Scapegoats and Concepts of a Plan: How Trump Fails Us

When a politician says he has “concepts of a plan” instead of a plan, there is no plan. And yet, that’s where we are with Donald Trump, nine years after he first launched a political campaign promising to replace Obamacare with something cheaper and better, nearly four years after he had four years to try to do just that. And fail.

Doubling down during Tuesday’s debate, he claimed he had “concepts of a plan” to replace Obamacare. Really? He’s got nothing. In fact, he sounds just like Nixon sounded in 1968, when he claimed he had a “secret” plan to get us out of Vietnam. That turned out to be no plan at all (remember “Vietnamization?”) and cost us seven more years there and tens of thousands of lives. The Affordable Care Act, about which I wrote plenty in this blog a decade or more ago, wasn’t perfect. But it was a whole lot better than what we had before it – and anything (save a public option) that has been proposed since. Back then, insurers could deny coverage because of pre-existing conditions and could skip mental health coverage entirely, and there was essentially no insurance market for individuals and small businesses. And insurance costs were out of control. We could have done better, it’s true. But we could have done a lot worse, too. Because Trump likes to complain about problems without offering any real solutions. This week, for example, Trump complained again about border security after single-handedly having killed a bipartisan border protection bill that had the support of, well, pretty much everyone else. And this is eight years after he promised that Mexico would build us the most beautiful border wall ever. That never happened. He’s not a problem solver. He wasn’t before, and he won’t be tomorrow or ever. And every time he rails about immigrants eating our dogs and cats or scapegoats people from “insane asylums” and “mental institutions” invading our borders and threatening our safety, I am reminded that my son Tim died of a fentanyl overdose on pretty much the day Donald Trump left office – fentanyl that probably crossed the border on Donald Trump’s watch. That bipartisan border bill had provisions to save other young people who self-medicate with drugs laced with foreign fentanyl. But Donald Trump doesn’t care. He would rather see them die and run on the headline than offer up a real plan to secure their safety. And go around barking about dog-eating immigrants, the “late, great Hannibal Lector,” and God knows what else comes into his head. I usually pull some punches in any political conversations I have these days, because I value others, and the opinions and feelings they have. Because so many of us of all ideologies just want to make our cities, states, and nation better. But I don’t feel that way about Trump. He is a poser who doesn’t care about any of us. He is responsible for the death of my son and others like him. He didn’t inject the needle, but he didn’t cut off the drug supply either. He is responsible for the deaths of hundreds of thousands of people from COVID-19 because he had no plan to deal with a pandemic when it arrived on our shores. He is responsible for the deaths of law enforcement officers because of the violence he incited on January 6th. (His excuse on Tuesday – all he did was show up and give a speech. That’s partially true; he did nothing to stop the riot afterwards.) He is responsible for the deaths of school kids and others because for four years he had no plan to deal with gun safety or gun violence. He is and will be responsible for the post-Roe morbidity and mortality of women and babies who can’t access pregnancy care because he had no plan to protect them (other than to “leave it to the states”). As Trump says, he’s not the one who fired all these weapons. I understand that. He just placed the targets. And that’s enough for me. Eventually, almost all our political choices come down to one question – with whom will I and the people I care most about be better off? Reasonable people can come to different conclusions about that. When Trump goes into the voting booth, you can be sure that he puts his interests first. And when I go into the voting booth this year, you can count on the fact that I’ll do the same.

States and Rebates

If you run a small business in Florida, are self-employed in Texas, or work for a large corporation in New Jersey ( see an update below ), then your state insurance regulators probably haven't been working for you. The news that 15.8 million people can expect $1.3 billion in rebates from insurers this year because of the Affordable Care Act (ACA) underscores how weak health insurance regulation has been in states across the country. It may come as no surprise that Florida and Texas, two leaders in the fight against ACA, have been exposed as anti-consumer. But they are not the only states with an anti-consumer bias. First, the good news: last week, the federal government announced that three-quarters of us will get letters beginning on July 1 telling us that our insurance plans paid out at least 80 to 85 cents in benefits for every premium dollar they collected. This means that under ACA they met the minimum standard for a reasonable benefit payout (which i...

Why the Republicans Have No Health Care Plan

There's a simple reason why (after more than a decade) Donald Trump and the Republicans have no plan to replace Obamacare. I'll explain in a few minutes. But first, some background. When the Affordable Care Act (or Obamacare) was passed in 2010, it was an effort to expand health care coverage to a lot of people who needed it, while controlling their costs. It had certain key provisions, not the least of which were that people couldn't be denied coverage for pre-existing conditions, that all chronic diseases needed to be covered fairly, and lifetime coverage caps had to be lifted. The problem was that if you left matters to insurers to set insurance premiums based on what this would cost, the price of insurance would rise dramatically. So the government took a look at three different programs and ultimately put them together into one system. For people whose income was so low that they couldn't afford any real cost-sharing, the government expanded Medicaid. For elders...

The Ten Best and Ten Worst States for Your Mental Health

Connecticut spends four times more per capita on state mental health services than Texas. In Florida, 25 percent fewer people report having mental illnesses than in Washington. Across the nation, there are significant differences in the amounts states spend on mental health services. Connecticut spends $189 per capita, while Texas spends only $39. But there are also significant differences in the reported prevalence of mental illnesses. For example, fewer than 18 percent of Floridians report having a mental illness during the past year, but in Washington almost 24 percent do. But what happens when you put spending and prevalence together? Some new rankings emerge that give you a measure of each state’s real commitment to protecting mental health – and treating mental illness – in their population. This week, I have ranked all fifty states using both spending and prevalence data. I have taken per capita m...

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