turmoil; Congress is paralyzed; and the world is looking on in astonishment and dread. If we are to survive and overcome this collapse, we must understand its sources.

There are two power centers in Washington, DC: the White House and the Capitol. Both are in disarray, but for different reasons.

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The White House–Calm and Dignified from the Outside and Messy and Toxic Inside

The dysfunctionality of the White House is largely a matter of President Donald Trump’s personality. To many experts, Trump’s behavior – grandiose self-regard, pathological lying, lack of remorse or guilt, expressive shallowness, parasitic lifestyle, impulsiveness, failure to accept responsibility for his own actions, and short-term marital relationships – are symptoms of narcissistic personality disorder.

The consequences could be dire. Pathological narcissists have a tendency to indulge in violent conflicts and wars (think of Lyndon Johnson and Vietnam or of Andrew Jackson and the ethnic cleansing of Native Americans). At a minimum, Trump lacks the psychological characteristics needed for constructive governance: honesty, dignity, competence, empathy, relevant experience, and the capacity to plan. According to some observers, Trump also shows signs of diminished mental capacity.

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The hope in Washington is that “adults in the room” will keep Trump’s dangerous tendencies in check. But the “adults” in Trump’s administration are increasingly military figures rather than civilians, including three generals (John Kelly, the new White House Chief of Staff, National Security Adviser H.R. McMaster, and Secretary of Defense James Mattis). Wise civilian leaders are the key to peace, especially given that America’s vast war machine is always revving. Recall John F. Kennedy’s military advisers, who advocated war during the Cuban Missile Crisis, or consider Mattis’s anti-Iran belligerence.

There are two other escape valves: the 25th Amendment, which charts a course for removing a president who is unable to discharge the responsibilities of office, and impeachment for “high crimes and misdemeanors.” Both measures are extreme in the US constitutional order, and both would depend on the agreement of Republican leaders. Nonetheless, one or the other may prove necessary and even urgent in the event that Trump’s psychological instability or political weakness leads him to launch a war.

The political meltdown in Congress is less dramatic, but serious nonetheless. There, the cause is not a personality disorder; it’s money. The legislative branch has been deeply corrupted by corporate lobbying and campaign contributions. Two brothers, the industrialists David and Charles Koch, worth a combined $100 billion, virtually own the votes, and voices, of Speaker Paul Ryan and Senate Majority Leader Mitch McConnell.

The result is politically perverse. Ryan and McConnell relentlessly push legislation favored by the Koch Brothers rather than the American people. The attempted repeal of President Barack Obama’s signature health-care legislation, the 2010 Affordable Care Act (“Obamacare”) had nothing to do with voters’ views or interests; it was simply what the Koch brothers (and other Republican mega-donors) wanted.

That’s why the repeal legislation was kept secret until the last moment and was never subjected to expert testimony or analysis – or even considered by a Congressional committee. The legislation could pass only if it was hidden from view and voted on in the middle of the night. In the end, three Republican senators jumped ship, siding with the American people rather than with the Kochs.

Between Trump’s narcissism and the Koch brothers’ money, the US government has become a shambles. Washington is still filled with many smart and talented people of both parties, but America’s political institutions and formal processes are diminished. The federal government is hemorrhaging scientific expertise, as researchers leave or are purged, and as agency budgets are targeted for deep cuts. Seasoned diplomats are flooding out of the State Department. Lobbyists, meanwhile, are installing cronies and hacks throughout the government.

Through the din, new drumbeats of war can be heard, most ominously against Iran and North Korea. Is it posturing or real? Nobody knows. Trump’s foreign and military policies are now announced in early-morning tweets, without the foreknowledge of the White House staff or senior officials. The situation is dangerous and deteriorating.

I suggest three immediate steps, and a fourth longer-term step.

The first step is to take Trump off Twitter. The US – and the world – needs public policy by consultation and deliberation, not one man’s worsening pathology. The American people, by a large margin, concur that Trump’s tweets are hurting national security and the presidency.

