There’s Talking and Then There’s Doing….

Over at Talking Points Memo, Josh Marshall makes a really important point. In a post reflecting on the various reasons that the rollout of the proposed healthcare overhaul has been going so badly, he points to the important role of a President in the passage of complex or controversial legislation.

True, the health-care bill has numerous glaring defects. As Marshall also points out, the defects should have been expected, since the GOP has been promising to do something that is basically impossible–continuing to cover people while offering more carrots and employing fewer sticks.

Even though Republicans control both houses of Congress and the Presidency, the bill faces formidable obstacles. Major stakeholders hate it,  Republican lawmakers are divided, and the bill won’t get a single Democratic vote. Faced with significant opposition, what is needed is what Marshall calls “the mix of formal and informal powers, favors and threats, public presence, the ability to protect or punish” that only a President can bring to bear.

This is something President Trump has shown virtually no interest in doing. We’re at roughly a month and a half into the administration. The GOP has unified control of the government and yet no significant legislation has moved at all. That is a stunning reality which the storm and chaos of Trump’s short presidency has largely obscured. But it is an almost unprecedented development. Some of this may be an inherent limitation because the President came into office as a minority President. But as I argued a month ago, the President simply has no appetite for the hard work of passing laws. He has defaulted to rolling out executive order after executive order, in most cases Potemkin decrees with vaguely legalistic language and limited actual impact. Like so much with Trump, it’s a mix of authoritarianism on the one hand and impatience and flimflam on the other. The upshot isn’t so much a poor man’s as a lazy man’s authoritarianism.

I think it is deeper than Trump’s obvious aversion to actual work. It is equally obvious that he has not the faintest understanding of how government actually works–and even less interest in learning what he doesn’t know. He is used to running a family business where he issued orders and people who were related to him and dependent upon his largesse obediently followed them. He wasn’t even the typical CEO of a publicly-traded company who would at least have to answer to a Board of Directors and shareholders.

A diligent and intellectually curious person with Trump’s background would be disadvantaged by that lack of relevant experience.  Trump is neither diligent nor intellectually curious (judging from his vocabulary and spelling of his tweets, he isn’t even very bright). Several of the skills that Marshall identifies as critical to the passage of legislation are simply beyond his capacity to acquire or exercise, and his self-obsession  precludes any engagement in the sorts of “schmoozing” required to cajole recalcitrant lawmakers. (It is impossible to imagine Trump strategically stroking the egos of crucial legislators.)

Ironically, the very traits that make Trump so manifestly unqualified for the Presidency  may end up saving healthcare….

Fingers crossed.


  1. While Trump’s obvious lack of knowledge about how the government works is easy to see, the problems inside of the Republican Congress up until now have been scarcely observed or reported on. But problems there are, and they are serious and deep.

    It turns out that the great big “Repeal and Replace” plan sold to the masses was never actually planned out. Now what they present to the people is a last minute, small minded proposal hatched out in desperation behind the locked door of a basement room in the Capitol. This is Paul Ryan’s leadership?

    Then there are the investigations of the Russian/Trump election fiasco. Every committee and sub-committee wants a piece of it, and Ryan seems to be letting the thing go its own way. Now the Tweeter in Chief is demanding that his personal concern over wire taps be added to the list to be investigated, and again Ryan follows instead of leads. That decision just might sink the lot of them.

    House leadership, the Senate’s McConnell is missing in action these days, wasn’t there during the campaign when it was possible to have stopped Trump, and it is not there now when what is needed is keen foresight as to where Trump is dragging the Republican Party and the country too.

    Given the keys to heaven, the Republicans don’t know how to unlock the door.

  2. Ken; as usual you are commenting in the abstract. No one in government, including President Obama, has EVER said to leave the ACA “untouched”. He has asked, urged, begged, pleaded and required members of Congress to submit viable changes and solutions to known problem areas. All the Republicans have done is spend millions of tax dollars prior to the presidential election in more than SIXTY attempts to repeal the ACA with no replacement in mind. They have proposed a conglomeration of deletions and additions to aid the wealthy and submit all bills to the poor, elderly and disabled, solutions which members of their own party are against along with the AMA, AARP, et. al.

