Take a Knee For Democracy: The Anti-Republicanism of Trump’s Firing Mad Tweet to Sports Team Owners

Underlying Donald Trump’s call for owners of major league sports teams to fire athletes who take a knee during the national anthem lies a dangerous premise–concentration of wealth mints the moral permission to censor speech. The notion that wealth mints the authority to curtail principled public acts of speech is not only anti-Democratic and Anti-American, it is specifically anti-Republican. It’s to this latter matter that I wish to direct your attention. Free speech and open public discourse, including vigorous dissent, were–the Founders understood–essential to the American experiment because such freedoms were and continue to be robust bulwarks against tyranny. That is in part why Jefferson believed that democracy would best thrive in a nation of small property owners. People of limited, but adequate resources, in a nation of widely distributed ownership of property, would have the capacity to sustain and voice independent views, and could not by dint of their wealth exert coercive power over the voices of citizens and those who represented them in public office.
The Republican notion that democracy, its freedoms and the strength of our union resides in the people was voiced in folksy fashion by President Lincoln, “God must have loved the common people–he made so many of them.” An observation that Richard Nixon quoted in the famous Checkers speech, the address that restored his viability as Eisenhower’s partner on the Republican Presidential ticket. Elsewhere in the speech Nixon personalizes the matter of Republicans being simple, common folk, having every bit the right to stand for office as the wealthy, by describing his wife Pat’s cloth coat, “I should say this—that Pat doesn’t have a mink coat. But she does have a respectable Republican cloth coat. And I always tell her that she’d look good in anything.”
It is instructive to reread Nixon’s Checkers speech for the standards of financial disclosure it voices, not because of Nixon’s moral character, but because of the Republican values to which it appealed. Back then, one might have described these as dyed in the wool principles of accountability, principles that stand in stark contrast to the unaccountable, parasitic plutocratic entitlement that defines practice in the Trump administration. By aggressively encouraging owners to censor the speech of players, Trump in effect is advocating a system of class-based rule, one in which unhindered speech is the sole perquisite of the holders of concentrated wealth. Nothing could be less Republican. Even Nixon knew that.


What 45’s Exclusion of the Transgendered from the Military Says About Our Closeted President

On the surface the President’s decision to exclude transgendered individuals from the military continues his pattern of authoritarian bullying–representing an entire group as a dangerous other, then threatening to ban, wall off, and now exclude all individuals belonging to this or that group from contact with an ever shrinking universe of those whom the demagogue defines as “us.” Central to this strategy is to select individuals so outside the system or so few in number and so marginalized that they have few if any effective means of fighting back—Muslims who reside outside the United States and do not have residency; Mexicans who reside here illegally, including dreamers, and now transgendered U.S. Citizens. The tactical aims here are simple: to fuel fear and anger; to feed prejudice; to rally a base with a trumped up wedge issue; to capture the news cycle, and to distract attention from the autocrat’s lengthening list of failures, corruptions, blunders and missteps, and from the consequences of a cruel, greedy, reckless and misguided policy agenda whose consequences put the nation and our world at risk.
But there is a deeper and more specific issue at play in 45s expulsion of the transgendered, one that goes beyond the now familiar stratagems employed by our errant President, an issue that exposes a profound truth about the President himself. To live a transgendered life is to claim as uncontestable the essence of whom one is, and it is to exercise the courage to express that identity fully in the face of an often hostile culture. To live a transgendered life is to express fully one’s freedom to live a life true to one’s nature, a freedom deeper still than that required to live a life according to ends of one’s own choosing, for we cannot genuinely elect the ends by which we will live until we are true to who we are. To express freedom so profound and with such courage could not be more American; to serve in the military to protect such freedom for all defines the highest form of service to Country, because it expresses patriotism that honors and cherishes our founding principles, rather than mere flag waving urgency. When we openly and fully include individuals of such virtue and constancy in our military,we rise to the promise of our founding principles.
By their insistence on living publicly as who they are, with pride, with love and without apology, transgendered individuals, contradict absolutely the premises and methods that have given rise to and steered this profoundly unAmerican presidency. It must give 45 fits that the transgendered live who they are plainly, while he, like Oz, stands behinds a curtain feeding us lies, deceiving us about his motives, insulting all who would hold him to account, much less oppose him, a man so fundamentally wed to his falsehoods that the resistance calls him by his presidential number, 45, rather than by his name.
Our fake President, who rails about the “fake news,” storms about on the public stage as perhaps the most closeted person in American. His ruthless determination to remain in the closet, causing him to use every lever at his disposal to change the subject, derail the investigation and coerce silence, while delusionally inflating his popularity, his productivity and his accomplishments, expose him for the pathetic, but dangerous fool, he is. Nothing can be more threatening to such a man, and to those who submit to his authority, than someone who is fully and completely out.
And so, as he feels the torch cutting through the wall of his safe of secrets, investigators with crowbars coming to pry open the door on his locked closet, is it any wonder that this President chooses now to deny the right of service to those who so fully express the freedom that defines the heart of our great American experiment, to live as they truly are? To me it’s no wonder at all, just a sorry truth.