Second, congressional leaders should agree, on a bipartisan basis, to constrain Trump’s belligerent proclivities. Article I, Section 8 of the US Constitution vests the authority to declare war with Congress, and Congress needs to reassert that authority now, before it’s too late.

Third, the world’s major powers – most urgently, America’s NATO allies, China, and Russia – should make clear that any unilateral US attack on Iran or North Korea would constitute a grave and illegal violation of the peace, and that matters of war and peace must be agreed within the UN Security Council. If the US had heeded the UN Security Council’s collective wisdom in the recent past, it would have avoided several ongoing disasters, including the chaos in Iraq, Libya, and Syria, and saved trillions of  dollars and many hundreds of thousands of lives.

The fourth, longer-term step is constitutional reform to move away the US away from its volatile presidential system to a parliamentary system, or at least to a mixed presidential-parliamentary system, as in France. The power of the president – and therefore the danger of a runaway presidency – is far too great.

Much more needs to be done to restore democratic legitimacy in the US, including introduction of stricter limits on campaign financing and lobbying. First and foremost, however, we must survive the dangerous Trump presidency by preserving the peace.

John McCain’s Act of Defiance


July 30, 2017

John McCain’s Act of Defiance

by Mark Singer

http://www.newyorker.com

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Republican Senator John McCain from Arizona–An American Legislator, Patriot and Vietnam War Hero

I had agreeable disagreements with two friends yesterday, several hours before the Senate’s 1:30 A.M. vote on the Republicans’ scaled-down motion to repeal the Affordable Care Act. When the final vote was called, three Republican senators—Susan Collins, of Maine; Lisa Murkowski, of Alaska; and John McCain, of Arizona—drove a long knife through the cold heart of Trumpcare/McConnellcare/Ryancare.

Senators Collins and Murkowski had stuck their necks out much further than any other Republican politicians in the country. For this they had been trolled, slandered, subjected to sexist insults, and bullied—most prominently by the President of the United States, a career scam artist who ages ago lost his marketing mojo. They weren’t buying it. For at least a few hours this week, Ryan Zinke, the never-not-an-Eagle Scout Secretary of the Interior and, until January 20th, a Republican member of Congress, was running strong in the competition for the most despicable thug in Washington, after he reportedly called Murkowski to indicate that her state would suffer as a result of her no vote. (Beautiful, Zinke! Beautiful!) Senators Collins and Murkowski weren’t buying that, either. Nor was Senator McCain.

One of my friends had read my piece about the dilemma McCain confronted, and told me candidly that he wasn’t really buying my argument, either. “An action that merely avoids indecency,” he said, “has only the palest claim to decency.” My friend has worked for many years in many ways on behalf of social and—especially—economic justice. Though he respected Barack Obama, and had voted for him, he took a dim view of many of Obama’s more centrist or conservative policies.

For McCain my friend had no regard (though he forgives him); his sins of commission and omission were many. Sarah Palin, in his view, was the most egregious transgression (hardly a minority viewpoint), but there were others, largely sins by association. In general, my friend loathes what he perceives as the rapacious capitalist cynicism of all the money-grubbing liars who run the banks and grease politicians of both parties and shuffle in and out of corporate boardrooms and Presidential Cabinets and talk out of every side of their mouths as the nation’s and the planet’s wealth and resources and social-justice gaps grow beyond their already criminally negligent dimensions. He detested Hillary Clinton’s candidacy. As for Trump, why bother? For months last year, the Republican nominee, anticipating electoral defeat and extreme humiliation, whined and screamed about a “rigged” election, all the while sliming his way to the White House.

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My friend is certainly not alone in seeing that we are in a Hobbesian present. The United States as a nation of laws, as he sees it, is over. Certainly for the time being, and likely forever. The U.S. as a governable nation, also over. The U.S. as a world power bringing (mostly) democracy and goodness to others—over. And so on. My friend is a wholly decent, patriotic citizen of a country he no longer recognizes, even as the view from his window remains a rural New England pasture.

