Thursday, September 21, 2017

The GOP Plays Politics With Your Health

President Donald Trump has had an awful first nine months in office.  His scandal plagued White House has been in a continuous state of chaos.  He has failed to unite the country, let alone his own party.  President Trump's approval ratings are at a historic low for any president, so he is desperate for a legislative win. 

Now beleaguered Republicans in Congress are hastily focusing their efforts on passing their latest repeal and replace measure for Obamacare in a effort to fulfill a longstanding political promise. The bill is sponsored by Republican Senators Lindsey Graham and Bill Cassidy.  The president, who has not read the measure, is enthusiastically cheering them on.  

The Republican's latest version of healthcare legislation will replace Obamacare with a measure that will leave untold millions of Americans without health coverage.   The exact impact and cost of their proposed legislation is not known because the GOP is rushing the bill through without an official scoring by the Congressional Budget Office.  They are also circumventing regular Senate procedures to take advantage of a short window that allows them to pass the measure with just 50 votes and a tie-breaking vote by Vice President Mike Pence.   Senate Majority Leader Mitch McConnell will bring the legislation up for a vote next week, according to his spokesperson.  

Under the GOP measure current expanded Medicaid funding for Obamacare recipients will be converted into block grants to the states that will be capped, putting states in the position of having to pay for any future shortfall.  Many state governors oppose the measure because they will immediately lose funding they have committed to paying, including Republicans.  New Jersey Governor Chris Christie said Wednesday, "I can't support a bill that takes $3.9 billion away from the people of the state of New Jersey." The authors of the bill seek to equalize the base per-person the federal government gives states.  But this would penalize those that are wealthier, for instance, Democratic states like New York, California and New Jersey, and benefit poorer Republican states like Mississippi and Alabama.   

The Graham-Cassidy bill would end Obamacare's individual mandate that requires everyone to buy health insurance or pay a penalty.  A pool including both healthy and unhealthy people was set up to help control insurance costs.  However, this bill will provide no incentive for healthy individuals to enroll in the market, which means only those in need of health care are likely to sign up. The cost burden would fall heaviest on seniors, a fact not lost on AARP, which said in a statement on Wednesday, the bill "could increase premiums and out-of-pocket cost by as much as $16,174 a year for a 60-year-old earning $25,000 annually if the wanted to keep their current coverage."  The AMA put it more bluntly in a tweet Tuesday, "Graham-Cassidy would result in millions losing coverage, destabilize insurance markets, decrease access to affordable care." 

Obamacare had protections for those individuals with pre-existing health conditions, they could not be denied health insurance. Trump, who during his campaign said that insurers should not be able to deny insurance to those with a pre-existing condition, tweeted Wednesday; "I would not sign Graham-Cassidy if it did not include coverage for pre-existing conditions.  It does.  A great Bill.  Repeal & Replace."  Technically the bill says it will not repeal Obamacare's rules about pre-existing conditions.  However, it does allow states opt out of rules, like a ban on charging higher premiums for sick people, the requirements on prescription drugs, the rules around how much insurers can increase premiums because of a customers age--elderly are more likely to have pre-existing conditions.  In a statement, the Blue Cross Blue Shield Association warned, "The bill contains provisions that would allow states to waive key consumer protections, as well as safeguards for those with pre-existing medical conditions."

This last ditch effort by Republicans comes two months after the Senate failed to pass a Republican repeal to Obamacare.  Meanwhile, bi-partisan health care negotiations, that had been proceeding in the Senate, came to an abrupt halt as Republican Lamar Alexander announced the talks had reached an impasse.   This came as a surprise to Democrats who charge that this is a tactic to get wavering GOP senators to vote for Graham-Cassidy.   Nonetheless, a group of 10 bipartisan governors sent a letter Wednesday to the Senate leadership arguing for a bipartisan solution and against Graham-Cassidy.  Some observers say that if Graham-Cassidy passes, it will be with a strictly party line vote just like Obamacare was. They say that will add chaos to implementation because the bill does not have broad support.

