Author Archives: Sheila

Discarding Medical Ethics

There really is no way to ignore the White supremacist and patriarchal roots of MAGA and the Trump administration. The behavior of ICE in conflating Brown skin with “illegal” status is one aspect; the bigoted nature of so many Trump’s insane Executive Orders is another. A recent federal court decision–handed down by a judge appointed by Ronald Reagan–expressed astonishment at the obvious discriminatory motive behind the administration’s NIH cuts. Etc.

Now, the administration is encouraging the VA to be “selective” in providing medical care to veterans. According to a recent report from The Guardian,

Doctors at Department of Veterans Affairs (VA) hospitals nationwide could refuse to treat unmarried veterans and Democrats under new hospital guidelines imposed following an executive order by Donald Trump.

The new rules, obtained by the Guardian, also apply to psychologists, dentists and a host of other occupations. They have already gone into effect in at least some VA medical centers.

Medical staff are still required to treat veterans regardless of race, color, religion and sex, and all veterans remain entitled to treatment. But individual workers are now free to decline to care for patients based on personal characteristics not explicitly prohibited by federal law.

Language requiring healthcare professionals to care for veterans regardless of their politics and marital status has been explicitly eliminated.

I sent this article to my cousin, a long-time cardiologist whose medical knowledge I sometime share on this site; he responded that this “goes against all the rules that guide the medical profession, not to mention against the guiding principles of this entire nation! It’s simply additional confirmation of Trump’s insanity, not that we needed it! “

According to the report, this permission of discrimination isn’t limited to patient care. “Doctors and other medical staff can also be barred from working at VA hospitals based on their marital status, political party affiliation or union activity.” The changes even apply to chiropractors, nurse practitioners, optometrists, podiatrists, licensed clinical social workers and speech therapists.

The administration claims that these changes were intended to support the president’s executive order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government”. That executive order purported to eliminate existing government protections from transgender people, and since it was issued, the VA has stopped  providing most gender-affirming care.

The administration has also forbidden a long list of words, including “gender affirming” and “transgender”, from clinical settings.

The article quoted a former VA administrator who said the changes would allow doctors to refuse to treat veterans based on the reason they were seeking care, including allegations of rape and sexual assault. Refusal could also be based upon current or past political party affiliation or political activity, and on personal behaviors like alcohol or marijuana use.

Most Americans fail to recognize just how extensive the VA is. The Department of Veterans Affairs operates the nation’s largest integrated hospital system; it has more than 170 hospitals and more than 1,000 clinics, employs 26,000 doctors and serves 9 million patients annually. It is hardly an exaggeration to say that rule changes of this sort are likely to have profound consequences.

In an emailed response to questions, the VA press secretary, Peter Kasperowicz, did not dispute that the new rules allowed doctors to refuse to treat veteran patients based on their beliefs or that physicians could be dismissed based on their marital status or political affiliation.

Dr. Arthur Caplan, a prominent medical ethics expert, called the new rules “extremely disturbing and unethical.”

The changes are part of a larger attack on the independence of medicine and science by the Trump administration, Caplan said, which has included restrictions and cuts at the National Institutes of Health and the Centers for Disease Control and Prevention, where the secretary of the Department of Health and Human Services, Robert F Kennedy Jr, last week fired every member of a key panel that advises the government on vaccines. The Guardian has earlier reported on a VA edict forbidding agency researchers from publishing in scientific journals without clearance from the agency’s political appointees.

Just one more drop in the ocean of ignorance and “othering” that characterizes MAGA and Trumpism. From the “very fine” people Trump insisted were among the bigoted rioters at Charlottesville, to his description of (majority Black) “shithole countries,” to his efforts to bar entry into America from Muslim countries, to his constant manifestations of racism, misogyny, and anti-Semitism, Trump has represented and ingratiated himself with the White “Christian” supremacists who form the base of his support.

America’s divisions aren’t political. They’re moral and ethical. And MAGA is on the wrong side of that divide.

