Friday, June 30, 2017

Change our Message: a Guest Post

Trump did not win because he was so good. He won because the Democratic message seemed so annoyingly smug to a great many people. 

By attending multiple campaign events in 2015 and 2016 I became aware that the Democratic message was flawed. It helped to be in the room and watch the lack of passion created by Hillary Clinton. It helped to be in the room at rallies when Republican candidates--Trump, yes, but it includes Cruz and Rubio and Christie who also won significant votes--as they quoted Democrats to elicit Republican resentment. Democrats may not have thought they were sneering, but Republican audiences heard the sneers, and so, apparently, did many others in states that were expected to vote blue.

The message guided the policies, and it became apparent that even Democrats did not really believe their own messages and their own messages were pulling them from their true selves. Democrats found themselves unable to condemn urban rioting, found themselves defending immigration scofflaws, found themselves positioned as the party that was less patriotic, less respectful of religion, and the one that in its effort to define and empower minority rights became the party that created a race-conscious backlash of whites who felt under siege by racists. Democrats were loyal to their teammates but not to their own values.  

So a lot of Democrats jumped ship. A majority of white women voted for Trump, notwithstanding indefensible behavior toward women. Fully a third of Hispanics voted for Trump, notwithstanding his saying that Mexico had sent its thieves and rapists here. Many Democrats were never-Hillary and saw her no better than Trump.

This blog argues "no, it will not."
I have not urged that Democrats become "more conservative". Instead, I have argued that Democrats and liberals become more realistic, more honest, and more like their own true selves. Democrats can be the party that is non-racist and dedicated to opportunity for all and justice for all. Democrats can represent the interests of working people and oppose aristocracies of wealth and power. It can be the party that protects the environment, and do so without hypocrisy, but to do so it needs to be a party that recognizes the externalities of both consumption and production. It can be the party of good, honest government, but then it needs to walk that talk. And it can communicate those values.

There are other people in America who understand that the 2016 election was a wake up call. One of them is Peter Rice.

Peter Rice is an journalist and writer who lives in Albuquerque, New Mexico. He has been observing many of the same things I have articulated in this blog, and has compiled them into a book, Liberal for Conservative Reasons. He stumbled upon this blog and thought we were birds of a feather. I asked him to send me a guest post comment on health care.


Guest Post, by Peter Rice:

"The health reform bill is stupid, but liberal arguments aren’t helping."

Peter Rice
We can perhaps relax for a few days, as the Senate’s efforts to eviscerate the Affordable Care Act are mercifully on hold. But be warned: This is probably just the eye of the storm, and soon enough, our fellow lefties will resume the same inward-looking arguments that helped us to get to this precarious point in the first place.

It will go something like this: Healthcare access is a human right. Any decent society takes care of sick people without worrying about the money. It’s the honorable and decent thing to do. Throwing people off insurance is cruel and will kill people.

Convinced? I sure am, but here’s the problem: I’m the choir you’re preaching to. Liberals don’t need to convince liberals. They need to convince conservatives, and using liberal arguments is a terrible way to do that.

Conservatives listen to these same talking points and come away with the distinct impression that it’s all a big plot to transfer money from successful people to a bunch of poor losers. This makes them angry, but also a bit gleeful, because they positively love talking about people they don’t like getting welfare they don’t want to help pay for.

So to review, our sanctimony and hand-wringing has only served to push the debate toward their home turf. That’s unfortunate and crazy, since there are perfectly good conservative arguments in favor of universal healthcare. It’s time to start actually using them.

The talking points go something like this: Passing a law that raises the uninsured rate may be cruel, but above all else, it’s a blow to fiscal responsibility and efficiency. It puts people in a position where the most logical and reasonable course of action is to pay nothing into the system and avoid relatively cheap primary care. If some catastrophe hits, they then fling themselves on the nearest emergency room, a place where single aspirin pills always seem to cost $53. The considerable bills for those services rendered might be put on a payment plan, but odds are good they’ll end up getting dismissed by a bankruptcy judge, so the hospital eats the cost by passing it along to everyone else. (This has always struck me as the perfect definition of socialized medicine.)

If that doesn’t sound expensive enough, consider the poor, the addicted, and the mentally ill in your town. Not out of empathy, of course (God forbid). Think about what it’s like to be you, a comfortable, well-insured member of the middle class, living in the same city with those people. And think about everything you have to lose if they don’t have access to healthcare.