Clearly, the best alternative is to fix the problems that exist in Obamacare.  But that would be anathema for Republicans who are largely focused on getting entitlement spending under control.  They are determined to reduce the size of the federal government.  They are committed to shifting responsibility to the states.  Of course, they need the projected savings Graham-Cassidy would provide to help finance their tax "reform" proposal, which would largely benefit the wealthy.  And those wealthy Republican donors have threatened to withhold campaign contributions unless a health care bill signed into law.  Furthermore, House Speaker Paul Ryan says he has greased the skids for the bill in his chamber.     

So the GOP leadership is intensely focused on fulfilling their campaign promise of repealing Obamacare. Kansas Republican Senator Pat Roberts told Vox, "Restoring decision-making back to the states is always a good idea, but this is not the best possible bill--this is the best bill possible under the circumstances."  He added, "If we do nothing, I think it has a tremendous impact on the 2018 elections--and whether Republicans still maintain control and we have to gavel."  

In other words, passing and enacting Graham-Cassidy is not about doing what's best for the American people, it's about doing what's best for the Republican Party.  It is not about doing the right thing; it is all about fulfilling a political promise.   

No wonder nearly 70% of all Americans disapprove of Congress.   And it's only going to get worse if Graham-Cassidy passes.  

Saturday, August 26, 2017

Trump Undermines America's Core Values

President Donald Trump promises to "Make America Great Again," but his words are nothing more than an advertising slogan.  Rather, his actions since taking office are undoing decades of progress towards a better America and undermining the very core values enshrined its Constitution: liberty, equality, justice and democracy.  

In the Declaration of Independence, the Founding Fathers wrote, "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are Life, Liberty and the pursuit of Happiness."  But under Trump all men are not created equal.  

For instance, last week Trump directed the military to stop an Obama-era directive that allowed transgender individuals to be recruited into the armed forces.  The order also bans the Department of Defense from providing medical treatment for transgender individuals currently serving in the military.  In July Trump caught the military by surprise when he tweeted, "Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgenders in the military would entail."  But a 2016 Rand Corp study commissioned by the Defense Department concluded that letting transgender people serve would have "minimal impact" on readiness and healthcare costs.  There are currently several thousand transgender people serving their country in the military.  

Voting rights are also being assaulted by the Trump administration.  Just weeks after winning the election but losing the popular vote, Trump took to Twitter to claim,  "In addition to winning the Electoral College in a landslide, I won the popular vote if you deduct the millions of people who voted illegally."   Trump assembled a commission in May to substantiate his false claims about voter fraud.  New York University's Brennan Center for Justice found, "examination after examination of voter fraud claims reveal fraud is very rare, voter impersonation is nearly nonexistent, and much of the problems associated with alleged fraud relates to unintentional mistakes by voters or election administrators."  Why is the Trump administration intent on spending millions of taxpayer dollars in search of a problem that doesn't exist?   The answer is voter suppression.  They are determined to impose policies that will discourage or make it harder for millions of eligible Americans to vote, especially minorities and the elderly who tend to vote for Democrats.  

Trump has used anti-immigrant rhetoric to fuel anger in his base supporters, especially against Hispanics and Muslims, the latter for whom his has issued a travel ban affecting six predominantly Muslim countries.  Former Maricopa County, Arizona, Sheriff Joe Arpaio regularly violated the rights of undocumented Hispanic immigrants, using racial profiling and inhumane treatment against them.  Last month he was convicted of criminal contempt of court by a federal district court judge for failing to stop using these tactics.   But crassly under the cover of Hurricane Harvey, on Friday President Trump issued a controversial pardon for Arpaio, an early Trump supporter, tweeting, "I am pleased to inform you that I have just granted a full Pardon to 85 year old American patriot Sheriff Joe Arpaio.  He kept Arizona safe!"  The pardon received bipartisan condemnation, including from Arizona Senator John McCain, who said in a statement, "The president has the authority to make this pardon, but doing so at this time undermines his claim for the respect of rule of law as Mr. Arpaio has shown no remorse for his actions."   Alas, this may be just a precursor for pardons Trump will issue in the future for his loyalists and family members who are under investigation in the expanding Russia probe.  