 
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The Power Of Image

In the wake of No Kings Day, we’ve seen a number of columns and news reports estimating turnout (current count: five million nationally) and comparing the enthusiasm of the protests with Trump’s lackluster and sparsely-attended parade in Washington. Many of those articles were interesting and even illuminating; one of the best–as usual–came from Paul Krugman, who took time off from his usual economic analyses to reflect upon the impact of such mass peaceful protests.

Krugman began with an important–and mostly ignored–observation: America is currently experiencing what scholars call “competitive authoritarianism.” Competitive authoritarian regimes are those in which formal democratic institutions are retained–elections continue to be held, for example, and other “democratic rules” are given lip service–but Incumbents violate the rules so often and to such an extent that the regime fails to meet the minimum standards for democracy.

Krugman says we’re not there yet, but that we are “teetering on the edge.” He also claims that “one of the most important ways we can step back from that edge is for ordinary Americans to engage in mass protests.”

Why should that matter? Why does the contrast between the poor turnout for Trump’s underwhelming exercise (what Krugman labeled as a “box office bust”) and the  enormous, enthusiastic participation in the No Kings protests matter?

It matters, as he explains, “because competitive authoritarianism rests largely on self-fulfilling expectations.”

While there is a cadre of Trumpist true believers who will obey the Leader under any circumstances, most of those doing the dirty work of undermining democracy and the rule of law are cowards and opportunists. They’re willing to participate in the destruction of America as we know it because they believe that many others will do the same. As a result, they believe that they are unlikely to face any personal consequences for their actions and may even be rewarded for their lawbreaking.

And what of those who oppose Trumpism? While there are heroes willing to take a stand against tyranny whatever the personal cost, most anti-Trumpists are reluctant to stick their necks out unless they believe that they are part of a widespread resistance that will grant them some measure of safety in numbers.

In other words, the victory or defeat of competitive authoritarianism will depend to a large extent on which side ordinary people believe will win. If Trump looks unstoppable, resistance will wither away and democracy will be lost. On the other hand, if he appears weak and stymied, resistance will grow and — just maybe — American democracy will survive.

Those of us who have been politically active will recognize the parallel to election campaigns, where momentum or an aura of inevitability sways less-informed voters to the probable winner’s side. (This is a truism that annoys the hell out of those of us who would love to believe that citizens vote after careful consideration of the policy positions of the contending candidates; unfortunately, in the real world, the desire to back a probable winner vastly exceeds such idealized behavior…)

So what we saw on Saturday was more than just the juxtaposition of a poorly attended parade that was supposed to glorify the Leader against massive, enthusiastic protests. We also saw a body blow to Trump’s image of invincibility and a demonstration that millions of Americans are willing to stand up for democracy.

It isn’t just the optics of five million plus citizens turning out in protest; as Krugman reminds readers, the resistance is gathering steam. He cites the “remarkable comeuppance” of the major law firms that bent their knee to Trump’s threats and are now seeing partners and major clients depart for firms that refused to be cowed, and the growing resistance to ICE’s lawless roundups of immigrants (including people who “look like” immigrants).

This isn’t the end of the assault on American democracy. It isn’t even the beginning of the end. But it may well be the end of the beginning. Trump spent his first 6 months in office trying to steamroller over all opposition, creating the impression that resistance is futile. Clearly, he hasn’t succeeded. On the contrary, resistance is stiffening, and those who preemptively capitulated seem to be paying a higher price than those who showed some backbone.

Although the tide may be turning, MAGA isn’t simply going to roll over and slink away. On the contrary, the administration’s power grabs will become even more aggressive and desperate, with growing efforts to intimidate, prosecute and even physically harm political opponents, as well as widespread efforts to suppress dissent with force.

Nonetheless, despite the difficult times ahead, America has just passed an important test. May freedom ring.

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Words Of Wisdom

One of my “go to” sources for political news and thoughtful analysis is Talking Points Memo. I nearly always find myself in agreement with its editor, Josh Marshall–and especially in his “cut to the chase” commentaries on our current political situation.