    “There’s Talking and Then There’s Doing…”

    “Let them eat cake!” continues to be their warring cry; this time with a mentally unbalanced, totally ignorant of government responsibilities OR limitations, early morning Tweety Bird, leading their charge, disguised as the president.

    “Ironically, the very traits that make Trump so manifestly unqualified for the Presidency may end up saving healthcare….”

    And; didn’t Marie Antoinette literally lose her head for her solution during the French Revolution? Hopefully; we are seeing the beginning of a bipartisan revolution with the battle over “Obamacare” vs. “Trumpcare”…and the Russian connection which will not be resolved with the Republicans investigating themselves and Trump.

  3. “There’s Talking and Then There’s Doing”

    You have a chance “to do” right now. Support H.R.676, introduced by Rep. Conyers, John, Jr. [D-MI-13]. He now has 63 Co-Sponsors.
    Expanded & Improved Medicare for All Act

    This bill establishes the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.
    Details may be found on this link.

    The next step is to E-Mail, write or call your Federal Representative and ask them to support HR 676. You can find your Federal Representative at Congress.Gov.

    “International experience shows that single-payer financing systems, like the one described in Rep. Conyers’ bill, are the fairest and most cost-effective way to assure that everyone gets high-quality care,” said Dr. Carol Paris, president of Physicians for a National Health Program, a nonprofit research and educational group of 20,000 doctors nationwide.

    The McMega-Media including NPR have totally ignored HR 676 Expanded & Improved Medicare for All Act.

  4. Trump won’t “strategically stroke the egos of legislatures.” He will threat and intimidate and he’s good at that and has a lot of levers to pull. Make no mistake, a Republican in the House from a red district will find it hard to stand up to him. Look how companies have danced around him (with the exception of Nordstroms and TJ Maxx) in the fear of getting caught in a tweet storm.

    This is what makes him so frightening. Of course, he isn’t a real businessman. (Which, in my opinion, is why Tillerson doesn’t have access. Like him or not. He’s the real deal. You don’t become CEO of Exxon otherwise.) I say this as a business consultant whose worked for several CEO’s of very large companies. A family business is a totally different animal. He’s never worked in or managed real teams, had to face shareholders, had to sell an idea internally, and on and on. It’s pathetic that the press didn’t make the public more aware of this difference.

    Michael Bloomberg called it at the convention–he’s a con-man. And, as Mayor of NYC where Trump was working, he knew exactly who Donald Trump is. And, as someone who built casinos in Atlantic City and Vegas…we can only guess who Trump had to make his infamous deals with.

    The only thing that will

  5. Manifestly unqualified indeed! That has a nice turn to it. When are we, whether Democrat or Republican, going to call a halt to Trump’s beyond reckless statements that may make sense in his cockeyed world but not in ours? I have seen foreign as well as domestic cartoons which lampoon him and his staff and suggest that they are not all there – and I am beginning to believe it. How else to explain that he “won in a landslide,” was “surveilled by Obama,” is so underappreciated for his contributions to a better world etc.?
    He seems to think that running the government is some sort of TV show where there are only winners and losers, that there is no right or wrong, that lying is fine etc. That may be the world he and Bannon have constructed for us, one where there is no past and no future but only now but I like to think that such a world is the diametrical opposite of the real world we inhabit and that truth and right and wrong should still be guides for the conduct of government in a democracy, that you do not give in to paranoia and his predilection to just say whatever comes to mind for some perceived temporary political advantage with little to no concern for its effect.
    The election is over; it is time to govern, govern responsibly and within the confines of our world, not some ill-defined venture into Bannon’s authoritarian “New World.” Where are the Republicans who are going to corral this wild mustang before he destroys the barn?