The president has gone to great lengths recently to explain his failure to attack white supremacists and the KKK, blaming the "fake media" for misrepresenting what he said.  However, the president regularly whips up supporters at his rallies with attacks on the press.  At a rally last week in Phoenix, the president leveled his latest assault, saying, "It's time to expose the crooked media deceptions...they're very dishonest people."  He added, "The only people giving a platform to these hate groups is the media itself and the fake news."   Yet the remarks he says were misrepresented were delivered by him on television and viewed by millions of viewers.   When Trump's back is against the wall he needs an enemy to lash out against, and the media is an easy target.  But his rages against the news media are deeply concerning as they may have a chilling affect or worse on a free press.  

Trump is clearly angry about his news coverage and frustrated with his lack of legislative success since taking office.  He has tried to derail the many investigations underway into Russian interference in last November's election, and, according to the Washington Post, he has made more than 1,000 false or misleading claims over the past eight months.  One of his biggest lies is that he has had one of the most successful presidencies in history.  To the extent Trump has accomplished anything, regretfully it is to undermine civil rights, human rights, voting rights, and press freedoms.  

Popular author Stephen King hit the nail on the head when he tweeted last month, "The news is real. The president is fake."  But, sadly, Donald J. Trump is the president.  

Saturday, August 12, 2017

Trump: The Divider-in-Chief

The man who promised "I alone can fix it" in his acceptance speech at the Republican National Convention last July has accomplished very little after six months in office as president.   Instead, President Donald Trump has instilled a culture of chaotic infighting at the White House, he has failed to articulate a coherent foreign policy and unnerved America's closest allies, and he has fueled unprecedented divisiveness within the Republican Party.  

Trump's bombastic campaign rhetoric mobilized millions of frustrated Americans to vote for him last November and secure him an Electoral College victory.   He made many brash and unrealistic promises, but thankfully he has failed to deliver on most of them.   Trump has not drained the swamp in Washington; he has only muddied the waters.  He has not built a wall along the U.S.-Mexican border.  He has not reformed taxes, he has not fixed healthcare, and he has done nothing with the nation's infrastructure despite the fact that Republicans control both houses of Congress and the presidency.  Instead, he has blamed Congress for his lack of progress.

Trump has been on the defensive about Russia's interference on his behalf in the presidential election. He fired FBI Director James Comey, he has considered firing Attorney General Jeff Sessions for recusing himself from the Russian investigation, and he has harshly attacked Russia special counsel Robert Mueller for his widening probe into the scandal.   Yet he thanked Russian President Vladimir Putin for expelling 755 people from the American embassy in Moscow in response to new economic sanctions approved by Congress.  "I'm very thankful that he let go of a large number of people because now we have a smaller payroll," Trump inexplicably said apparently not knowing that these diplomats and staff will continue to be paid.  Where's the outrage Mr. President?

While the stock market has reached a record high in anticipation to reduced corporate taxes and regulations, there is a growing concern about the future.  Trump's favorability rating in the national polls has slumped to a record low for any modern day president.   Even some of his most loyal supporters are beginning to raise their eyebrows.   But Trump has tried to manipulate public opinion through his constant use of Twitter, often attacking the "fake media" and his opponents.  The tweeter-in-chief explained his reason last month, "My use of social media in not Presidential - it's MODERN DAY PRESIDENTIAL.  Make America Great Again!"

Last December, then President-Elect Donald Trump laid out his military policy.  "We will stop racing to topple foreign regimes that we know nothing about, that we shouldn't be involved with," he said at Ft. Bragg.  "Instead, our focus must be on defeating terrorism and destroying ISIS, and we will."   But Trump's failure to effectively govern the country, and his inability to stop investigations into Russian interference and possible collusion with his campaign, may have changed his perspective.    

A timely leak that a U.S. intelligence agency "assesses North Korea has produced nuclear weapons for ballistic missile delivery, to include delivery by ICBM-class missiles," triggered a brash response from the president.  "North Korea best not make any more threats against the United States," he said at a meeting on the opioid crisis at his New Jersey golf club.  "They will be met with fire and fury like the world has never seen."   Trump's shoot from the hip response rattled diplomats and military experts because an attack on North Korea would lead to millions of casualties in South Korea and the region, including Americans.  Nonetheless, Trump continued his threats on Friday saying the U.S. was "locked and loaded," although the military had taken no additional action.  