The Future of the Democratic Party Lies in Offering a “Square Deal”

What We Need from the Democrats is a “Square Deal”

WAPO columnist Dana Milbank reports today that Congressional Leaders of the Democratic Party are about to announce Their agenda for the 2018 Election. They’re headlining this agenda, Milbank reports, as, “A Better Deal.” Milbank, describing, its populist tone, and centrist economic message, suggests that this might just be what’s needed.

It’s easy to see why: The message is focused, it’s economic, it suggests prospect, and it’s positive. It says, we’re about more than resistance, and we remember and revere our roots in FDR’s “New Deal,” and Truman’s, “Fair Deal.” It’s also profoundly off-base and guaranteed to fail: Here’s why. “Better” is a relative term. It raises questions and inspires doubt. “Better than what?” “What makes it better?” “How can we trust you to give us a better deal when you haven’t given us something better so far?” It fails in its desired populist appeal because effective populist messages create confidence by offering sureties, better’s relativism feels wimpy and unreliable, almost unAmerican. It’s that evasive, coastal elite vagary that breeds distrust and leaves liberals holding the bag when the little guy feels like he’s getting the short end of the stick.

The party leadership’s historic intuition about going back to the great deals by which the democratic party built and sustained its governing coalition is entirely on point, but “better” doesn’t cut the mustard. In fact it doesn’t provide sufficient mustard to cover a ballpark frank. So what kind of deal should the democratic party be offering? A “Square Deal.” If we want to win, we need to become the party of the Square Deal.

Unlike “better,” square is grounded, concrete, absolute; its good, right, basic, decent and American. It’s “fair and square,” connected directly to Truman’s fair deal. The historic tie to what made the Democratic party is stronger, truer and more accurate than the squishy “better,” and those connections define precisely the qualities that the Democratic party must embrace if it’s to gain the public’s trust and win its votes. A square deal is honest, proper, respectful, reasonable, ethical, stable, candid, even-handed, moral, just, non-partisan, right, due, grounded and American–everything that politics under present Republican leadership is not, though it should be. A square deal is what voters want, nothing less and nothing more, and only a square deal can break the impasse in Washington.

If the Democrats want to win and win big, they will offer not a “better deal,” but a square deal. That’s something we can all get behind.

Healthcare in the Language of State

The failure of McConnell’s version of 45care opens an historic opportunity to do health care right, by which I mean establishing a universal healthcare system that increases longevity and quality of life for all Americans at lower cost as measured by: percentage of GDP; average per patient cost of delivered care, and the percentage of income that individuals  pay for healthcare through taxes, premiums and out of pocket expenses.  Democrats are well positioned to seize this opportunity and to drive the debate in a direction grounded in meaningful and relevant performance standards, but will rapidly squander it if they continue the small bore tactical rhetoric of recent weeks.  It’s not that I disagree with the points that they’re making, but their tone is defensive, their scale small, and their aspiration (Bernie aside) inappropriately puny.

Imagine if JFK were alive today and that he and his speechwriters were gearing up for a 2020 run for the Presidency.  What would they say?  Would they talk about tinkering at the margins with Obamacare or would they speak to something larger?  If you were to ask Bill Moyers, I suspect that he would tell you that they’d say something like this:

“Obamacare, a legislative accomplishment of great humanity and historic proportion, was the second act in our march as a nation toward providing healthcare for all in a manner appropriate to the American Prospect and worthy of shared American dream of living in health, safety and happiness.   Our first step on that journey was the creation of Medicare and Medicaid, which provided secure care for millions of Americans in need.  Obamacare, the second step on that journey, extended coverage to millions more, while sharp reducing the rate of cost increase in our healthcare system.  Now we enter the third and final stage, a stage in which we must build on these remarkable legislative foundations and provide a system of care that truly meets the needs of all Americans, one in which no American fears that he or she or a beloved family member will not received needed care and treatment in a timely, effective and dignified fashion.  We know that anything less is unworthy of our great nation and that it is within our means to secure the health of our citizens, while making our healthcare system a model for the world.  To ask for, or to achieve, less would be to forsake our nation’s deepest and most fundamental values: Life, Liberty and the Pursuit of Happiness.

A healthcare system that leaves enormous gaps in care and coverage; a healthcare system that enriches intermediaries while leaving individuals without necessary care; a healthcare system that bankrupts working Americans; a healthcare system that yields shorter and less healthy lives than those enjoyed by the citizens of peer nations deprives us of our ability to live by the values and aspirations of our great national experiment. Our lives, our liberty and our capacity to pursue happiness are grounded fundamentally in our individual health and in our common interest in securing good health and well-being for each and all.  Choice between poor coverage and no coverage is not freedom, it is a failure of imagination and a cover for the greed, mendacity and cruelty of those who would kill the poor and subject middle-class families to fraught and shaky lives simply to benefit the wealthiest among us.  Such a concept of freedom has nothing to do with the Jeffersonian ideal of a vital deliberative democracy made up of a vigorous nation of small property holders.  Jefferson understood that people without resources could not fully exercise their freedoms or fulfill their citizen duties.  Our health is our most precious resource. Without it we are nothing, and so in our health our freedom resides.

