Can President Trump "make America great again"?

“Great again.” The question is, how will we measure “great” and “again”? What were the halcyon days of the United States and in what ways?

The GDP Definition of “Great”— The White House, despite all its internal, warring factions, is defining “great” strictly in terms of economics: GDP, job numbers, and Americans’ disposable income (a questionable indicator of The American Dream). You would think that by paring down the dozens of issues that affect the U.S. and its people to these three would make it very easy to be “great.”

The Historical Definition of “Again”— But maybe, not great again; even during the Reagan years, people in the bottom tiers of the U.S. socioeconomic classes were struggling, some kinds of taxes were replaced by other kinds of taxes. Unemployment tends to follow international economic swings, so the fact that things actually got worse while Reagan was president is somewhat similar to what President Obama inherited as the globe was taking an economic dive (in large part due to financial institution over-extension with debt offerings). Again? Under FDR? Truman? Nixon? Reagan? Bush #1? Bush #2?

The 2017 Federal Budget Definition of “Great”— Almost every issue is now framed in terms of theories about what will make the U.S. GDP grow faster than that of other countries. The exceptions are increases in military funding, Dept. of Homeland Security funding, and a $1T investment in “infrastructure” (to be a shared expense with businesses that participate). “The Wall” is based on a different theory of economic benefits vs. the cost of construction, maintenance, and staffing. Drawing from the White House budget document, we can see the places where Americans can expect less:

• Major reduction in healthcare insurance availability and in healthcare services available.
• Reduced and eliminated financial institution regulatory oversight (reintroducing the circumstances that led to the financial institution collapse of 2007–2008)
• Substantial reduction in access to Medicaid, Supplemental Nutrition Assistance, temporary financial assistance (aka “welfare”), and the Children’s Health Insurance Program for families living in poverty
• Substantial reduction in government oversight/administration of student loans
• Substantial reduction in funding for teacher training, after-school programs for children living in poverty, and programs designed to give children living in poverty and those with disabilities or other learning disadvantages a “boost” in completing their education and being prepared for post-high school education/training; move from support for public schools to greater support for private and religious K-12 schools
• Reduction in support for farmers/agriculture (plus the elimination of much of the workforce that plants, tends, and picks the crops)
• Reduction in retirement benefits for federal employees (other than senators and House representatives)

The devil is in the details. For example, a quick look at the spreadsheet in the budget document shows that the federal deficit decreases as percent of GDP for a couple years, and then it increases as percent of GDP. Another issue is whether the targets for these reductions are achievable. As an example, look at reductions in Medicaid as a way of understanding what’s behind some of these cuts. The major fraud committed with Medicaid comes from healthcare providers. (In Medicare, the major fraud is split between insurances billing for services not received by patients and healthcare providers delivering treatments that are not needed or are over-billed.) However, the “remedy” being offered in Congress and the White House is to reduce the number of people who are eligible for Medicaid. It’s not clear how remedying something other than the root cause of the problem will make things great for anyone other than those insurance companies and healthcare institutions that are unscrupulous.
And then there’s this: The theories about rapid GDP growth for middle- and working-class Americans and for the working poor are based on a premise that has been proven false: When corporations make more profit, their shareholders benefit, especially if they don’t expand their workforce. By law, corporations are required to maximize shareholder returns. The stock market rise is based on the belief that corporations will continue to make record profits, not that they will expand their workforce.

We’re already great! The U.S. is already great. In fact, in many ways, it’s the best it’s every been… even if you just look at GDP. Yes, the U.S. can get even better, but that’s different from claiming it’s not great now and it will be later. Unfortunately, “Make America great again!” has a sound bite advantage over “Make America even better than it’s ever been!” American nostalgia for what never was is infamously resistant to facts.

U.S. Quality of Character— Since the November election the rest of the world has been judging the U.S. more harshly. They had their frustrations with G.W. Bush and Barack Obama— frustrations that pale in comparison to what they’re feeling now. They’re judging the President and the 63 million Americans who voted for him because the White House’s notions of what makes a “great” country should include a lot more than GDP.
Let’s assume that a “great America” has something to do with the “quality of character” of the nation in the way that it treats its citizens, residents, and world neighbors. Quality of character includes being

• honest & prudent
• self-disciplined in behavior
• respectful of others
• collaborative
• well-informed
• generous/benevolent
• dependable
• persistent & consistent
• principled (making decisions and behaving based on fundamental ethical principles)
• benevolent/generous (of spirit and deed)
• responsible (taking responsibility for one's words and deeds, plus looking out for all Americans, in our case)

In other words, for the U.S. to be “great,” its leader(s) need to have these qualities of character. Of the eleven characteristics listed, President Trump demonstrates about one (persistent but not consistent; principled in some ways and lacking integrity in others— awarding 1/2 for each).