But the president was not done issuing threats.  Following a meeting with Secretary of State Rex Tillerson and UN Ambassador Nikki Hailey the president directed remarks at Venezuela, which has been in a state of crisis under its president, Nicolas Maduro.  "You know, we are all over the world and we have troops all over the world in places that are very, very far away," he said.  "Venezuela is not very far away and the people are suffering, and they are dying.  We have many options for Venezuela, including a possible military option if necessary."  

Suddenly the man who had campaigned vigorously against senseless wars was warmongering.  American diplomats scrambled to ease growing tensions in both Asia and South America.  Meanwhile, Chinese President Xi Jinping warned Trump by phone on Saturday to "avoid remarks and actions that escalate tensions on the Korean peninsula."   And Peru's foreign minister, Ricardo Luna, who has been a vocal critic of the Venezuelan government, issued a statement, saying in part,  "All foreign and domestic threats to resort to force undermine the goal of reinstating democratic governance in Venezuela, as well as the principles enshrined in the UN charter." 

As tensions escalated with North Korea and Venezuela, violence broke out in Charlottesville, Virginia, led by hundreds of white nationalists protesting the removal of a statue of Robert E. Lee, a Confederate army general.  The Virginia governor declared at state of emergency.  The former imperial wizard of the Ku Klux Klan, David Duke, was among the protestors.  "We are going to fulfill the promises of Donald Trump," Duke told reporters Saturday, to "take our country back."   President Trump, who failed to denounce David Duke and the KKK during his campaign, tweeted a response on Saturday that failed to specifically mention the KKK.  "We ALL must be united & condemn all that hate stands for.  There is no place for this kind of violence in America!  Let's all come together as one!"   

As events around the world continue to spin out of control the man who bragged "I alone can fix it" has once again revealed himself to the world as unqualified to be president.  Trump told Reuters reporters last April, "I thought it would be easier."  Unfortunately, the longer Trump is president the tougher it gets for everyone else.  

Thursday, July 20, 2017

"Very Unfair to the President"

President Donald Trump has completed the first six months of his scandal plagued and underachieving presidency on the defensive about Russia, health care, his temperament and Twitter. Recent polls show that Trump's overall favorability is at an all-time low, and up to now his loyal supporters have continued to back him, although a small minority of them is beginning to have doubts according to a Reuters/Ipsos poll.  

In an interview with the New York Times Wednesday the president was in full attack mode, his default tactic when he feels pressure.  Attorney General Jeff Sessions was among the first members of Congress to support then candidate Donald Trump.  His support was rewarded with one of the most important cabinet posts, but Sessions recused himself from overseeing the Russian investigation, which was the right thing to do.  But not according to the president. "Sessions should have never recused himself, and if he was going to recuse himself, he should have told me before he took the job and I would have picked somebody else," Trump said.   He then added, "It's extremely unfair, and that's a mild word, to the president.  So he recuses himself, I then end up with a second man, who's a deputy." 

Worse than that, Trump noted that Deputy Attorney General Rod Rosenstein is from Baltimore.  "So his deputy he (Sessions) hardly knew," Trump recalled.  "Rod Rosenstein, who is from Baltimore.
There are very few Republicans in Baltimore, if any."  Then he points out that Rosenstein appoints Special Counsel Robert Mueller to look into Russian interference in the election.  Mueller had interviewed for FBI Director with the president the day before he was appointed to head the investigation.  In his New York Times interview Trump reveals he reacted, "I said, what the hell is this all about?  Talk about conflicts."  Then Trump made a threat relating to Mueller.  "There were many other conflicts that I haven't said, but I will at some point," he said.  

President Trump accused Comey of trying to use as leverage a secret dossier with sensational but uncorroborated allegations regarding the president.   "When he brought it to me, I said this is really made-up junk," Trump said of the allegations.  Comey had earlier told a Congressional hearing that he told the president of the dossier because he thought the media may be publishing it soon. Trump said Comey's testimony was "loaded up with lies."