If poor people avoid preventative medicine, they are more likely carry communicable diseases, which you are then more likely to get, so you lose. If they become too sick to work, their contributions to Medicare and Social Security go down just as their dependency on welfare goes up. And it makes it harder for any kids in the picture to move on to bigger and better things, which you will pay for later. You lose again, again, and again.

And what of the addicts? You’re welcome to dismiss them as a bunch of hopeless losers, but that doesn’t make them go away. Less money for treatment means more theft, more vagrancy, more trips to the ER to treat overdoses, more cops, and more jail cells. You get to pay for it all, and lose again. And the mentally ill? A few therapy visits may make the difference between graduating from high school or not, and that’s a difference of tens of thousands of dollars into the federal treasury through various payroll taxes. Fail to push that situation toward the right direction, and you lose again.

Cutting subsidies to poor people’s health insurance only saves money if they are all suddenly raptured the second they get booted off their plan. Back in the real world, it just means they pay for nothing until things get so bad that the rest of us swoop in and pay for everything. That’s a living conservative nightmare, and all the more reason we should refocus our healthcare finance debate. It’s true that this repeal bill is cruel, but conservatives won’t listen to that argument. Luckily, it’s also true that this bill goes against everything conservatives stand for, and I like our chances with that.


Peter Rice is the author of Liberal for Conservative Reasons: How to stop being obnoxious and start winning elections, which is available on Amazon. Contact him through

Thursday, June 29, 2017

Hiding out on Health Care: Deny. Delay. Distract.

Greg Walden cannot distract the way Trump does.  Walden is quiet, modest, earnest.   So he hides out from the Trumpcare disaster he helped create.

Deny. Delay. Distract.

Two days ago this blog observed that Greg Walden was hiding out.  He had climbed high up onto the GOP leadership ladder and was made Chair of the Energy and Commerce Committee that had primary responsibility for writing the "Repeal and Replacement" of Obamacare.   Greg Walden was in the center of the great national policy debate on health care.  

Busy at work
Problem for Greg Walden:  He sold an impossible dream.  He is now stuck with a broken promise.   He sold people what they wanted--what anyone would want, something really wonderful in the form of patient centered health care that was affordable, accessible and really, really great.  Walden, like Trump, told people that if elected he would create a health care system that was cheap, universal, simple, and excellent.  The grave problem for Walden is that what he sold is, of course, impossible.  

In the real world the public could get one of those four, not all four.  The House version of the health care bill settled on "cheap."   The House and Senate bills are less, not more, but they are in fact cheaper.  Taxes on people earning $250,000 or more will go down, and many of my former clients are delighted.

Some 120,000 of Walden's constituents--people do do not earn $250,000 a year--will lose health care access.  It means that rural hospitals in Medford, Ashland, Klamath Falls, Bend, Pendleton, will go into a financial death spiral because they will provide emergency services from people who cannot pay.  It means uninsured people go to collection and bankruptcy.   It means he breaks his promise to make possible affordable health insurance to people over age fifty who have pre-existing conditions.  

It is miserable to need to tap dance politically, asserting things that are arguable, but essentially untrue, things that he wants to be accurate but which are contradicted by objective facts.   Walden doesn't want to be dishonest, but he is stuck.  

News Photo from Politico
Strategy number one is to deny.   The story Walden and his colleagues are putting out is that things are in fact OK and that even though there is less money that people who really need a subsidy will get it and that even though the high risk pools don't have enough money to support access for people with pre-existing conditions that, somehow, they will work.  Perhaps the states will pony up the missing money.  Meanwhile, they criticize the CBO reports which say that less money means less coverage.  And they advertise, running sunny ads declaring victory.

Walden knows better, but some of his colleagues are asserting that everything will be great and they are sticking to the story.  After all, possibly the states will really step up.  Possibly Oregon will find money somewhere and use it for healthcare not PERS and higher ed and infrastructure.  It is possible.  

Strategy number two is to delay.  Actual implementation of much of the reductions do not take place until after one or two election cycles, not until after 2018 in the House version and after 2020 in the Senate version.   You are all right now, what's the concern?

