Is This Really Trump’s First and Last Offer on Health Care?

Is This Really Trump’s First and Last Offer on Health Care?

Ever been to a used car lot and been told that their great discount price would end the second you stepped off the lot? Especially by a salesman who only works one day a week? Supersalesman Trump has hit the Republican House with that cheap trick this week to get them to vote this Thursday for the two week old AHCA health care plan. This plan was only vetted one week ago, by the CBO, as being fatal to 24 million American’s healthcare plans.

At a rally last week, Trump said that the plan would be great, when passed, with slight modifications. The modifications are not spelled out.

So are we to believe that after Trump led several rallies a day for his two year campaign and presidency with the main theme of killing Obamacare, and replacing it with the greatest and cheapest plan, that he would throw a tantrum and take home his checkers board if he doesn’t win his first game? Especially since he is more sensitive about his reputation than anybody we have ever seen in public?

After seven years of opposing Obamacare, and six years of canceling it, do we really think that Republicans will abandon their efforts after only two weeks of shopping for a new car but so far only being shown one? After telling their voters for years that their Obamacar would break down soon?

Republican House members signed on for two years of work, of which they have only done two and a half months, and only two weeks reading a less than 100 page AHCA plan. If they quit now on their main pledge, maybe we should stop paying them for the rest of their term.

Unfortunately, the Freedom Caucus of 30 Reps, opposes the AHCA because they want important provisions cut, including essential coverage.   But cutting essential coverage may be seen by the Senate parliamentarian as altering the cost of the bill and not fitting in under Reconciliation.  That means that Democrats in the Senate could then filibuster the bill.

Trump promised us a hugely better healthcare law, and maybe he thinks this is the best that he can get. So much for the “Art of the Deal”. But Trump has the Freedom Caucus over a barrel too. They have to come home with a new healthcare law, or their devotees will be very disappointed. How many of them actually know what the details are, anyhow? The problem with the extreme rush to pass the modified bill today is that there is no CBO coverage estimate or cost estimate of the hastily modified bill.

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Trump Now Owns the AHCA Healthcare Plan

Trump Now Owns the AHCA Healthcare Plan

In President Trump’s 2020 Campaign Speech in Kentucky last night, he took ownership of the American Health Care Act (AHCA) by fully backing its passing in the House two days from now, on Thursday.  This morning, he met with the House Freedom caucus, and threatened the re-election of any Republican Representative who voted against the AHCA.  It wasn’t clear if they would just be in trouble with Trump voters, or if Trump might send a nasty tweet about them, or actively campaign for a hand-picked and loyal primary challenger.  That is total ownership. 

The AHCA cuts 24 million people in ten years, and 14 million in the first year.  Many of them are Trump supporters.  The House has put on a rider of an additional 75 billion dollars to support Medicaid and almost seniors in age, who will be subject to the 5 to 1 cost ratio to young people, from the present 3 to 1.  The use of this money is not yet specified.  It seems too much for each year, and is probably over 10 years.  The AHCA is supposed to save 334 million dollars over 10 years.

Trump said that he could not present tax cuts until the AHCA was passed.  This makes it pretty clear that the AHCA savings were not going to deficit reduction, as they are presented, but to tax cuts, and undoubtedly weighted to the rich.

In Trump’s Kentucky speech, he railed against President Obama and the Congress passing the Affordable Healthcare Act (AHA, alias Obamacare) both without transparency and in a rush.  Only a few sentences later, he urged Representatives and Kentucky Senator Rand Paul to pass the ACHA in three days and without resolving the Medicaid and almost Senior problems.  There is no use wasting internet electrons calling this hypocrisy, since that word applies to almost everything that Trump does.

Finally, Trump repeated his slogans, including “Make America Safe Again”.  Again, cutting 24 million from health care does not make America safer.  Nor does the 18% cut in the NIH for future medical care advances.

Trump’s threatening the re-election of his fellow (?) Republicans is a very serious threat, which Trump seems easily capable of insuring.  Considering a primary threat, that could make any Republican nervous.  Most Republicans are in safe gerrymandered districts or in red states, where there is no real Democratic threat.  This new Trumpian threat is akin to the Tea Party havoc of a decade ago.  It wasn’t present in the 2016 election, since nobody knew that Trump would win, or continue in the political scene.