Trump's interview reflects a man who is concerned that the special counsel has expanded his investigation into the financial dealings of Trump businesses.  U.S. banking regulators are reviewing hundreds of millions of dollars in loans the Trump organization received from Deutsche Bank, according to the New York Times.   Deutsche Bank recently paid more than $600 million in penalties to U.S. and British regulators for laundering money for Russian entities.  

Bloomberg reports, quoting a person familiar with the investigation, that "FBI investigators and others are looking at Russian purchases of apartments in Trump buildings, Trump's involvement in a controversial SoHo development in New York with Russian associates, the 2013 Miss Universe pageant in Moscow and Trump's sale of a Florida mansion (at a huge profit) to a Russian oligarch." 

Trump was asked by the New York Times, "If Mueller was looking at your finances, and at your family's finances, unrelated to Russia, is that a red line?"  Trump responded, "I think that's a violation. Look, this is about Russia."  But then the reporters followed up asking if he would fire Mueller, Trump said, "I can't answer that question because I don't think it's going to happen."

Trump could not directly fire Mueller.  He would have to order Rosenstein to do it, the man who appointed the special counsel in the first place.  Rosenstein has testified to Congress he will not fire Mueller.  Meanwhile, Attorney General Jeff Sessions vowed at a news conference Thursday to stay on, "We are serving right now.  The work we are doing today is the kind of work that we intend to continue."   

With a constitutional crisis involving the investigation into Trump finances looming over the horizon, the president's comments and actions betray a man with something to hide.  He is scared, he is vulnerable, he is angry.  The Washington Post reported late Thursday that Trump's lawyers are "actively building a case" against what they believe to be Mueller's conflicts of interest.  The paper also reports that Trump has asked about his power to pardon aides and family members. 

Sure, Trump can feel like the victim, he can feel that he is being treated unfairly, but he has brought it all upon himself.   Nothing will stop the special counsel.  And if Trump fires Mueller, another will be appointed.   If he pardons aides and family members from criminal charges, he will risk being removed from office.  

The truth will be revealed, justice will be done.  America will be great again.  

Saturday, July 1, 2017

Trump's Twitter Tirades

President Donald Trump's latest vicious personal attacks on Twitter are abusive, demeaning and shameful.  Yet the president and many of his supporters approve of his tactics, saying that he is just fighting back against the daily barrage of "fake media" attacks.  The president hopes to discredit his media critics with schoolyard taunts and mudslinging because he believes it will appeal to his most ardent supporters.   

The president has focused his latest assault of insults on MSNBC anchors Joe Scarborough and Mika Brzezinski, the hosts of the weekday program "Morning Joe."  Saturday he tweeted, "Crazy Joe Scarborough and dumb as a rock Mika are not bad people, but their low rated show is dominated by their bosses.  Too bad!"   Scarborough is a former Republican Congressman and Brzezinski is an experienced news anchor who is the daughter of the late Zbigniew Brzezinski, a highly respected foreign policy expert and American diplomat.  "Morning Joe" is the second highest rated cable news program in the morning, drawing nearly one million daily viewers. 

The conflict with Scarborough and Brzezinski has been intensifying since Trump took office.   The anchors have been increasingly vocal about Trump's lies and many of his actions as president.   Last week The Washington Post revealed that a fake Time Magazine cover showing Trump was hanging in the bar of his Doral Golf Resort in Florida.  The cover displayed a large headline: "Donald Trump: The 'Apprentice" is a television smash."  That cover has since been removed.

Brzezinski and Scarborough talked about the phony cover last week on their program.   Trump pounced with a series of morning tweets Thursday.  "I heard poorly rated @Morning_Joe speaks badly of me (don't watch anymore). The how come low I.Q. Crazy Mika, along with Psycho Joe, came," he began with his first tweet.  He continued with a second tweet, " Mar-a-Lago 3 nights in a row around New Year's Eve, and insisted on joining me.  She was bleeding badly from a face-lift.  I said no!"