America’s greatness has always lain in its relentless hope, hope made real through our consistent expansion of freedoms and opportunity to lead richer, wiser, kinder and more fulfilling lives.  Our avid pursuit of a system that ensures the health and well-being of all is entering its third and final stage, and all of us as Americans can be proud that we have the opportunity to join in fulfilling this great American project together.  Leaders in the Republican party have threatened that they will now make Democrats “own” Obamacare, but this viewed in the long arc of history, this is no threat at all.

We are proud to own Obamacare, just as we continue to be proud to own Medicare and Medicaid as two of the great legislative achievements of the American Century. Understand that Obamacare is not and never was an end in itself, it is an act in a longer story, a story whose promise of hope embedded in that historic legislation we are committed to fulfill.  With the failure of “repeal and replace,” we have arrived at an historic turning point, a point of hope and a point of opportunity.  As Democrats we know that this is the moment to raise our sights, not to lower them. We know that it is time to enroll all Americans in the great project of creating a healthcare system that includes all, and that is a model for and the envy of the world.  Any politician who asks for and is willing to deliver less fails to understand what every citizen knows in their bones, caring well for our common health can and will demonstrate our greatness as a nation and as a people.

Exiting the Paris Accords: Why The Smart Fool at our Helm Chose to Nullify this Wise Compact

Donald Trump’s decision to exit the Paris Climate Accords represents a profound, but unsurprising misunderstanding of the nature and effective resolution of an important class of collective action problems. This misunderstanding was evident in the President’s characterization of the Accords as a “transaction,” when most pointedly, like other durable multi-party agreements, the accords are a compact–a far different entity from a transaction. It is not surprising that Trump would understand such an agreement as a transaction because his world view is framed entirely through the lens of a business executive who, for five decades, has ruthlessly and with guile pursued his narrowly conceived self-interest. This transactional perspective also explains why Trump is determined to undo our collective alliances and to exit treaties–whether they be on trade or the environment–that have multiple signatories.
Throughout his career Trump has framed his self-worth in terms of his ability to get leverage over his negotiating partners by any means possible, and a willingness to default on his obligations to contractors and lenders when he can exploit gaps in the enforceability of the contracts he has entered into. In economic parlance, Trump looks for bargaining situations in which he can extract economic rents, and business situations in which he can take advantage of asymmetries of information, resources and power that allow him to free-ride on the efforts of others. Trump understands viscerally, that in a two party negotiation asymmetries of power and information give leverage to the stronger party. By contrast, in multi-party arrangements it’s far easier for weaker parties to free-ride, extracting excess benefits as the price of their willingness to participate in an agreement that at the margin still benefits the larger actors.
As a developer, it’s no wonder that Trump hates such behavior. He knows full well the rents that the last owner to sell a property can extract from a developer trying to assemble a parcel, and nothing upsets Trump more than the notion that someone might be able to gain leverage over him in a deal. Accordingly, he looks with disdain at alliances such as NATO, where allies free ride to some degree on the alliance, securing benefits disproportionate to their relative contributions, trade agreements that incorporate asymmetric benefits, and climate accords that do the same. He’s correct in his assessment that in bi-lateral arrangements, the U.S. can extract and enforce larger concessions from its counter-parties than it can in many multi-lateral compacts. This insight, however, does not mean that in the long-run bi-lateral treaties and accords always constitute, to use his favorite term, a better “deal.”
Compacts, unlike transactions, are durable agreements among several parties that establish common values and objectives, codes of behavior appropriate to these ends, and mechanisms for developing practices that strengthen the efficacy of these compacts over time. A well conceived and executed compact incorporates all actors whose participation is necessary to achieving its underlying purpose, and those actors whose participation is beneficial to that end. Put differently, an effective compact is one that that is well matched in size, obligations and membership to resolution of, or meaningful progress toward, resolution of the underlying collective action problem. (Compacts that subvert larger collective interests are badly formed, an insight that provides the basis for the clause in the Constitution that forbids two or more states from entering into an interstate compact without the approval of Congress.)
In such a compact, the relative stakes in achieving a collective solution may vary considerably. Accordingly, actors with lower genuine stakes in contributing to a collective solution are positioned well to extract concessions (by playing “weak threat” positions) in order secure their participation, and to meet their obligations in the breach during the life of the agreement.
That parties with lower stakes in the outcome can exploit weak threat opportunities for defection, does not mean that a multi-lateral agreement is ill-advised. If the benefits to the more deeply invested players on net exceed the costs, and if better alternatives to resolving the underlying problem are not practically available, then such agreements hold merit. Yes, they should be fiercely negotiated; yes they should have strong monitoring provisions, and as strong mechanisms of enforcement as are practical, but some degree of distortion within the agreement is an acceptable price when it yields a greater good. This is what Trump profoundly fails to understand. He fails to grasp this basic truth because it violates his core belief that success is defined by getting over on the other guy. Not only is that poor business practice, it’s a naive and foolish means of conducting foreign policy.
As he looks for points of reference in his quest to Make America Great Again, Trump would do well to recall that our path toward nationhood began not with the Mayflower Transaction, but the Mayflower Compact. His withdrawal from the Paris Accords is both ill-considered and unAmerican. Ultimately today’s action is one that will be seen as a defining moment in the utter failure of his Presidency.