Quality of Character and Treatment of Americans— Further marginalizing people living in poverty, including the working poor (67% of those on Medicaid), taking funds from the public schools that working-class and poor families must depend on for a quality education, and increasing the financial assets of the upper class disproportionately more than that of the middle- and working-classes are actions that are contemptuous of many, if not most, Americans. This is a consistent mentality: The wealthiest nation on Earth should do whatever it can to accelerate its economic growth, even at the expense of others. And the wealthiest individuals in the U.S. should do whatever they can to accelerate their financial growth, even at the expense of the rest of the nation. This is not a mentality we normally associate with a high quality of character. It is selfish in terms of assets and power. It applies to many in the current White House.

Quality of Character and Treatment of Allies— Since the beginning of Donald Trump’s bid for the presidency, he has maligned, snubbed, and disrespected U.S. allies and their leaders while praising despots like Vladimir Putin, Kim Jong-un, and Rodrigo Duterte. His profound deficit in knowledge about world affairs is not just a deficit in being "well-informed"; it is actually a deliberate preference not to know the facts: He would not attend intelligence briefings after the election, deeming them a waste of his time; he says he does not like to read and prefers to base decisions on his “gut.” In a meeting with President Xi Jinping, Trump volunteered that ten minutes spent talking about North Korea introduced him to some of the complexities in dealing with Kim Jong-un and that government. (And that statement was given the same importance, by Trump, as noting that the chocolate cake they’d had was “fantastic.”) However, it is not just Donald J. Trump who is treating allies with disregard. There are others in the White House who are rabid nationalists (not just Steve Bannon, by the way). To be clear: Most members of the U.S. Congress, especially the Senate, recognize the importance of respectful and tactful international relations… especially with allies. They, too, represent the nation and, in that capacity, their quality of character should be acknowledged, at least in that regard.

Can President Trump make America great again? Probably not, unless we consider only GDP and not who within the U.S. benefits from that. Surely not, if we consider the quality of character of the nation’s leadership and the nation’s domestic and foreign policies.

Cuts to Medicaid? What do we need to understand before applauding or condemning?

At the time of this writing, many people are expressing outrage at the proposed cuts to Medicaid funding. Before taking constructive action, we need to know a whole lot more than that the Trump White House budget calls for “a large cut to Medicaid and Medicare funding.” This terse statement, which can be found in many news summaries, is utterly insufficient to deciding whether to be incensed or encouraged… or somewhere in between.

The proposed deep cuts to the Medicaid budget are bound to have a profound impact over the next decade... should nothing change to prevent what's proposed for 2020 and beyond. The proposed Trump budget calls for a 25% reduction in federal Medicaid expenditures by 2026, relative to what is currently estimated on the books. The proposal, which is based on the current House version of the AHCA, is not that easy to summarize in a single statement. What the Kaiser Family Foundation "opines" must be based on a lot of assumptions about how those reductions will impact various states and where individual states will choose to cut their Medicaid rolls. Are those in skilled nursing facilities likely to be "discharged" as the means of adjusting to the eventual 25% cut in federal Medicaid funding? There is no state that has made that kind of decision. Questions about how to adjust over the next decade have barely been asked and have definitely not been answered by each of the 50 states. Perhaps I'm missing something?

Because the Republican Congress follows confederate ideology, the solutions to this gradual, federal budget cut must come at the level of individual states. The federal government will provide less; states can decide whether to supplement with state funds or to cut the number/type of people who are eligible. In the current version, any state that has not already expanded eligibility would be forbidden from doing so. For example, some states, under the ACA, extended Medicaid eligibility to cover *anyone* living in poverty. Other (mostly Republican-dominated) states did not. The default is that the individual must meet more than the financial criteria (less than 133% of poverty level).

Across the United States, only 23% of non-elderly recipients of Medicaid are not employed. 63% have at least one family member who is employed full-time. [Henry J. Kaiser Foundation website, "Distribution of Nonelderly with Medicaid by Family Work Status"] Of those 23% who are not currently working and are *able* to work, what percentage of them would find employment that paid so much that they would no longer need Medicaid? I can't find anywhere that provides the data and an answer to this question.