Strategy number three is to distract.  Greg Walden's website talked about everything else he is doing other than health care, which this blog reported two days ago.  Yesterday I received an email update from Greg Walden.  Here is the web version of the email:  "Quick Update" e-mail    He is busy with the VA Accountability and Whistleblower Protection problem, busy touring The Dalles Dam to see first-hand the inner working of hydropower generation, going to work to reopen the Cultus Lake Forest Service campground, meeting rodeo fans at the Crooked River roundup, seeing the widow of a victim of pancreatic cancer, meeting Oregon home builders, meeting students involved with Oregon Rural Electrical Cooperatives, expanding broadband internet access, advocating for career and technical education, and urging people to keep in touch with him on the various important issues that face them.     

Town Hall look
These are all matters of concern for a Representative, but notice what is missing:  Not a word about the issue that represents 1/6th of the economy, that is the culmination of 7 years of attacks on Obamacare, that is the daily headline news as the country sorts through its options, and that was a primary responsibility of Walden personally and in his committee.

Walden does not have the personality for a first class distraction.  The news photo above catches Walden at a candid moment.  It is classic Walden:  1.  behind someone else.  2. looking earnest and attentive and sincere.  3. mouth shut, listening.   His overall demeanor is serious and helpful, not showy.    His appearance at the Rogue Valley Town Halls are a reiteration of this.   

It is the Greg Walden nature to be modest, unassuming, earnest--and to hide out from the grim truth that his healthcare "repeal and replace" is nothing like what he told people it would be.  He had the exhilaration of selling a dream and now he has to live with a reality that contradicts the dream.  It is only natural that he hides.

Even a typo changes the subject
Donald Trump exhibits a different strategy, one that works for him and works at the presidential level.  Big, bold, wild.  The healthcare matter may be the central domestic policy issue but Trump news is all about Russia, Obstruction of Justice, Fake News at CNN, a 2020 fundraiser, the Trump Hotel, Syrian poison gas, Obama letting Russia steal the election for him, and on and on.

Trump can distract with something big.  Walden is doing what he can do:  hide.

Wednesday, June 28, 2017

OnTrack Case Study, continued

OnTrack received criticism.    Effects, reaction, counter-reaction, disaster.

The travails of OnTrack--a southern Oregon addictions recovery nonprofit agency-- is a cautionary tale.   Businesses, non-profit agencies, politicians, and government agencies can learn from this.

Click Here for the original post
On June 18 this blog presented a commentary on a general failure of OnTrack to deal effectively with critics over operational problems.  Its communication failure has severely damaged the agency.   It went from an award winning and highly regarded program into one that lost contracts and may disintegrate, all in less than nine months.   

What went wrong?   They handled criticism poorly.  They looked baffled, leaderless, and not in control.  The let their critics tell their story.
Department of Labor

The whistleblower.  The most dangerous people to anyones freedom, finances, and reputation is a disgruntled former teammate, especially the disgruntled present or former employee.  The insider knows the story behind the scene and has credibility because he or she knows them from the inside.

Whistleblowers are useful.  They are protected by law.  The public tends to like and believe the person who appears to risk their job or reputation to tell the secret problem.  They are perceived as truth-tellers: the emperor has no clothes!  Or they are public protectors, revealing some crime or mistake, putting the public at risk.

Business owners, managers, agency heads all need to take notice:  Americans are disposed to define whistleblowers as the hero of the story.  It fits an archetype narrative, the good guy taking on the powerful guy.   The overwhelming weight of hero myth and fiction goes toward celebrating the whistleblower.  Erin Brockovich.  John Dean.  Robin Hood.  They have a phrase that rings nicely in heart and head: telling truth to power.  People love that notion.  It projects that justice will prevail.. 

What about Judas betraying Jesus?  What about the Rosenbergs?  What about Loose Lips Sinking Ships? 

Whistleblowers are heroes. 
Yes, they are real examples of treachery and secrets being revealed for bad purposes, but the overwhelming weight of narrative is the other direction.  People reading this blog need to stop and recognize the reality and risk in their own lives.   If your secretary or some other employee tells a story about you, to fellow employees, or especially to the media or to government regulators, he or she will have more credibility than you.  

Moreover, your secretary or other employee has legal protection, and the complainer cannot be retaliated against.  If the complaint is of an allegation of discrimination on any protected class, or something of sexual harassment or intimidation or pressure, then the charge must be investigated by third parties with you carefully excluded from the process so that you do not influence or taint it.  You are assumed to be guilty, or maybe a little guilty,  and likely to try to cover up the investigation.   Your employee's own subjective understanding of the reality of the situation--"I felt awkward by what I thought he was getting at, and I didn't want to say anything, but I didn't like it, especially after I got home that evening and thought about it"--can be the standard against which you will be judged. 