Can Bernie Learn?

Bernie Sanders remains America’s most popular politician, and one of the few who are genuinely loved and admired by large swaths of the population. (To note his popularity is not to deny either his controversy, the fact that his brand of progressivism has let many on the left feel marginalized, or that his recent assertions about who is and who is not a progressive have alienated more.)   He is taking this popularity now to the hustings, touring with Democratic National Committee Chair, Tom Perez to rally the resistance, and to ensure that his message of economic justice, healthcare as a basic right, education for all, and taking human responsibility for climate change, seriously frames the debate for both the mid-term and the 2020 elections.

That the chair of the Democratic National Committee, not Sanders’ choice for the role, is traveling as Bernie’s sidekick says much about the mismatch between the power structure within the Democratic party and the political interests of the public writ large.  For the Democrats to prevail in the mid-terms, they will have to close this gap, but they are not the only ones who need to evolve.  Sanders must too.

While one can assign a variety of reasons for Sanders’ loss of the 2016 nomination, a principal cause was his failure to win the trust, energy and support of the majority of African American and Latino voters.  Sanders’ inability to garner more than 30% of African American votes during the primary process is particularly significant, and the reason has at least as much to do with his ideas as it does with the political capital that the Clintons amassed with this community over the decades of their public life.

With remarkable consistency Sanders has framed his political views through the lens of Democratic Socialism as a means to economic justice.  During the early stages of the campaign Sanders assimilated social justice to economic justice, coming late to the game (and only under pressure) with respect to incorporating social, particularly racial justice, defined on terms different from simply economic opportunity into his campaign rhetoric.  For Sanders this extension of his rhetoric was not a come to Jesus moment, but a pragmatic extension of language in the face of constituent pressure.  It rang hollow, felt thin and drew few votes.  Today, as Sanders heads out onto the road, he has largely retreated to his core message of economic justice, and his advocates,as they did then, counter criticism from leaders in the African American community by asserting that Bernie’s tide will lift all votes.  This is unfortunate because it profoundly misses the point and raises the question of whether Bernie can learn?

Inclusion as a matter of social justice is both morally and logically prior to the construction of policies that secure economic justice.  It is not and never has been the other way around.  Economic policy, the granting and enforcement of property rights, the organization and policing of markets, the allocation of GDP across private, not-for-profit, the public sectors and the informal economy, and the concentration and dispersion of wealth within and across social groups depend fundamentally on who is at the table when the rules are made, and on the conditions of their participation in the room.  When inclusion is broad-based and the conditions for free and genuinely empowered participation robust, the design of economic policy can be structured to attend wisely and justly to the varied needs of groups whose present opportunities have been shaped by centuries of systematic social and economic injustice.  Otherwise, it cannot.  Economic justice defined simply in terms of class conflict, a la Sanders, cannot generate either social or economic equality, be it of outcome or opportunity, because it ignores the path dependency of outcome and opportunity on differential histories of exclusion, appropriation and exploitation based on group membership.  Put differently, Sanders’ sentiments are noble, but his theory of political-economy is wrong.

Sanders has occasion and opportunity to achieve greatness, but to do so, he must come to understand that social justice write large, of which economic justice is a dimension, requires broad-based inclusion, and he must act accordingly.  What does this mean in practice?  It means that he must begin to speak in terms of social justice, of inclusion and of remedying patterns of historical, non-class based inequality, that remain wired into our culture and fervently defended by its beneficiaries across the economic spectrum.  It means that he must shape his policy prescriptions with the advice and visible input of progressive leaders across the spectrum of historically excluded groups, but particularly within the African American community, who are rightly suspicious of whether Sanders truly speaks to the best interests of their constituency.  It means that his tour with Perez must grow.

His tour must grow in its composition, including more faces, more voices, more colors, more more women and more perspectives.  It must grow in its itinerary, going directly into communities, rural and urban that have been most neglected.  And it must grow in its heart, becoming a tour of open arms, welcoming and inclusive.