The Congressional Budget Office estimate for this AHCA change in Medicaid coverage is that it represents an $800 billion total reduction in Medicaid costs between now and 2026. As a reference, for fiscal year 2016, total Medicaid spending was $574.2 billion. [Henry J. Kaiser Foundation website, "Total Medicaid Spending"]

Of course, I hope that the proposed changes at the federal level do not happen. We already have great disparity in Medicaid services between states. A gradual 25% cut at the federal level would undoubtedly exacerbate that disparity.

For now, I think we should all be planning ahead, to the extent we can put aside our own resources. With or without the AHCA, something has to change with Medicare and Medicaid. Either the withholdings for those programs have to increase or some other major change in healthcare for older adults and poor people has to happen. Insurance has to pay for itself. We will also need to pressure federal and state officials to develop plans that answer the question of what we do with the people who become ineligible for Medicaid and do not have the means to pay for essential care for themselves and their families. And the answers have to be viable; they cannot fly in the face of facts.

The State of a U.S. Democratic Republic as We Enter 2017

The official form of government in the United States is still a democratic republic. Over the past two decades, our form of government has been shifting away from this. As we see with the growing gap in wealth between working-class people and the wealthiest people, where the influence of the working class and middle class has dwindled and the voice of the poor is even less influential, we also see the increased power and influence in governance that has occurred. Wall Street (and similar financial institutions worldwide) caused the Great Recession, and yet, they are being given additional abilities to run the same bad-debt practices that caused the recession, especially in the U.S. That requires tremendous influence. This form of government is a plutocracy.

U.S. governance has been moving closer and closer to a plutocracy, capping that achievement with the recent federal elections. We now have “a society ruled by a few of the wealthiest citizens.” This is not debatable: We now have a White House with cabinet and staff members with the highest level of wealth in the history of the country— by far. It’s a matter of definition, not debate. Whether this is good or bad is up to each of us to decide.

The tattered remnants of our democratic republic form of government include that the majority of Electoral College electors got to vote for who our president and vice president would be. The democratic republic, in this case, breaks down at the state level, where there is not “one person, one vote.” Most states have a winner-takes-all model for selecting electors. States with large populations have a proportionately lower number of electors than states smaller populations. If California had the same proportion of electors as Wyoming, it would have 199 electors. It had 55. Is this what citizens want as a way to elect a president and vice president? Perhaps. After all, in the Senate, every state has the same number of senators. But in the House, the number of representatives per state is loosely proportional to the size of the state's population.

Another way in which the democratic republic remains is that we elect members of Congress to act on our behalf, and we can contact them with our position on issues. To the extent that they don’t represent our positions, we can work toward electing someone who better represents our positions.

The current state of the U.S. democratic republic form of government can easily be summarized in terms of whether ordinary Americans are willing to do their job as citizens. As Thomas Jefferson said, "If we are to guard against ignorance and remain free, it is the responsibility of every American to be informed."

Too many Americans are poorly informed. Many are quite ignorant about the rest of the world-- even in their own Western Hemisphere. With the amount of misinformation and ill-logic that is readily available, few take the time to check the facts. The sheer magnitude of unsubstantiated conspiracy theories that have been believed without question is staggering. Finding the facts means going to primary sources. What did this politician say? Read the transcript; don’t believe someone’s paraphrase that is likely to be slanted. Read Reuters and Associated Press factual reports rather than news sources that have their own obvious agenda. Never believe a politician. The adage is this: How do you know if a politician is lying? His mouth is open.

Someone said that the House of Representatives has a bill that’s going to do X, Y, or Z? Look up the bill. They are all available at congress.gov. Do not trust your friend to summarize for you; don’t trust social media; definitely don’t trust a Super PAC “newsflash,” no matter how much they represent your political ideologies.

When Americans are unable or unwilling to search for facts, we cannot have an effective democracy. Perhaps we’ve never had a perfect democracy, but when the Oxford Dictionary chooses “post-truth” as the 2016 international word of the year, we are definitely headed in the wrong direction. When we have verified facts and someone in the White House comes up with the term “alternative facts,” as if that were a thing, we are definitely headed in the wrong direction.

This is the state of our U.S. democracy: Citizens leaping away from informed participation in their government.