My other friend shared an equally jaundiced view: she had always thought of McCain as a conventional company man. “His sincere fidelity is to the institution,” she said. “It’s not an issue of humanity, or even a lack of humanity.” So, as an Annapolis graduate and a Navy pilot, and, likewise, as a prisoner of war, he behaved as he thought he should. McCain had been equally a creature, especially in recent years, of a Republican Party that moved further and further to the right, and further away from the bipartisan comity that he had for decades claimed to revere. “Let’s agree that a part of his biography is a tale of heroism and selflessness,” she said. “But if we’re talking about motivation, that’s far more banal.”

I agree with some of my friends’ sentiments. But, in my understanding, as the hour of the vote approached, John McCain elected not to be a company man. The institution that he had belonged to and loved for thirty years, the U.S. Senate, had become intolerable. Dishonorable.

For weeks and months, a burgeoning-until-overwhelming majority of Americans told their senators and congressmen that they did not want Obamacare declared null and void, its knotty flaws notwithstanding. Many of the forty-nine Republicans who cast votes in favor of this repeal knew that those votes bore the stench of unforgivable betrayal of the once-American ideal: equal treatment under the law, due process, and the unwritten imperative for a common purpose. Or perhaps they recognized that in their heads but were blind in their hearts—to their everlasting shame.

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John McCain, bearing scars ancient and new, acutely aware of his mortality, humble but standing a very tall five feet nine, approached the hour when he had to choose. He chose to vote with his soul—in defiance of the bottomless soullessness that, when the ultimate moment arrived, he rejected.

Mark Singer, a longtime contributor to the magazine, is the author of several books, including Character Studies.

Trump was right about health care for most of his life


March 31, 2017

Trump was right about health care for most of his life–Go Back to Basics

by Dr. Fareed Zakaria

https://www.washingtonpost.com

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Since becoming POTUS, DJT is under pressure

The recent Republican debacle on health care could prove to be an opportunity. It highlighted, yet again, the complexity of the U.S. system, which continues to be by far the most expensive and inefficient in the advanced world. But President Trump could actually use the legislative collapse to fix health care if he went back to basics and to his core convictions on the topic, which are surprisingly intelligent and consistent.

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Markets would not work well in Healthcare

There is an understandable impulse on the right to assume that health care would work more efficiently if it were a free market, or a freer market. This is true for most goods and services. But in 1963, economist Kenneth Arrow, who later won a Nobel Prize, offered an explanation as to why markets would not work well in this area. He argued that there was a huge mismatch of power and information between the buyer and the seller. If a salesman tells you to buy a particular television, you can easily choose another or just walk away. If a doctor insists that you need a medication or a procedure, you are far less likely to reject the advice. And, Arrow pointed out, people think they don’t need health care until they get sick, and then they need lots of it.

Every advanced economy in the world has implicitly acknowledged his argument because they have all adopted some version of a state-directed system for health care. Consider the 16 countries that rank higher than the United States on the conservative Heritage Foundation’s Index of Economic Freedom. All except Singapore (which has a unique state-driven approach) have universal health-care systems that can be described as single-payer (Medicare for all), government-run (the British model) or Obamacare-plus (private insurance with a real mandate that everyone opt in). Hong Kong, often considered the most unregulated market in the world, has a British-style government-run system. Switzerland, one of the most business-friendly countries, had a private insurance system just like the United States’ but found that, to make it work, it had to introduce a mandate.

While producing a CNN documentary on health-care systems around the globe, I was particularly struck by the experience of Taiwan, another free-market haven. In 1995, 41 percent of its population was uninsured and the country had very poor health outcomes. The government decided to canvass the world for the best ideas before instituting a new framework. It chose Medicare for all, a single government payer, with multiple private providers. The results are astonishing. Taiwan has achieved some of the best outcomes in the world while paying only 7 percent of its gross domestic product on health care (compared with 18 percent in the United States). I asked William Hsiao, an economist who helped devise the country’s model, what lessons they took, if any, from the United States. “You can learn what not to do from the United States rather than learn what to do,” he replied.