Rather than a whirlwind revival of Bernie’s greatest hits, let this tour become a rolling revue that travels far and wide, that brings new voices to the stage, that contrasts Trump’s hate filled rhetoric of exclusion, with a big-tent embrace of our human variety–one that allows that progressivism is a shared impulse to make life fairer, more human, more vibrant, more fulfilled, more varied and more just, an impulse that finds diverse forms of expression, whose details are hammered out in policy making, not in the imposition of litmus tests by gate-keepers named Sanders, Warren, or anyone else.  Let this tour become a bandwagon in which people are encourage to bring their instruments and jam.  What could be more American than that? What could be more Democratic?  What could be more likely to turn the tide?

I hope fervently that Bernie can learn, and if he needs example from his seniors, he might look to B.B. King whole played nearly every night of the year into his 80s, to Bob Dylan’s 1975 Rolling Thunder Revue, which brought many voices onto stage and found harmony in the variety there, and to Leonard Cohen whose tours during his 70s were miracles of generosity and grace. Let it Roll Bernie, let it roll.

Bannon Takes Aim at American Exceptionalism

Yesterday at CPAC Steve Bannon advanced an explicitly “nationalist” agenda. I put nationalist in quotes because that is Bannon’s choice of word. To my knowledge, this is the first time in our history that a senior White House official has sought to advance right wing nationalism as a central pillar of a sitting President’s policy agenda. This was not done Eisenhower, by Nixon, by Ford, by Reagan or by either of the Bushes, and certainly it has never been part of the rhetoric of any President from the Democratic Party.

Let me be clear, Bannon is not talking about nationalism in the basic sense of a nation’s fundamental autonomy and right to self-governance. He’s also not talking about bread and butter patriotism understood as love of homeland and country, something common to American citizens whatever their politics. 45’s political strategy advisor is also not talking about American Exceptionalism, which is grounded in the principles that underwrite our liberal democracy and on the merits of actions taken in support of those principles. The principles that underwrite our democracy are available to all, and our determination to uphold them is what has made us great in the eyes of the world and can continue to, not the petty, weak, cowardly, bigoted, bellicose jingoism that lies at the heart of Bannon’s “nationalism.”

Bannon’s remarks, slipped casually into his onstage lovefest with Reince Preibus, were designed to assimilate Conservatism to his alt right nationalist agenda. This ought concern principled conservatives as deeply as it does independents, liberals and progressives, perhaps more so because it is Conservative values that he is most directly seeking to subvert.

Bannon’s bid for nationalism is meant to open the door at a national policy level to the ugly identity politics that the Alt Right has been pushing from the fringes for some time. That Preibus simply let this appeal to nationalism pass, shows both Bannon’s relative power in the White House, and the ease and willingness with which this administration is willing to dispense with defense of the principles that have made America exceptional, in part to rally its base, but more fundamentally because the Trump administration’s bias is authoritarian, not Democratic. Do not let Bannon’s remarks go unchallenged. Democracies die when such rhetoric is advanced rather than eschewed by those at the top of our governing structure. That such a statement should pass with such little notice is a sad day for America indeed.

The Andy Card

So who’s Andy, and what’s his card?  Andy was W’s chief of staff from 2001 through 2006. He was a low-key professional and by all accounts ran the White House well.

A couple of weeks into the Trump Administration, Andy was on cable news grading the Trump administration’s early performance.  His assessment was charitable, giving them low-early grades, but describing the Cs they were getting as “learning-curve grades.”  Somewhat surprisingly, given his history with the Bushes and the weight they place on family loyalty, Card (yes, that’s his last name) presented a rather sunny view of Trump and his prospects.   As I watched his relaxed and deft performance, I realized that Andrew Card was announcing his availability for the Chief of Staff job presently held by Reince Priebus.   He didn’t criticize Reince, didn’t go after him, just kind of casually reminded folks that he has the tools needed to assemble and run a strong White House staff.

Two weeks in, no particularly sharp public criticism of Reince and already Andy was letting us know that he’s waiting in the wings.  In light of what’s happened since, a rather astute reading of the cards in the room.   With still a week now remaining in Trump’s first month in office, we’ve seen the meltdown of the public face of his White House and growing controversy over 45’s most important staff appointments.   If Trump wants any chance of running a credible Presidency, Spicer, Conway and Miller will have to go, and go soon.  Michael Flynn, Trump’s national security advisor is dangling in the wind; Steve Bannon, though consolidating power within the White House is not only drawing strong opposition from Democrats but raising deep, though largely private, concerns in senior Republican circles, and the emerging perception in pundit-world  is that Reince has been muscled to the side–an unsustainable position for a chief of staff.   Meanwhile, CNN’s saying that the White House needs to find its David Gergen, a competent Washington insider who understands the town’s internal operations and can make them work for the Presidency.   They observe that there are few in the limited pool of relevant talent who would want to risk their reputation in a Trump Administration.  And that’s Andy’s card.