It is both a legal standard, and it is a public relations standard: your employee will have credibility.  You, presumably, have something to hide. 

OnTrack had a disgruntled manager who had a story to tell of Executive Director Rita Sullivan raising her voice, clapping her hands near her, and facilities that had problems.   The OnTrack board benched Dr. Sullivan so they could investigate.  I don't know the actual story but I surmise they were led by legal counsel to do this, so the investigation would have credibility in the face of the lawsuit that was threatened.

An an employer is in a public relations dilemma.  Their hands are tied.  In some cases they may have significant evidence that makes the whistleblower's credibility questionable, or worse, but they may be prohibited from revealing it.  Employees have privacy rights. Moreover, if in fact any complainer is not a credible observer it raises the question why the complainer was an employee in the first place.  The employee's employment is evidence of credibility.  The clearest way to end that evidence--firing the employee because he or she is dishonest or has a conflict of interest or some other impediment--is not available. 

The media wants to report the news, and controversies are news.  Again, readers of this blog with responsibility for the reputation of an organization take notice: complaints are news.  The headline will be the complaint: "Problems found."   For most news media, the initial story will not be headlined, "Agency refutes allegations."  (Actually, this is exactly how Fox News would cover criticism of Trump, with the refutation being the lead, however most of the time a fair and independent media will lead with the accusation, with a response to follow.)  

Whistleblowers have friends and allies.  There may well be more complaints, and the media and the public is primed to re-think the situation.  It isn't "a problem."  It is a pattern, a big problem.

 Readers of this blog who are in positions of authority may have lost the memory and recognition that employees have their own perception of what is fair and reasonable.  No one likes being told they are wrong or do do things a certain burdensome way, even if it is required by law.  Employees see their portion of the picture but not necessarily the big picture.  Employees get fired.  Employees see office politics.  Employees assume--suspect--that someone other than themselves got the promotion because of some undisclosed non-job-related reason.  In the case of OnTrack, new employee complaints came forward, and they went to the media and the media covered their complaints as a Big News Story.  It was a pattern!


Never appear to be leaderless.   Benching Dr. Sullivan left OnTrack without an expert spokesman who could represent that the organization was competent to handle the ongoing challenges and criticisms.

Don't accept the premise of the criticism.  Organizations have problems and employees will voice complaints.  The fault of OnTrack was that the organization's board, without Dr. Sullivan, accepted the premise of the criticisms that reports of facility problems (bathroom mold, dampness under carpet) were big deals, not routine deals.   The critics and the news media have every reason to want to see a report of a problem as significant and newsworthy.  The counter to that would have been a credible spokesman who put it into context.  Then the story could have been "Problems Faced and Addressed, just like Every Day.  Competent Management on Duty."   Instead, the story was: "Oh my God! Problems!"

Boards need to accept as a cost of doing business a deeper management bench.  I have been on multiple boards and I have faced withering criticism for attempting to have a management bench (especially during my term as County Commissioner.)   The general public and the employees and a resource-constrained management may all see a flat management structure as a virtue.   All the stakeholders may value "thrift."  They may perceive Assistant Managers and Deputy Managers as a sign of management laziness and unnecessary and top heavy management.  Executive Directors are inadvertent participants in this problem.  My observation is that they tend to be very highly motivated and hard working.  They want to provide value.  They want to set an example of dedication and devotion to the mission.   

Board members should take warning from the OnTrack example.  When Dr. Sullivan was benched to do the investigation the organization did not have an adroit, knowledgeable, here's-how-we-do-things leader.  The management bench was too thin.  It is a common problem but it needs to be defined as what it is, a problem.  Boards need to insist that their Executive Directors not do too much.

Get on top of the problem immediately.   Below is an op-ed article from Dan Horton, published in the Mail Tribune last Sunday.  Dan is an architect who had worked with OnTrack for many years helping them with their facilities.  This letter came five months too late to change the story.   It is the kind of story that likely would have changed the narrative, had it been part of the original public understanding of the complex work of the organization.   Better late than never, but late is too late.