Americans often assume that despite its costs, American health care provides better services than others. We often hear about the waiting time for care in other countries. But according to the Commonwealth Fund, among industrialized countries the United States is in the middle of the pack for wait times, behind even Britain . Moreover, one of the world’s leading experts, Uwe Reinhardt of Princeton, has found that Americans use less care than the average for developed countries when it comes to things such as seeing a doctor and spending time in the hospital. The problem with the free market is that there is little profit in prevention and lots in crisis care.

Trump has now taken up the call to repeal Obamacare. But until recently, health care was actually one of the rare issues on which he had spoken out, before his campaign, with remarkable consistency. In his 2000 book “The America We Deserve,” he wrote:

“I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses. . . . We must have universal healthcare. . . . The Canadian plan . . . helps Canadians live longer and healthier than Americans. There are fewer medical lawsuits, less loss of labor to sickness, and lower costs to companies paying for the medical care of their employees. . . . We need, as a nation, to reexamine the single-payer plan, as many individual states are doing.”

Trump was right on this issue for much of his life. He has now caved to special interests and an ideology unmoored by facts. He could simply return to his convictions, reach out to Democrats and help the United States solve its health-care crisis.

From Obamacare to Ryancare to Don’t Care and maybe Trumpcare


March 15, 2017

From Obamacare to Ryancare to Don’t Care  and maybe Trumpcare

Twenty-Four Million Reasons the G.O.P. Health-Care Bill Is No Good

 By John Cassidy
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Is Ryancare the alternative to Obamacare?

For days, the political world had been waiting nervously for the Congressional Budget Office (CBO) ’s assessment of the House Republicans’ Trump-endorsed proposal to replace Obamacare. On Monday afternoon, when the numbers-heavy report finally appeared, one figure it contained dominated all the others: twenty-four million.

This was the C.B.O.’s estimate of how many fewer people would have health insurance if the Republican legislation—which is called the American Health Care Act—passes. In 2018, the first year that many of the bill’s changes would go into effect, fourteen million “more people would be uninsured under the legislation than under current law,” the report said. The difference “would rise to 21 million in 2020 and then to 24 million in 2026.”

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By anybody’s terms, twenty-four million is a lot of people. It is far larger than the fifteen million that two economists from the Brookings Institution had suggested last week that the C.B.O. might come up with. “To put the 24 million coverage loss in perspective, that reverses the entire coverage gain from the ACA,” one of the Brookings economists, Loren Adler, said Monday on Twitter.

As recently as January, Trump was promising that his Administration would provide “insurance for everybody.” Even for a President whose acquaintanceship with the truth is a casual one, explaining away the figures in the C.B.O. report could be tricky. It was not surprising, therefore, that the White House quickly dispatched Tom Price, the new Secretary of Health and Human Services, to rubbish the C.B.O. analysis. “We disagree strenuously” with the coverage estimates in the report, Price told reporters at the White House. Price insisted that the G.O.P. plan would “cover more individuals at a lower cost.”

Price didn’t provide any numbers to back up this claim. He hasn’t got any. (In fact, on Monday night, Politico reported that the White House’s own internal analysis of the health-care bill projected that twenty-six million fewer people would have coverage over the next decade.) The only thing that the Administration and its allies on Capitol Hill have to fall back on is the vague promise to follow up the A.H.C.A. with a second piece of legislation that would give insurers more freedom to offer cheaper, lower-quality plans, which, in turn, might persuade more young and healthy people to sign up. But that’s a pie-in-the-sky promise. Changing the rules for insurers would require sixty votes in the Senate, which the Republicans don’t have.

The C.B.O. analysis didn’t account for the possibility of insurers being able to offer cheap and lousy plans. The main thing driving its conclusions wasn’t changes to the individual market but the House Republicans’ reckless and deliberate assault on Medicaid, the federal program that provides health care for the poverty-stricken and the working poor. In estimating that twenty-four million people stand to lose their insurance coverage, the C.B.O. said that fourteen million of this total would be accounted for by reductions in Medicaid rolls.