If Reince goes, Andy’s positioned himself as first in line, and because there aren’t many waiting in the wings, Card has bargaining power.   Card would be able to insist on a full house cleaning, one that included not only Spicer, Conway and Miller, but Bannon and Flynn.  He’d be able to say, “If you want my services, these folks have to go, otherwise no deal.” Whether Trump would let go of Bannon in order to get Card, is an open question, but he’s good at firing folks when they no longer serve his interests.  (Of course if Bannon has things on 45 that we don’t know about, the calculus changes.)  That’s real leverage, leverage that Card could exploit to build a strong White House staff.

Preibus a politically astute party operative,  though operationally inexperienced is doubtless aware of the Andy card.  If he wants to hold power, he’d do well to orchestrate a successful house-cleaning and do it soon.  But can he convince Trump?   Time will tell.

Universal Access and the Big Lie: Why the Republicans are Talking About Health Insurance Rather than Healthcare

The heart of a robust system of healthcare beats to a simple tune: Give every citizen high quality care at the lowest possible delivered cost both to the individual and the nation–the latter measured as the percentage of GDP accounted for by our entire healthcare system.  A healthcare system that beats to this tune consistently delivers on several goals that determine quality of care: 1) people’s longevity, health and functionality are increasing relative to those of prior generations; 2) the healthcare they receive is convenient, comfortable, supportive honest and effective, and 3) their dignity and privacy are consistently respected.  In such a system patients routinely report high satisfaction with the care they are receiving, the quality of their relationships with their primary care doctors and others in the healthcare profession with whom they work; they are not fearful that they will be denied the care they need; they are not swamped with confusing paperwork and contracts for service that make them fear they may be signing their lives away, and they are happy with the outcomes of their preventative healthcare and their courses of treatment.

For the system to function well, it must satisfy these goals within the context of two cost constraints: 1) cost of delivered care must not be concentrated on individuals with high healthcare needs but must be distributed throughout the population, and 2) the system must be organized to minimize the total costs, while maintaining quality, so that the price we all pay to provide excellent healthcare for everyone is as low as possible.  When quality is low and costs are high the system is failing.  When care is unevenly distributed and quality varies widely, the system is failing.  When costs are concentrated on some, causing them to forgo healthcare that they need or lose their shirts to get it the system is failing.  Simple, right.

“Yes,” some say, “this is simple in principle, but it’s just a fantasy.  You can’t have your cake and eat it too.”  Well yes, that may be the case if: the system we’re working with is organized to achieve these goals; we’ve reached the physical limits of longevity and quality of life, and there’s a hard-wall limiting our capacity to innovate in delivering quality and efficiency improvements to the system.  In the United States, none of these conditions hold. We’re paying more for less service and we’re living shorter, less healthy lives than our counterparts in many developed countries.   Consequently, we can design and run a healthcare system that delivers on all these goals, provided that we design, manage, evaluate and compensate it correctly–and that’s where the Republicans come in.  They don’t want these things, not remotely.

Yes, they gesture vaguely in this direction by talking about things like “patient-centered care,” hoping that we will infer from this language that they actually want to bring down the individual and national cost of healthcare, while driving quality up, but nothing could be further from the truth.  Their interest lies in concentrating money, power and resources in the hands of the big healthcare industry players, regardless of the effect this concentration has on delivered care, cost and outcomes.  They don’t want you to know this, so they are framing a conversation that diverts our attention from these simple, reasonable and achievable healthcare system that serves everyone well without breaking the bank.   They do this by talking about “health insurance” rather than “healthcare,” and they market the idea of “universal access,” as opposed to “universal care,” as a means of delivering quality, efficiency, fairness and freedom to healthcare “consumers.”

Republicans want us to talk about insurance, rather than care– because this seemingly small switcheroo provides a big payoff for their clients in the insurance industry–it provides political cover for denying care while increasing insurance industry profits, even as such denial diminishes the effectiveness, the efficiency and the equitability of the healthcare system.  Within the “insurance” model Republicans describe, denying people care for pre-existing conditions makes some sense, and they sell this internal logic well.  Their argument appeals to our sense of fairness, and to the value we place on personal responsibility.  Its a false appeal, but when delivered cleverly, one with emotional resonance.

The argument goes like this.  Insurance is about the pooling of risk.  This is true for any kind of insurance, auto-insurance, property insurance, workplace insurance and so on.  It’s about about buying an option to cover risky bets, like driving a car, whose distribution of results can be predicted on an aggregate basis, but not at the level of the individual.  When, however, we know things about a person with certainty, or in a way that alters this individual’s risk profile vis a vis the broader population (i.e. this person has a long history of DUIs) we wisely deny that individual insurance or alter his or her insurance fees to reflect what we know about this specific person.