A final note on my relation to the story:   I personally know and admire Rita Sullivan.  I have been a donor to the organization, both money and melons as a gift to employees and their clients.  My son worked there part time a few years ago doing filing for minimum wage.  I generally thought her leaving employment there was self destructive to OnTrack because it seemed to me from the outside to be a graceless way to push into retirement the visionary leader who had done so much to grow the organization.  I had thought a celebration of her work would have served their purposes better than terse announcements of separation.   But I am not angry with the OnTrack board.  I consider them more as victims, oddly inept,  baffled by a situation, perhaps poorly advised by counsel.   No doubt they were well intended but trapped by what they thought were their legal obligations to investigate problems and to say nothing that would get them in trouble. They bunkered.  It turns out that saying nothing is part of what got them in trouble.   They let critics tell their story and there was no counter story nor context.

I put the op ed below.  If the Mail Tribune asks me to remove it, I will do so immediately.  As inadequate compensation to the Tribune, let me urge readers here to subscribe to the newspaper for two reasons: one to be a better informed community member and citizen, and the other is to support an essential public service, a community newspaper.  We still have one and I am grateful for it.

Guest Opinion: OnTrack, community owe Sullivan an apology

As the architect who has worked with OnTrack for over 20 years, I am familiar with the facilities and maintenance of OnTrack properties. Dr. Rita Sullivan acquired these properties, some of which are over 50 years old, on behalf of OnTrack during her 39 years of hard work.
One of her main goals was to make certain that these properties were maintained at a level of safety and condition such that no one could point out which housing units were owned by OnTrack for low-income tenants. No properties were substandard.
I ask the community to drive by Stevens Place on Stevens Street, Sky Vista on Stewart Avenue/Orchard Home, and particularly the new affordable housing development next to Sky Vista. Sullivan worked for eight years to obtain funding for this project and achieved it only because of the recognition and respect she garnered statewide over those long years of work.
I know the properties inspected by DHS and OHA in January, months after Sullivan left OnTrack, were always well maintained during her tenure. It is disingenuous to allege unattended maintenance was the cause for the problems to follow. There was always good maintenance by Ontrack maintenance staff and always ongoing remodeling of OnTrack properties, continuous replacement of floors, furniture, appliances, windows, roofing, repair of walls and doors and so on. The OnTrack board was supplied with a capital needs improvement schedule which I put together in December 2015 for their use as a guide to items to be addressed in the immediate future and through year 25. Board members’ refusal to step forward and acknowledge this and to proclaim surprise is inexplicable.
Because the tenants who come in are initially not good tenants, are frequently still in the throes of addiction and do not understand how to keep housing clean, Sullivan made sure that there was constant vigilance, first and foremost regarding safety, that there were continual walk-throughs by staff to teach clients how to become good tenants. I myself have seen her physically work on these apartments to help clean them.
Ask any landlord how quickly a property can be destroyed — often within days. Without constant active oversight the conditions that the inspection agencies saw in January, months after Sullivan left, are not surprising. The mostly cosmetic makeover now being done by OnTrack will not survive the next batch of clients unless the board imposes the same kind of oversight that was required by Sullivan.

As both Tonia Moro and Rick Nagel worked at OnTrack during the summer of 2016, they should have known what was required. No child was ever hurt until after Sullivan left and oversight failed. Sadly, the recent newspaper timeline is incorrect in many respects, including this one.
Why is there no recognition and honoring of the 39 years of productive and dedicated service Sullivan provided rather than the continual trashing of her reputation over the condition of properties she carefully and comprehensively maintained? Does no one wonder why, when she left in November all contracts were in force, all inpatient and outpatient programs in Jackson and Josephine counties were running as usual, and the drug courts were operating as intended? DHS and OHA staff had been in the facilities, visitors from other counties and states had been there to review an example of best practices with the idea of replicating in their communities, yet two months after she left, OnTrack was in complete disarray?
Rita Sullivan is owed a vast apology and community recognition of her many years of service and sacrifice.
— Dan Horton is the owner of Daniel R. Horton Architect in Eagle Point.

Tuesday, June 27, 2017

Trumpcare is an orphan. Walden is in hiding.

Trumpcare is likely to fail.  Republicans say, "Whew!"  Greg Walden is busy doing everything to distract us from his role in this.

Every salesman knows that awful feeling:  the product doesn't live up to the advertising and sales brochures.  