  6. Sheila’s right … which shouldn’t surprise anyone. She’s usually right. Fake President Donald Trump “has not the faintest understanding how government actually works. ” Furthermore, he hasn’t the faintest understanding how anything works. That may be because there’s no evidence he has ever worked.

    Republicans are waiting for Trump to guide them through a sound and sensible course of action and to take any blows that voters are going to throw at anyone who suggests an unfair plan to replace Obamacare. That isn’t going to happen. Trump will endorse nothing that makes him look like anything less than a god.

    What the voters want are the same health policies that members of the house and senate are getting … for free. Fat chance.

  7. Louie! Great idea! Health care across Europe and in Japan is falling under its own weight and you support a move to government provided health care. Everyone on this site complains about government corruption and yet in the same breath call for more government control of anything?

  8. Yesterday one of his spokespeople came out and said that he doesn’t want this bill to be called Trumpcare.

    This is a man who wants his name on a hotel owned by a corrupt oligarch in Azerbaijan. But he doesn’t want his name on this.

    So of course, we should call it Trumpcare, or perhaps RepublicansDon’tCare.

  9. I just watched Michael Steele, former RNC Chair, getting a huge laugh over Republicans passing Trump’s health care bill out of the House at 4:30 this morning. He said it is the same thing the Democrats did in 2009 and 2010; and he actually sees no difference between saving lives and saving more money for the wealthy in this country. Quantity over quality is the Republican standard.

    I got a huge laugh over the Washington, D.C., restaurant who is suing Trump for loss of business and income due to the presence of him and his Trump Tower as White House #Two. Hopefully; others will join in and this will become another form of anti-Trump movement. I even support all those wealthy people in West Palm Beach, Florida, the exclusive stores along Worth Avenue if they take the same action.

  10. Louie,

    First off, Medicare is NOT FREE to those of us covered by it. Not only did we pay for it while working, we now pay a monthly premium which rises every time our Social Security has a small increase.

    Swcond, in reading the summary, it applies to all public and non-profit institutions (not private concerns). And yet calls for funding from those it is not covering.

    This does not seem equitable.

  11. Ken:
    The federal government is the only unit of government that can operate a national health care system properly, equitably. The healthcare issue is large and the other options – no public health care, let insurance companies continue to run the system, let the states decide – won’t work.

    The federal government may not be able to operate the system at a profit, but it can operate it fairly.

  12. Barbara G, I never said Medicare was Free. As retiree I am aware I paid into to it, and continue to do so via Social Security. I am lucky I also to have coverage through the VA. Medicare for All is not free either, there is a section on funding. There is a much longer piece in the text: Payment of providers and health care clinicians. SEC. 202.

    The Medicare For All Program, through its regional offices, shall pay each institutional provider of care, including hospitals, nursing homes, community or migrant health centers, home care agencies, or other institutional providers or pre-paid group practices, a monthly lump sum to cover all operating expenses under a global budget.

    (1) IN GENERAL.—The Program shall pay physicians, dentists, doctors of osteopathy, pharmacists, psychologists, chiropractors, doctors of optometry, nurse practitioners, nurse midwives, physicians’ assistants, and other advanced practice clinicians as licensed and regulated by the States by the following payment methods: (I have not listed all these)

    Right now we are being fed a binary choice of ACA vs TrumpCare, when there is a third option. The last time we had a Heath Care discussion Universal Heath Care or Single Payer was not even given a fair chance.

    Here is a good link >

  13. Ken Glass @ 10:25 Health care across Europe and in Japan is falling under its own weight and you support a move to government provided health care.

    The Government under HR 676, would not provide the Health Care, i.e., employ the providers.

    Total expenditure on health as a percentage of GDP.
    Source CIA World Fact Book 2014
    Australia 9.4%, Canada 10.4%, France 11.5%, Germany 11.3%, Japan 10.2%, USA 17.1%. The percentages cited by the World Bank are exactly the same as the CIA’s.