That Republicans claim, is why we should not require insurance companies to cover pre-existing conditions.  They illustrate the point with folksy anecdotes like one I heard last night, where an elected apologist for universal access held forth about a reputed friend of his who had “bursitis.”  In this tale, the man with bursitis was unable to secure new insurance because bursitis was a pre-existing condition.  The politician claimed that this man said he would be happy to pay for his bursitis treatment, because he was more than willing to take responsibility for his existing condition, but was still denied coverage because, and this is where the tale gets sketchy, under the law they couldn’t offer him a policy without coverage for bursitis.

The politician’s point was that his friend knew he had the condition.  There was no risk, because the condition was a given and despite his willingness to take responsibility for this known he wasn’t allowed to.  (Boy that sounds like government messing with personal responsibility and common sense.)  Now wouldn’t it be better if we could take responsibility for such matters and get the insurance we need.  It’s a folksy story, well told, and it goes down smooth.  It’s the kind of story that’s not too easy to disagree with as its being told, but this pol, like so many of his colleagues had slipped a Mickey in the drink.

The conditions we care about are not relatively minor (albeit painful) conditions like bursitis, but big things like cancer, diabetes, sickle-cell anemia, Alzheimers, heart-disease, and a host of other high cost debilitating conditions that no average American could adequately treat, especially given rules preventing Government bargaining over price, within their own resources.   Allowing insurance companies to deny coverage for pre-existing conditions like these means that millions of Americans will not get the care they need and that they will live shorter, less productive lives with unnecessary suffering for themselves and for their families.  (Of course there are other ways outside of insurance to provide health-care, but I’ll get to that later.)

The costs born by such preventable circumstances will not only be carried by the individuals unfortunate enough to have denied conditions, but by their families–in the form of stress, economic loss, and diminished productivity, and by their communities who will have to deal with the social consequences of the needlessly frayed and diminished lives resulting from a policy that invites widespread denial of existing conditions.  For a party that claims to be “pro life” and to believe in “family values,” this seems a mite strange, but “you know it would be great if it could be different, but that’s not how insurance works.” End of story.  Or is it?

Of course not, this bait and switch story is based on a big lie, a very big lie.  The big lie is that the efficient, effective delivery of healthcare at the lowest individual and aggregate cost maps directly and completely onto a profit maximizing health insurance model.  It does not.  When providing healthcare, as opposed to insurance, what we care about is “pooled cost,” distributed over the population, not “pooled risk.”   These are not the same.  Pooled cost means that, together, we’re going to pay for the total cost of the healthcare system and to find a way to distribute that cost in our society widely, so that people who have serious medical problems can get the care they need when they need it.  When we think in terms of “pooled cost,” we have enormous incentives also to reduce risk, by providing preventative care, support for healthy lifestyles, and innovations in treatment that produce better and less varied outcomes.  We also have incentives to cut fat from the system, real fat, like insurance, which only covers “pooled risk,” being used as a poor proxy for real health coverage while delivering billions in unjustified profits to its providers, imposing layers of bureaucracy, bargaining and paperwork that dramatically increase cost to providers and increase the risk of patients confronting uncertainty about what care they can and will receive.

This is not to say that a well designed healthcare system might not include an insurance component.  My own view is that a capably organized single payer model that allows for free choice of providers within that structure is the best alternative, but one could imagine other options such as comprehensive care plans offered by competing providers (not insurance companies), who as part of their risk management strategies might insure against catastrophic costs at the level of the group, in essence laying off some of the risk to a larger pool.  The critical factor in designing policies and institutions that meet our healthcare needs, foster innovation, distribute care equitably and drive down cost, will be ensuring that the focus of policy reform is on healthcare, not health insurance.  Insurance, a tool, not an end in itself. It might be part of a larger equation, but its logic is inappropriate to the situation and should not frame the debate.  So how did we get to the big lie in front of the circus tent?

In common parlance we tend to use the term “health insurance” to mean the coverage we need to ensure that we get proper, dignified and effective healthcare promptly when we need it.  By insurance we really mean coverage for care, not insurance in its technical sense.  Republicans know this, but they are substituting a technical argument about what insurance is for what we actually mean when we throw the term about at the kitchen table. They’re doing it to keep the nominal terms of the debate the same, but to change their meaning.  It’s an old trick, and a clever cover for a big lie.  In the old days this deft maneuver was called a “chicane,” a “quibble” meant “to prevent justice.”  If we want to do right by the American people,  let’s concentrate on how to deliver great healthcare to all at a good price and not be taken in by these sellers of an all too dangerous policy elixir.

Endowing Our Culture

Sadly, and yet entirely predictably, Donald J. Trump has announced his intention to end funding for the National Endowment For The Arts.  Whether he succeeds or fails in this endeavor, Trump’s action reflects a broader pattern in which nominal Conservatives have sought to end the stewardship role that would logically be at the heart of any truly conserving political philosophy and agenda.  They seek a fire sale of public lands, invite drilling on environmentally sensitive areas, attack liberal arts education in our schools, abandon their custodial responsibility for the climate and undermine the great and successful institutions of our democratic experiment.