There are still some supposed arbiters of real fact.  The Congressional Budget Office, led by a Republican who is on record hating Obamacare, reports what everyone realized all along was, of course, true:

   **Trumpcare cuts taxes on the high income people who now pay Obamacare surcharges.

   **Trumpcare cuts Medicaid eligibility, pushing people off it.

   **Trumpcare reduces subsidies for insurance, making it much more expensive.

   **Some 22 million fewer people will end up with access to healthcare.

No one is selling Trumpcare like they really mean it.
With nearly 50 GOP senators about to vote for the bill, and with the bill being the culmination of 7 years attacks on Obamacare, it would seem logical that there would be a chorus of people who would say, "Yes!, this is exactly what we wanted!  The bill does what we intended!"

No.  There is no one.  

Instead, the bill is criticized from the right saying it does all of the above but it isn't enough because it is now simply a bad version of more Obamacare (Paul, Lee, Johnson, Cruz).  The bill is criticized from the GOP moderates saying it does exactly what the CBO says it does,  which is too much, because it will hurt the working poor and the uninsured 50-65 year olds in their states and districts (Collins, Heller, Murkowsk).

Officeholders who plan to vote for the bill are forced to criticize the CBO so they can stick to their script: the law would be cheaper, more universal, simpler, and better than Obamacare. That's what they sold the public.  That's what the people want to buy.  That isn't what it is.

They are in that awful place understood by any salesman who has responsibility for representing a product that simply does not live up to the sales literature.  The salesman goes through the motions, barely, maybe.   The salesman admits there are problems but allows there are some good points.  He tries to preserve his credibility long term by not putting his heart into it, saying it is up to the customer.  He looks for something else to show the customer.

Trumpcare is an orphan.  I am not aware of anyone who is out there actually saying with heart and urgency that Trumpcare is great on its merits.  Donald Trump himself says it is necessary, and that we have to pass something, not that it is actually good.  

If it fails in the Senate--which seems more likely now--then the GOP will have dodged a bullet.  They can continue to weaken Obamacare and fail to repair its problems, then criticize it.  Better to look weak than to look responsible for a bad product.

Walden busy not talking about Trumpcare
Is it really a bad product?   Pretty good evidence is the behavior of one of its signature authors, my own congressman Greg Walden.

Greg Walden lacks Trump's gift for distraction.  Trump would create a news crisis; Walden is too earnest and moderate for that.  Instead Walden presents himself as a busy beaver, focusing on everything except that thing which must not be mentioned.

He knows when the product doesn't live up to the hype.  Walden cannot send off 59 missiles, or shove a Montenegro prime minister, or fire an FBI director, or do a tweet that dominates the news.   But he does what he can do.

He tours a Columbia River dam. 

It is sixty years old.  Maybe it is timely to consider adding more electrical generation.  In the photo Greg is intent on something, looking concerned and concentrating on something important, but whatever it is is, it's not the CBO report on the bill his committee produced.

Trumpcare is an orphan
Page one of his official website tells constituents that there are "Ways Greg Can Help" doing important things for constituents, including ordering flags, arranging White House and Capitol tours, meeting with students.  Yes, the Trumpcare proposal changes Medicaid expansion to some 129,000 people in his district, but his attention is elsewhere.

Meanwhile, his page one website lists news articles on the things at the top of Walden's attention.   As always, the hard thing to notice is what is not there: the House version of the Trumpcare proposal.

Greg Walden is playing defense, and it may work for him.  He helped author a proposal that will cause trouble in his District, while simultaneously pretending, in the face of CBO and media reports to the contrary, that it is actually good for the district.  Greg is a good soldier.  He is loyal to his party and its agenda.  They said they would repeal and replace Obamacare.  He does his duty.

Loyal soldier on the GOP team
He will be safest politically if he can say that everything died in the Senate and that his proposal would have been wonderful, if only it had gone into effect.  It would be like the poker player who was bluffing and who never was called to show his hand.  I now expect this outcome.  Greg will be free to sell hope and good intentions and smoke.  It would have been great, if only.

But one piece of evidence is open and obvious from the Greg Walden website: Greg Walden is not out there selling Trumpcare.  Indeed, he is hiding out from his own proposal.  

That is the vulnerability for Greg Walden.   It was written in his own committee.  His fingerprints are on it.  The glove fits.

Monday, June 26, 2017

Trumpcare is War on the States

Trumpcare punishes the states.   Which states?  All of them, but especially blue ones.