    Total health expenditure per capita (per person) in US dollars. 2015
    Source Organization for Economic Co-operation and Development (OECD)
    Australia $ 4,420, Canada $ 4,608, France $ 4,407, Germany $5,267,
    Japan $4,150, USA $ 9,451.

    Average life expectancy at birth in years, and rank out of 183 countries.
    Source Data List by the World Health Organization (2015)
    Australia 82.8 years rank # 4, Canada 82.2 years rank # 12, France 82.4 years rank # 9,
    Germany 81.0 years rank # 24, Japan 83.7 years rank # 1, USA 79.3 years rank 31.

    Source CIA World Fact Book
    Australia 82.2 years, Canada 81.9 years, 81.8 years, Germany 80.7 years, Japan 85 years
    USA 79.8 years.

    I am not seeing a fall here in these numbers: US vs Europe, Canada and Japan. We pay more here the USA as % of GDP and Per Capita and have a shorter life life expectancy.

  14. The ACA was the alternative to Medicare for all, which will have to happen eventually. At least the ACA allowed 20 million more people to get insurance who otherwise wouldn’t have it, it did away with lifetime caps and denial for pre-existing conditions, but it’s far from perfect. That’s because the hogs are still feeding at the trough–big insurance, big Pharma, big hospital systems with overpaid CEOs. They are the ones who are opposing a single-payer system and who stand in the way of making the ACA work, and their only motivation is money. They’re going to squeeze every dime for as long as possible. Hospitals are buying up doctor practices and extending their control by purchasing small town hospitals and constructing new ones in more affluent suburbs, all to wield power to withstand a push back and keep revenues up. With the Republicans in control, they believe they can continue to stave off the day when the US actually provides uniform health care for all. It will have to happen eventually because the piggery cannot go on forever. It raises my blood pressure to hear Republicans talk about the “insurance market”. The profit motive and life and death don’t belong in the same system, any more than police, fire protection and free public schools do. Smarter countries, like Sweden, England, Canada and others know this.

  15. Greetings to all. As one other person has noted, Medicare is not free. There is a monthly premium withheld from the SS Check. I’m on SS so I don’t know about disability checks but I’ll bet there is a premium. Secondly, Medicare does not pay the entire medical bill. If a person does not wish to pay what M/C doesn’t pay she/he must buy a Medicare Supplement Policy from an commercial insurance company that will be willing to sell you such a policy. The biggest expense that my wife and I have each month is the premiums for our two policies. $725.00 combined. For some strange reason my wife’s policy cost more than mine and I am 5 years older than she. I don’t have enough left to buy a beer.

  16. irvin; you are correct except…even with Medicare supplemental (I have IU Health Care) there are always co-pays. The “free” flu shots at my IU clinic are provided during a pre-approved meeting with a nurse who takes vitals, updates general medical information, Medicare is billed for that service but not the shot and I am billed a co-pay. The “free” preventive mammogram is free (now every two years) but the radiologist who reads the test and reports the findings, bills Medicare and I have a co-pay for that service.

    Yes; Social Security Disability checks have the same Medicare payment deducted from checks; the disabled do not qualify for Medicare till they have been on Social Security Disability for a minimum of two years. Because I had additional income ($189 monthly retirement) I was disqualified for Medicaid assistance so had no medical care and disqualified for any other public assistance.

  17. Greetings JoAnn.. Each of us have different coverage I guess. As man I am free of many of the exams that women have and then they have a cost factor that men do not have. It should be uniform. If we have insurance and pay a hefty premium then we should be coivered. As one other man noted, he has V-A coverage for what ever. I also have V-A Coverage but Medicare and my MSP are billed and I pay $9.00 out of pocket for any and I mean any 30 day supply of a prescription drug. There has to be fair plan for all, not just special groups. I really would like a beer.
    Just kidding , I have a beer any time I want. Irvin BAA

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