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Any Hope for Trumpcare?

It is important to understand how this estimate was arrived at, and why it is reasonable. Under the Affordable Care Act, the federal government lifted the income threshold for Medicaid eligibility to nearly a hundred and forty per cent of the poverty line. At the same time, Washington also promised states, which administer Medicaid, that it would pay ninety per cent of any costs entailed in this expansion. Thirty-one states, including sixteen that now have Republican governors, took the feds up on this offer. The G.O.P. bill would end the Medicaid expansion in 2020—sooner, possibly, if the White House accedes to demands from ultra-conservative groups. The legislation would also change the way the rest of the Medicaid system is financed, shifting to a “block grant” model in which Washington would pay a fixed amount to the states for each recipient.

As a result of these changes, the C.B.O. report said that “some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee pending in the program would be capped.” The end result would be a big drop in enrollment and also a big drop in spending—eight hundred and eighty billion dollars over ten years. “By 2026, Medicaid spending would be about 25 percent less than what CBO projects under current law,” the report says.

The drop in spending on Medicaid helps explain why the C.B.O. estimated that the G.O.P. reform would reduce the deficit by three hundred and thirty-seven billion dollars—a fact that some Republicans seized upon. But why, you might ask, would the deficit be reduced by just three hundred and thirty-seven billion dollars over ten years when spending on Medicaid would fall by eight hundred and eighty billion dollars? The answer is that the bill would take most of the money that is saved from reducing Medicaid and hand it out to rich people in the form of tax cuts. The legislation would abolish the 3.8-per-cent Medicare tax on investment income and the 0.9-per-cent surtax on ordinary income that the A.C.A. applied to people who make more than two hundred and fifty thousand dollars a year. According to the C.B.O., getting rid of these taxes and some annual fees that the A.C.A. imposed on insurers would reduce revenues by five hundred and ninety-two billion dollars over ten years.

If the Republicans really wanted to fulfill Trump’s promise of insuring everybody—or, at least, preventing a big fall in insurance rates—they could have taken the five hundred and ninety-two billion dollars and used them to maintain the Medicaid expansion. Or to enlarge the new tax credits they want to offer for the purchase of individual insurance, which, in some cases, would be much smaller than the subsidies offered under Obamacare.

And I mean much smaller. In a table at the end of its report, the C.B.O. provided some “illustrative examples” of how different types of people might fare under the new system. Take a single sixty-four-year-old with an annual income of twenty-six thousand five hundred dollars. Under Obamacare, after receiving a generous federal subsidy, this person would pay seventeen hundred dollars in annual premiums. Under Trumpcare, or Ryancare, or whatever we want to call it, this person would pay fourteen thousand six hundred dollars. That’s an increase of twelve thousand nine hundred dollars!

To be sure, the way the new system would be set up, not everybody would be a loser. For example, a single forty-year-old with an annual income of sixty-eight thousand two hundred dollars could end up saving more than four thousand dollars a year, according to the C.B.O.’s figures. But, in general, people would pay more, at least in the early years after the measure goes into effect.

In the first few years, as some healthy young people drop their insurance plans because they are no longer mandated to purchase them, premiums would go up fifteen or twenty per cent, the report says. After 2020, average premiums could start dropping, and by 2026 the C.B.O. projects they would be ten per cent lower than under the current law. But that would mainly be because insurers would be offering cheaper, crappier plans to young people, and older people would be dropping insurance because they could no longer afford it. It will be interesting to see how Trump tries to sell that prospect to his supporters, many of whom are older and living on modest incomes.