It might be clever payback to those blue states the GOP thinks coddled public employees and expanded Medicaid.   Trumpcare does more than pass the buck.  It delivers a bomb.

Frequent Guest Post writer Thad Guyer made the suggestion that there is some craft--or at least a happy accident--in the way that Trumpcare forces states either to raise taxes or to take the blame for kicking blue collar workers off Medicaid.  The states get the blame, not Trump and the GOP Congress.   Not only does Trumpcare escape the blame but chaos in the states is good for the Republican brand.

Guyer wrote:

"The awful convergence of your PERS and pension blogs awaits if the GOP kicks healthcare to the states. This will be especially true in blue states like Oregon with crushing PERS deficits. It will be retirees vs. the working poor. Red states that resisted public unions and government pensions will end up more politically and fiscally stable in the coming budget wars. This is a large unstated GOP strategy. "

States with Republican governors generally refused to take federal money to expand Medicaid.  It will be blue states that will experience Trumpcare as a loss, with people kicked off a benefit they once had.  And blue states will have the hardest time replacing that lost Medicaid money.

There are multiple websites evaluating the fiscal health of states.

Overall Financial condition.  The states in the worst overall financial position are in fact blue states: Illinois, New York, Massachusetts, Connecticut, Maryland, DC, and California.   Only Kentucky is a red state outlier in that group of the most fiscally stressed, and it had a Democratic governor.   I have written several times about Oregon's intractable problem (one the legislature again failed to resolve this session--it is just too hard) and Oregon is far from the worst: 30th out of 50.

Click here: Oregon is ranked 30 out of 50 states.

Underfunded Pension Liabilities.  Here is another analysis of the fifty states, this one looking specifically at unfunded pension obligations.  The higher the number, the greater the problem of unfunded pension.  Again, the great problem states skew blue, with Connecticut (50), Illinois (48), New Jersey (47), and Michigan (46).  Again, Kentucky is among them (49).   

Click here: Unfunded Liability Chart


Can Trumpcare effectively pass the buck?  No, in the short run, but long term, yes.  State government chaos helps the GOP brand.

State legislators and governors are not quiet patsies.  Both Republicans and Democrats in the states will object, loudly, to having the burden passed to them.  They will join the chorus of opponents to Trumpcare, saying that it isn't their fault that hospitals are in trouble and that people lost benefits.  

Some states will deal effectively and proactively with the impending loss of Medicaid funding, whether or not Trumpcare goes fully into effect.  Oregon just did.  Oregon's legislature was  able to pass a special tax on healthcare providers.  

How did they accomplish that?  Because healthcare providers did not really, deep down, oppose the tax.   

The tax on them is a mechanism to shift costs from the insured middle class to pay for the uninsured working poor getting benefits through Medicaid.  The fees paid by the full-freight patients will make possible the revenue to fund Medicaid, so the money comes back to the providers, with a big federal match.   Hospital providers need Medicaid, otherwise they provide uncollectible services for free.  (This is one of the great bipartisan political vulnerabilities of Trumpcare: Hospitals will suffer under it and middle class voters care about hospitals.)

A tax to fund Medicaid
But Oregon was a close call.  It passed with exactly one Republican vote, just enough.  Many other states will not be able to cope, and blue states' legislatures will face angry disappointed voters, which leads to political chaos.  As Democrats discovered, political unrest, whatever the cause, leads to a populist revolt against government.   

Michigan in 2016 is a classic example.  The failure of local government in Flint led to a takeover by an agent of a Republican governor, who then made decisions that put high levels of lead into the water supply.   Chaos.  In the face of that chaos, Michigan voters did not express its anger at the party of the governor.  It expressed it at government generally, and the blue wall of Michigan voted for change, not for Democrats.  Its electoral votes went to Trump.

Democrats perceive themselves as the party of good, effective government, and that is their brand ideal.   Republicans perceive themselves as the party of small government, encouraging individual freedom and self reliance, and that is their brand.   Chaos in government does not hurt the parties equally.  Chaos injures the Democratic brand and helps the Republican brand.

If Trumpcare passes, and the states go into a tizzy, generally it helps confirm what Republicans have been saying all along: that government is the problem and it cannot do anything well, so vote Republican.

Sunday, June 25, 2017

Near Consensus on Health Care: More is Better

It's easy to miss the obvious.  Democrats want more and better health care access.  The standard Republican message agrees.  Almost everyone agrees that health care access is a right.