Recently, Marshall considered the navel-gazing of the “usual subjects.” He began by citing two recent Bulwark essays. One, by Matt Yglesias, engaged in the sort of “analysis” that drives me up the wall–Yglesias criticised the Democratic Party for clinging to positions that he believed imposed “a decisive disadvantage when it comes to winning the Senate in 2026 and in a challenging position when it comes to the Electoral College.” He argued for a “major repositioning on issues like guns and fossil fuels (among other issues) to make Democrats more competitive in states like Iowa or Texas.

Jonathan Last made a very different argument–and like Marshall, I found it far more persuasive.

The argument was that Democrats are the opposition and that the role of the opposition, especially in such a binary, Manichean moment, is to systematically disqualify the party in power. Any naval-gazing or attempted rebrands are somewhere between irrelevant and counterproductive.

Amen.

Marshall argues that pundits’ emphasis on policy prescriptions misreads the situation in which we find ourselves–that it is a bias held by people who think and write– and that ignores reality. “Opposition parties win when they manage in whole or in part to discredit the party in power — almost always with a ton of help from the party in power itself.”

I spent 21 years teaching law and public policy. I absolutely believe in the importance of policy prescriptions, in the need to consider what the evidence teaches us about policy decisions and mistakes. But if there is one thing I am absolutely convinced of, it is that elections aren’t won or lost by adjusting the nuances of this or that policy.

As Marshall notes,

Democrats who are currently focused on repositioning the party away from being “woke” sound like they’re in a time warp. People are scared about losing their jobs. They’re upset about authoritarian attacks on the rule of law. There’s deepening pessimism about a looming recession. A big focus on “wokism” seems mostly like someone speaking from the past. It’s just not what people are thinking about right now. They’re worried about Trump and the climate of chaos and uncertainty.

Again: politics is all about salience. That’s why people so frequently get themselves mixed up with polls. Maybe your issue has 80-20 support. But if it’s not what voters are voting on, it’s irrelevant. Americans overwhelmingly oppose Trump White House cuts to medical research. But it’s not getting a lot of traction at the moment. Because most people don’t know about it. It’s not a driving focus of the news. It’s salience is low. So it makes sense for Democrats to do everything they can to focus more attention on it.

There’s a mountain of evidence to the effect that people who are against something are more likely to cast ballots. I am confident that every person who participated in the No Kings Day protests will get to the polls.

As Marshall says, the salient issue right now is Trump and the damage he is doing to America. It isn’t only Democrats who are appalled by the assaults on reason and competence and liberty. As one of my favorite protest signs has it, IKEA has better cabinets, and a majority of Americans recognizes the damage that is being done by these clowns and ideologues–to the economy, to health care, to America’s global role, to constitutional governance.

For that matter, every Republican I worked with “back in the day” when I was a Republican and the GOP was a political party rather than a fascist cult is horrified by Trump and terrified by the direction he is taking the country.

Marshall is absolutely right that Democratic success depends upon opposition to Trump and MAGA, not to the fine-tuning of  a positive vision. As he points out, “the positive vision emerges from the outlines of what you oppose. But fundamentally the job of an opposition is to oppose. Don’t overcomplicate it. It’s not simply that you gain more ground from opposing than from grand-strategizing. You learn more from it too.”

America has a lot of long-term systemic flaws, and we need to pay attention to them and fix them. But right now, we need to rid America of today’s Confederates, the MAGA White Nationalists who are trying to remake us into a very different country.

You don’t debate the best way to make the plane safer while it’s going down.

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Listing The Obscenities

On Tuesday evening, I participated in a Zoom hosted by Indivisible of Central Indiana. It was focused on Trump’s “Big Beautiful Bill,” and if you can stand yet another enumeration of that insult to Americans, I’m posting my comments below.

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As Heather Cox Richardson has said, the Republicans’ “One Big, Beautiful Bill” is MAGA’s attempt to replace the government we’ve had since the 1930s with one that reflects the goals of Project 2025.

It is also an effort to rob the poor to further enrich the wealthy.

The Bill is 1000+ pages, but in this brief presentation I want to highlight the major elements—and alert you to the fact that, despite the fact that it is billed as a “budget,” it has numerous, damaging non-fiscal provisions which should be ruled non-germane in the Senate, but may not be.