These tweets shook Washington as even many frustrated Republicans described them as inappropriate.  Scarborough and Brzezinski, who recently got engaged, delayed their scheduled vacation to respond to Trump Friday morning.  Both anchors denied Trump's account of what happened New Year's Eve, saying it was Trump who asked them to come by.  Then Scarborough revealed that the White House had asked him to seek forgiveness of the president for his critical coverage or The National Enquirer would publish an article revealing his then secret relationship with Brzezinski. The publisher of The National Enquirer is David Pecker, a close friend of the president.   Trump soon responded on Twitter to their appearance.  "Watched low rated @Morning_Joe for the first time in a long time.  FAKE NEWS.  He called me to stop a National Enquirer article.  I said no!  Bad show," Trump wrote.  

Sadly Trump's outrageous behavior is sexist and it is just the latest in a series of misogynistic attacks he has leveled against women over the years.  Last August in a debate Fox News anchor Megyn Kelly confronted Trump.   "You've called women you don't like 'fat pigs,' 'dogs,' 'slobs' and disgusting animals," she noted.  Trump interrupted, "Only Rosie O'Donnell."   "Look at that face," he said last year of his then opponent Carly Fiorina.  "Would anyone vote for that?  Can you imagine that, the face of our next president?"   Early last year his tweeted an unflattering picture of Senator Ted Cruz's wife next to one of Melania Trump, adding "a picture s worth a thousand words."  

When he feels cornered or he is getting criticized, Trump's default position is to get mean.  There are no limits to his impulsive strikes.  This is the way he has operated throughout his life.  Businessmen who have dealt with him describe what they call Trump's "punch-hug."  In intense negotiations he has yelled, used personal insults and foul language, only to later come back with a hug, as if to say "Come on, don't you see it my way?"    White House press spokesperson Sarah Huckabee Sanders told reporters Thursday, "I don't think you can expect someone to be personally attacked day after day, minute by minute and sit back," she said.  "The American people elected a fighter, they didn't elect somebody to sit back and do nothing."  

But Americans don't want Trump to tweet.   Before his most recent spat with Brzezinski, Fox News released a poll showing just 13 percent of Americans approve of Trump's tweeting, while 46 percent disapproved.  A slim majority of those polled said they consider the president's online posts as official statements.   

The Trump White House has struggled to accomplish its agenda.   Its efforts to repeal and replace Obamacare have failed.  Its efforts for tax reform have been stalled, and its controversial immigration ban has struggled in the courts.  Meanwhile, the president has insulted allies, demeaned NATO, and he has failed to stop North Korea's nuclear program.   He is described as furious about the ongoing investigations into the role Russia played in the American elections, and whether members of the Trump campaign colluded in that effort.  He has frequently used Twitter to attack the investigations and those conducting them.  

It will be interesting to see how Trump handles Russian President Vladimir Putin when they meet next week for the first time since he took office.  Will he even bring up the Russian interference?   Will he use his punch-hug technique on Putin to insist he end Russian meddling in America's elections, to withdraw from Crimea and Ukraine, and that he end his support for Syrian President Bashar Al-Assad?   

It is probably more likely he will ask Putin what steps he would suggest to control the American press.   Then after the meeting he will tweet, "Vlad and I had a GREAT meeting! We are going to work together to make America GREAT again!"

Thursday, June 29, 2017

On Being Presidential

President Donald J. Trump:

In a two-part tweet, Trump said he “heard poorly rated @Morning_Joe speaks badly of me (don't watch anymore).” He then went on to hit Brzezinski: “how come low I.Q. Crazy Mika, along with Psycho Joe, came … to Mar-a-Lago 3 nights in a row around New Year's Eve, and insisted on joining me. She was bleeding badly from a face-lift. I said no!”

This is cyberbullying, and indicative of the president's severe lack of character and sanity. 

Monday, June 26, 2017

GOP Senators: Where's Your Heart?

Senate Republicans are pushing hard for a vote this week on their plan to repeal and replace Obamacare, aka the ACA.   But the Senate plan takes coverage away from 22 million Americans, according to a report from the Congressional Budget Office released on Monday.  The CBO also projects the plan will reduce the deficit by $321 billion over the next decade.  And the bill's authors utilized some trickery to get their bill scored slightly better than its House counterpart proposal, which President Donald Trump called "mean."   