The hardest thing to notice is the thing that is so obvious that it goes without saying. Goldfish in a bowl take water for granted.  Take a moment and notice what is not happening. The Obamacare/Trumpcare debate is all about who is actually being covered better but no one is saying, "Darned if we should have to pay for that teenager's asthma.  If she wheezes and dies on the playground, tough luck.  It is her problem, not my problem or the taxpayer's problem."

There is a fringe on the right, including Rand Paul, Ted Cruz, Ron Johnson, and Mike Lee who are opposed the Trumpcare proposal on principle.  Their argument goes in the same direction as the main GOP position: that Trumpcare provided great healthcare access for nearly everyone.   The main GOP position is that is is good; the resisting four senators say that is the very problem with it.

Off GOP message.
The four Senators are making a clear and principled argument.  There is only so much money.  They say we need to make choices between missile defense and healthcare for the working poor.  Missile defense may save millions of lives, including ours.  Health care for the children of people who work at Walmart will save hundreds of lives here and there,  but only hundreds, vs. millions.  We make the tough decisions.   

The underlying premise: health care is a consumer choice, not a right.  The parents of that teenager should have worked harder in school, got better jobs, ones with benefits.  Parents who make $22,000 a year aren't really that poor and they should have made choices on how to spend their money and should have had family coverage.  Therefore, the teenager's predicament is her family's choice.  It is the consequence of freedom and personal responsibility, not a government responsibility.

On GOP message.
GOP Congressman, Jason Chaffetz, briefly voiced this idea and immediately he and other GOP lawmakers backed off.  It looked cruel and unrealistic and mean,  and it was 180 degrees off message.   The Trumpcare message was that we were going to give people coverage, people who were losing coverage due to the problems with Obamacare and the exchanges. Trumpcare was more and better, not less.   The Trumpcare message minimizes the "losers" of benefits and assumes they will manage on their own.  

The main GOP message: Trumpcare means more and better.

Greg Walden, the GOP Chair of the House Energy and Commerce Committee whose committee had primary responsibility for shaping the Trumpcare bill, exemplifies the messaging.  Look at his language:  "More than eight months ago House Republicans unveiled a Better Way, which included our vision for repealing Obamacare and replacing it with a patient-centered, 21st century health care system. . . . We are protecting those patients living with pre-existing conditions.  We're not returning to the days of lifetime caps or annual limits. . . . We will keep our promise to not pull the rug out from anyone as we transition away from this failing law.  Under our plan, we're moving forward."

Notice what is not there in the establishment GOP message: Talk of thrift.  Talk of the hard realities of poor choices or bad luck.  Talk of people getting less because heath care costs money we don't have.  Talk of people lazy people sponging off the overburdened taxpayer.

It is as if, in a hard fought football game, there is no defense or pushback--except by Rand Paul and three other senators who are understood to be outside the mainstream.  And even their opposition confirms the main point.  They don't like Trumpcare for the same reason the main GOP says is good about it:  it covers too many people too well.  Trumpcare is not libertarian, tough minded, free market, personal responsibility, tough luck legislation.   Trumpcare is, they say, just a version of socialism.

Republicans have gotten soft--at least on health care.    

The Libertarian message.  
Establishment Republicans do not want to say straight out and clearly that we cannot afford to do everything, nor do they want to argue that in fact Trumpcare means less and cheaper, not more and better.   So we have a odd message dance.  Trumpcare goes a long way toward doing what Rand Paul wants--but not far enough for the four senators, so they oppose it for its generosity.   Meanwhile GOP messaging is that Trumpcare is actually really generous and covers more people better, and that is good, not bad.   

Alas, the message runs up against reality and truth of the proposal.  Trumpcare is less and worse, not more and better.

The CBO, Democrats, hospitals, and the media all say Trumpcare in fact reduce access to health care, which ,of course, it must because it in fact cuts costs and benefits dramatically.    The GOP establishment cannot admit it, the 4 holdout senators say it is true but not enough, and the Democrats say it is true but way too much and cruel because of it.

There are no full throated supporters of Trumpcare because it is built on a premise that was never, ever possible, but one Trump repeated in the campaign:  that we could have an Obamacare replacement that was simple, cheaper, universal, and better.  Trump and the GOP oversold it and now they are stuck with a political mess.