John Cassidy has been a staff writer at The New Yorker since 1995. He also writes a column about politics, economics, and more for newyorker.com

When Facts don’t matter in America


March 13, 2017

When Facts don’t matter, Trump’s White House is the sole arbiter of truth.

by Paul Krugman@www.nytimes.com

Image result for Paul KrugmanDr. Paul Krugman-The Nobel Laureate in Economics

The U.S. economy added 10.3 million jobs during President Obama’s second term, or 214,000 a month. This brought the official unemployment rate below 5 percent, and a number of indicators suggested that by late last year we were fairly close to full employment. But Donald Trump insisted that the good news on jobs was “phony,” that America was actually suffering from mass unemployment.

Then came the first employment report of the Trump administration, which at 235,000 jobs added looked very much like a continuation of the previous trend. And the administration claimed credit: Job numbers, Mr. Trump’s press secretary declared, “may have been phony in the past, but it’s very real now.”

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Reporters laughed — and should be ashamed of themselves for doing so. For it really wasn’t a joke. America is now governed by a president and party that fundamentally don’t accept the idea that there are objective facts. Instead, they want everyone to accept that reality is whatever they say it is.

So we’re just supposed to believe the president if he says, falsely, that his inauguration crowd was the biggest ever; if he claims, ludicrously, that millions of votes were cast illegally for his opponent; if he insists, with no evidence, that his predecessor tapped his phones.

And it’s not just about serving one man’s vanity. If you want to see how this attitude can hurt millions of people, consider the state of play on health care reform.

Obamacare has led to a sharp decline in the number of Americans without health insurance. You can argue that the decline should have been even sharper, that there may be troubles ahead, or that we should have done better. But the reality of the law’s achievement shouldn’t be in question, and you should worry about the consequences of Trumpcare, which would drastically weaken key provisions.

Republicans, however, are in denial about recent gains. The president of the Heritage Foundation dismisses the positive effects of the Affordable Care Act as “fake news.” In Louisville over the weekend, Vice President Mike Pence declared that “Obamacare has failed the people of Kentucky” — this in a state where the percentage of people without insurance fell from 16.6 to 7 percent when the law went into effect. And as for the likely impacts of Trumpcare — well, they literally don’t want to know.

When Congress is considering major legislation, it normally waits for the Congressional Budget Office to “score” the proposal — to estimate its effects on revenues, outlays and other key targets. The budget office isn’t always right, but it has a very good track record compared with other forecasters; even more important, it has always been scrupulous about avoiding partisanship, and therefore acts as an important check on politically motivated wishful thinking.

But Republicans rammed Trumpcare through key committees, literally in the dead of night, without waiting for the C.B.O. score — and they have been pre-emptively denouncing the budget office, which is likely to find that the bill would cause millions to lose health coverage.

The truth is that while the office got some things wrong about health reform, on the whole it did pretty well at projecting the effects of a major new bill — and far better than the people now attacking it, who predicted disasters that never happened. And whatever criticisms one may have of its forthcoming score, it will surely be better than the ludicrous claim of Tom Price, the secretary of health and human services, that “nobody will be worse off financially” as a result of a plan that drastically cuts subsidies and raises premiums for millions of Americans.

But this isn’t really about whose analyses of health policy are most likely to get it right. It’s about Trump and company attacking the legitimacy of anyone who might question their assertions.

The C.B.O., in other words, is in the same position as the news media, which Mr. Trump has declared “enemies of the people” — not, whatever he may say, because they get things wrong, but because they dare to challenge him on anything.

“Enemy of the people” is, of course, a phrase historically associated with Stalin and other tyrants. This is no accident. Mr. Trump isn’t a dictator — not yet, anyway — but he clearly has totalitarian instincts.

And much, perhaps most, of his party is happy to go along, accepting even the most bizarre conspiracy theories. For example, a huge majority of Republicans believe Mr. Trump’s basically insane charges about being wiretapped by President Obama.

So don’t make the mistake of dismissing the assault on the Congressional Budget Office as some kind of technical dispute. It’s part of a much bigger struggle, in which what’s really at stake is whether ignorance is strength, whether the man in the White House is the sole arbiter of truth.