Before getting to the truly horrifying fiscal mischief, let me share with you some of the most egregious non-fiscal provisions:

  • A measure to cripple the courts by prohibiting any funding from being used to carry out court orders holding executive branch officials in contempt. Passage of this measure would enable Trump and his officials to defy court orders at will.
  • The addition of billions to various parts of Trump’s deportation efforts, ramping up those efforts to the tune of an additional trillion dollars That includes $45 billion for construction of immigration jails (more than 13 times ICE’s current detention budget.) In addition, it would allow the indefinite detention of immigrant children and would charge families $3,500 to reunite with a child who arrived alone at the border. Asylum seekers will be charged an “application fee” of at least $1,000.
  • The administration would be given authority to label nonprofits as “terrorist-supporting organizations,” and terminate their tax status- an open invitation to suppress the free speech and activism of climate and civil liberties organizations, among others of which Trump and MAGA disapprove.
  • The bill would eliminate the National Weather Service, making local weather reports far less accurate.
  • One provision would allow the administration to sell off national parks.
  • A particularly ugly provision repeals the $200 excise tax on the sale of gun silencers, which have no lawful purpose other than concealing shootings.

Other bits of “fine print” more directly support the major goal of the bill, which is, as I’ve noted, to protect the extremely wealthy against efforts to get them to pay their fair share of taxes–basically, the bill exempts rich people from paying their dues to the country that made their accumulation of wealth possible. (For example, the bill would basically eliminate an Estate Tax that is already massively favorable to the top 1%.)

The “guts” of the bill are the fiscal provisions. Basically, the bill is an effort to fund the extension of Trump’s tax cuts for the rich by eliminating health care for the poor and middle class.

The Congressional Budget office estimates that as many as 16 million people would lose health insurance under the House-passed version of the bill. The annual cuts to Medicaid would average over 70 billion dollars a year—the same amount millionaires and billionaires would gain in tax cuts. The media has focused on those Medicaid cuts, but a number of analysts have explained that measures that have been minimized as “technical revisions” would essentially repeal Obamacare.

Not only would millions of individuals lose their health insurance, the consequences of these cuts would close many, if not most, rural hospitals and would have a dramatically negative impact on local economies, ironically mostly in Red states like Indiana. Economists have estimated that depressed local spending under the House bill would force the loss of 850,000 jobs. (Health care is the largest employer of any sector of the economy; it employs 18 million workers.)

Republicans who claim that they’re just adding “work requirements” to Medicaid are lying—the budget cuts 715 billion from Medicaid and 335 billion from Obamacare (the Affordable Care Act). And prior experience in the states has demonstrated that work requirements do nothing but erect paperwork barriers that throw eligible people off Medicaid; as we’ve learned from those previous efforts, Medicaid recipients who are able to work are already working—most Medicaid recipients are disabled, elderly or children.

There’s much more. The bill weakens the Child Tax Credit, by lowering the eligibility income threshold, so millions of children will suddenly become ineligible. It expands school vouchers–continuing the GOP effort to destroy public education and shift tax dollars to religious institutions, in violation of the First Amendment. It includes a variety of “Stealth Cuts’ to the Affordable Care Act that will increase out-of-pocket costs and make insurance more expensive for those people who are fortunate enough to retain it.

As if the assault on poor folks wasn’t mean-spirited enough, the bill also has deep cuts to SNAP. The House-passed version would cut nearly $300 billion from SNAP, the Supplemental Nutrition Assistance Program, according to Congressional Budget Office (CBO) estimates. That would be by far the largest cut to SNAP in history, and it would mean that millions of low-income families would lose some or all of the food assistance they need to afford groceries and feed their children.

SNAP has been the nation’s most effective anti-hunger program, and the bill cuts it by roughly 30 percent. These extreme cuts are actually deeper than the $230 billion in cuts the original budget resolution called for because the bill adds tens of billions of dollars in new spending for farm programs, and pays for those dollars by taking more food assistance away from people with low incomes.