I recall a conversation back in 1986 with Winthrop Knowlton, the past President of publisher Harper & Rowe, and then the Director of the Center for Business and Government at Harvard’s Kennedy School.  Win leaned forward from his chair and observed that he had become concerned with a trend in our culture that he described as a shift away from, “our being an endowing society.”  We discussed the matter at some length. At the end of the conversation he asked me to spend some time looking further into the question.

I cannot recall exactly where this project led, or what precisely I reported to him, but I do remember our coming to a notion that there were forces in the culture that mitigated against the traditional sense that social and economic elites bore a responsibility for intergenerational stewardship of institutions, resources, and norms of good citizenship.  The hoary admonitory imperative, “For whomsoever unto much is given, of him much shall be required, (Luke 12:48), invoked famously by Kennedy in its now more familiar locution, “For those to whom much is given, much is required,” seemed with some regularity to be going through a process of being cashiered for a loose Conwellian, “Acres of Diamonds,” notion of virtue inhering in the acquisition of wealth itself, and the correlate premise that by dint of its possession, the wealthy were virtuous.

By this process, one feared that Boeskian virtue (made infamous in popular culture by Michael Douglas’s, “Greed is Good” speech in the Oliver Stone film, Wall Street, and by the prosecution and incarceration of junk bond king, Michael Milken) would over time become assimilated to the concept of civic virtu, thus vacating both the neoclassical virtues of American Republicanism, seen by the Founders as essential to capable citizenship and effective statecraft, and the premise that the production of and engagement with the fine arts represented a profound and vital fulfillment of the American experiment.  Wrote John Adams to his wife,

I must study politics and war, that our sons may have liberty to study mathematics and philosophy.

Our sons ought to study mathematics and philosophy, geography, natural history and naval architecture, navigation, commerce and agriculture in order to give their children a right to study painting, poetry, music, architecture, statuary, tapestry and porcelain. ~ John Adams, Letter to Abigail Adams (12 May 1780)

Thirty years later we have in Trump the manifest expression of this fear fulfilled.   Mr. Trump, whom we might term the President Regress, a man who chooses to enter office by announcing his desire for parades in Washington to show military might, and to kill the very endowment that represents the apogee of our Second President’s hopes for the future of our newfound state, represents the instantiation of the premise–anathema to the Jeffersonian vision of a nation of small property owners–that material wealth is a warrant of virtu and that it, accordingly, mints exceptional permissions to those of its holders who attain public office.  The voting logic behind such a premise–“he has made it big; therefore he is good; therefore I will vote for him, so that my life can be made better by dint of his greatness”– is the desperate, but voluntary, substitution of vulgarity for citizenship.

As citizens, we may be many, but we are each one, and by the exercise of our individual judgment, restraint, courage and discipline we make together a nation great and good.  As herded voters, who allow ourselves to abdicate our citizen reserve in favor of the bloated projection of the “great man,” we abandon our dignity and become no longer citizens, but the vulgar masses, free perhaps to consume with what few resources we have, but not the self-reliant and discerning individuals who experience the genuine autonomy that our American experiment has always been meant to defend, to honor and to preserve.

In this context, Trump’s determination to kill the National Endowment for the Arts, and the humanities, and to privatize public television, represents a misanthropic ploy meant to further debase us by appealing to our gluttony rather than our taste.  But that at its heart is what assimilating wealth to virtu means–it is to prize excess over restraint, consumption over stewardship, the here and now over the future and the well-being of those who follow in our paths. Ultimately, it is to laud dispossession over endowment.  As such, it is a choice to be a poor ancestor.

To end this essay there, without offering a step in the direction of something better–while dramatic–would be to cede the day.  As a citizen, this is something I will not do.  The arts (and letters) are central to our life as a nation.  They frame our history, heal our wounds, illuminate our aspirations, reveal our variety, expose our controversies and frame our future.  We can grant neither their funding, nor their function to the dissipative whims of an authoritarian narcissist who has now taken the reins of power.  Rather, we must secure the place of the arts and safety for their full expression with vigor, discipline and flair.

Imagine then a two pronged approach to ensuring a place the arts as the living national treasures they so richly have come to be: 1) An active, visible and visual fight not merely to preserve the endowments and public television as Federally funded programs, but to expand them, and 2) A potent private effort to create national foundations for the arts, fully endowed and committed by incorporation to funding the arts and to supporting their vital role in our democracy into perpetuity.  At present, the funding for the National Endowment for the Arts sits at approximately $150,000,000, a true endowment in the form of a foundation or cluster of foundations that could maintain this level of funding into perpetuity would require approximately three billion dollars.  It is well within the capacity of existing American Foundations and the resources of private philanthropists acting collaboratively to establish now such structures, endowments that will serve not only as bulwarks against ill-intended reductions in Federal funding, but as potent signals about the importance  we place on endowing our culture.