The Senate GOP proposal will phase out Medicaid's expansion, it will cap Medicaid spending to the states, it will repeal Obamacare taxes used to fund the program, and it will restructure subsidies to insurance customers.   The federal government currently picks up between 50 and 100 percent of the states' healthcare costs.  The Republicans want to reduce these costs through block grants that are capped to slow growth.  This will leave it to the states to cover any difference and administer healthcare.  But the effect will be to reduce federal Medicaid spending over time, leaving millions of those who need support most without health insurance.   

In January President Donald Trump told The Washington Post, "We are going to have insurance for everybody.  There was a philosophy in some circles that if you can't pay for it, you don't get it.  That's not going to happen with us."   The House GOP earlier had passed their version of health care, which President Trump feted at a White House ceremony with Congressional Republicans.  But later he turned on them by describing the bill as "mean."  Now he is pushing for passage of the Senate Republican bill, which is not dissimilar to the House version.  

Health care represents one sixth of the U.S. gross domestic product, or more than $2.6 trillion.   Medicaid spending has reached $575 billion annually.  The Health Insurance Association of America defines Medicaid as a "government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."  Republicans have long strived to cut Medicaid costs in an effort to reduce the U.S. deficit.   They believe that block granting it to the states will make it more efficient.

The federal government's options for reducing Medicaid costs are limited.  It can reduce the number of people covered, it can reduce the benefit coverage, it can pay less for benefits, it can get doctors and hospitals to accept less in reimbursement, or it can ask beneficiaries to pay more.  Both the House and Senate bills would have a devastating impact millions of Americans by throwing the problem to the states and cutting the growth of Medicaid subsidies over time through a cap on spending.    While the CBO shows that healthcare price increases will in a couple years be less under the Senate version than Obamacare, those covered will get less for their money.  

For more than seven years Republicans have railed against Obamacare.  President Trump campaigned heavily against Obamacare, pledging at a Florida rally in October to repeal and replace it.  "That begins with immediately repealing and replacing the disaster known as Obamacare," he promised.  "You're going to have such great health care, at a tiny fraction of the cost--and it's going to be so easy."   Four months later a frustrated President Trump told reporters,  "It's an unbelievably complex subject.  Nobody knew health care could be so complicated."   

Senate Republican leadership turned this complicated task over to thirteen of its members, all men, who then crafted its health care bill behind closed doors.  The measure was released to the public last Thursday, leaving little time for public scrutiny.  The Affordable Care Act, by contrast, was debated over months of hearings and Republicans added more than one hundred amendments to the legislation.   Clearly Senate Leader Mitch McConnell knew his caucus's bill would be unpopular.  But now President Trump is championing the Senate bill, even though it will adversely impact millions of his own supporters while giving tax breaks to the rich, like the Trump family.  All Trump, a self-proclaimed dealmaker, cares about is making a deal.

Ultimately, someone has to pay if health care is to cover those who can least afford it.  The American Medical Association sent a letter to Leader McConnell warning that the Senate's Obamacare repeal plan could hurt America's "most vulnerable citizens."  The key to covering more Americans while lowering health insurance costs is risk sharing, where the healthy contribute to pay the costs.  But Congressional Republicans are more focused on fulfilling their campaign promise to repeal Obamacare, even at the risk of losing Congressional seats in the 2018 Midterm elections, especially in those states that have already accepted Medicaid coverage.  

Yet President Trump is exhorting Republicans on Twitter--driving them to close the deal and perhaps off the cliff in 2018.  "Republican Senators are working very hard to get there, with no help from the Democrats.  Not easy!  Perhaps just let OCare crash & burn!" he tweeted Monday.   Of course it would be easier to fix Obamacare, and former House Speaker John Boehner warned Republicans that once you give people and entitlement you can't take it away.

So Republicans have replaced a "mean" proposal with a less mean proposal.  Now passage rests in the hands of a handful of uncommitted Senate Republicans.   Were Hippocrates, the father of medicine in Western Culture, alive today he would give each of them this advice:  "Do no harm."

But this is politics, and nobody knew it could be so complicated.