And despite the GOP’s purported concerns about budget deficits, the bill blows up the budget deficit. According to the Congressional Budget Office, the bill will increase borrowing by a total of $2.4 trillion by 2034, because the $1.3 trillion in cuts to Medicaid, food stamps, and other programs don’t even come close to canceling out $3.7 trillion in tax cuts for the rich. Just the tax cuts going to the richest 5 percent outstrip the cuts to Medicaid and food stamps by 300 billion. If you add in interest costs, the total debt the bill creates exceeds $3 trillion.

This is just a horrible bill, and it needs to be defeated.

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Journalism In The Age Of Trump

History confirms the existence of what we might call “fringe folks” in every society–people who, for whatever reason, have embraced conspiracy theories and/or rejected credible evidence of reality. The question for our age is: how did we get to a point where these deluded and arguably dangerous individuals have assumed authority? What has enabled a certified nutcase like RFK, Jr. to hold sway over the health of Americans, or a man seemingly devoid of contact with either knowledge or reality to become President of the United States?

As regular readers of this blog know, I attribute much of this state of affairs to our current information environment–a fragmented environment that allows Individuals to “curate” their preferred realities. (I used to tell the students in my Media and Public Affairs classes that if they really believed aliens had landed in Roswell, I could find them five internet sites with pictures of the aliens…)

I think it is fair to say that one of the reasons for the proliferation of alternate media sources, including widespread propaganda outlets, has been the inadequacy of mainstream, “legacy” journalism. There’s a reason that so many of the most professional journalists have abandoned their positions with those legacy outlets and decamped to places like Substack–a reason why so many of us depend upon the daily reports from reputable scholars like Heather Cox Richardson and Paul Krugman, and look askance at news reporting that continues to “sanewash” and normalize behaviors that are objectively insane and abnormal.

A recent example: my husband and I were watching an NBC national news report on the shocking assault by administration goons on California Senator Alex Padilla, when he tried to ask a question of Secretary Kristi Noem. The report repeated Noem’s assertion that the Senator had failed to identify himself. It didn’t call that assertion a lie, despite the fact that widely available video of the incident showed that Padilla had done so. 

Shouldn’t we be able to rely on journalists to highlight lies being told by Trump’s collection of clowns and ideologues? Why has it been so difficult for legacy media to call a lie a lie?

Recently, a reader shared with me an article from the Columbia Journalism Review, exploring that question. It began,

Perhaps the most basic task of journalism is to distinguish truth from falsity. To identify the facts, and to present those facts to a readership eager for information. Journalists may once have believed that their responsibility stopped there—but in today’s media environment, it’s become clear that delivering facts to the public is not so straightforward. Distinguishing true from false, which often entails calling attention to false information, risks amplifying and even legitimizing that information. There is no better contemporary example of this problem than the media coverage of Donald Trump.

Trump’s brazen dishonesty in his public comments is without political precedent in this country. During his first term, the Washington Post’s fact-checking database clocked 30,573 untruths. That rate shows no sign of slowing during his second term, and now he seems to be combating accusations of lying by simply manipulating who is allowed in the press pool.

Granted, as the article notes, journalistic norms weren’t created for a President like Trump. The belief that “both sides” of a situation should be covered ignores the reality that both sides often don’t deserve equal weight. (It also ignores the fact that many issues have more than two sides, but that’s a different problem..)

The article argues that legacy journalists need to find new ways to talk about false information–for example, not describing a tweet or statement as “racially charged,” but as racist; calling a lie a lie, not a “misleading statement.”

The Columbia Journalism Review is a respected journal, and I was happy to see that it was taking on what has proved to be a hugely consequential problem, although its discussion is arguably too little and too late. Thousands–probably millions–of citizens now get their information (or misinformation/lies) from non-legacy sources, from the Internet’s wild west of sources peddling everything from informed analyses to ideological claptrap.

Journalists used to be gatekeepers, deciding what news was needed to keep the citizenry informed. There were certainly problems with that role, but I would argue that the information world we inhabit today–where each of us must be our own gatekeeper–is no improvement. Quite the contrary.

I wonder: If mainstream journalists had been doing their jobs these past couple of decades, would we now have a federal government composed of racist cranks and misfits and conspiracy theorists? I doubt it.

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