There are some caveats to the Trump threat, however.  First of all, it loses President Trump a lot of potential Republican friends, especially if they have to accede to his threat.  It also endangers their reputation in their districts if they cannot stand up for their special projects that will be decimated by the steep domestic budget cuts.  It also increases Democratic opposition and anger, and encourages Democratic financial support, if they are in close districts.  Trump’s current approval rating is about 39%, and it has generally been sinking.  The Trump-directed controversies have increased in number and depth, rather than getting fewer and subsiding.  Even in the 2016 campaign, Wisconsin’s Paul Ryan skipped rallies where he would have to appear with Trump. 

There are 237 Republicans in the House, plus 4 Republican vacancies where they have joined the Trump administration.  That is a lot of Republicans to campaign against, if they wanted to revolt en masse on some issues.  Even 30 in the Freedom Caucus is a lot to oppose en masse, and a lot of them are demographically backed in their districts.

Clearly, the AHCA has become an important issue this week for Trump.  But its catastrophic effects as analyzed by the CBO was only known for a week, and Trump was lukewarm about the House Ryan plan before.  We all know that Trump hates to lose.  But sometimes, not winning on obtaining a very bad investment is a good deal.  So happy.

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Let’s Hope the Leak Investigation Does Not Dig Too Deep

Let’s Hope the Leak Investigation Does Not Dig Too Deep

First there is Mick Mulvaney, Director of OMB, leaking that he wrote the budget, from Trump’s vague and overhyped campaign statements.

Then, there was Kellyanne leaking the existence of the Bowling Green massacre, something so secret that it had been kept from everyone else at the White House and the Cabinet. It had never even been mentioned in the Daily Intelligence briefing.

How can we forget Trump publicly leaking “what happened in Sweden last night”. That event or events, were even kept secret from the Swedish government. When revealed, they were so secret that they were vigorously denied, even until this day.

Back to Kellyanne, and her leak that there was an alt-fact universe that only the administration knew about. Actually, that was also the source of Fox News during the campaign.

Then there were the real leaks. Trump connection Roger Stone leaked that something big was coming from Wikileaks, and also about John Podesta.

Rudy Giuliani predicted announcements from the FBI about Clinton’s emails.

Trump himself is known from leaks that nobody else knew, such as that Obama was not born in the US. Recently, there was the largest inauguration crowd of millions. Also, that he won the popular vote except for from three to five million illegal immigrant voters. Then, that he had the largest electoral vote victory since Reagan.

I, and others, have been suspicious that Trump himself was the leaker of his state tax returns, when his $900 million loss guaranteed him years of federal tax deductions. Then the leak of his federal tax front pages of 2005, when he paid a large amount of taxes.

The leaks of the moment are the claim that Obama tapped Trump Tower, or, that the Brits did it, or that “tapping” was really keeping an eye on the Tower, like TV does every day, and shows the comings and goings to their viewers.

We finally learned that Trump’s golf handicap is an amazing 2.8. Is this another Trump self leak? And is it real, or hyped, as everything about Trump is.

So much to distract us from real stories such as the health care replacement, the extreme and unjustified budget cuts, the constitutional fights in the courts, and the opinions of Supreme Court Justice nominee Neil Gorsuch.

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OMB’s Mick Mulvaney Created Trump’s Budget

Mick Mulvaney Created Trump’s Budget

I was going to avoid the loud press coverage of the day on Trump’s “tapping, tapping at my chamber door” (sorry, Edgar Allan Poe), and the real DNC tapping. But I was going to focus on the apparent absence of advise and consent on the Trump budget. Mick Mulvaney, Director of Trump’s Office of Management and Budget, said on a public TV program that Mick was told to make up the skinny budget based on Trump’s campaign speeches. I think that was the biggest leak of all. It said that even Trump-Bannon had not made up a real budget.

Most importantly, it shows that the skinny budget had no real input for the exacting size of the non-defense budget cuts. It has no explanation for why the NIH cuts are almost twice the 10.5% of the non-defense cuts. Except that Trump once disparaged the NIH, as he has disparaged everything. Other than the small, highly politicized and very busy Trump campaign team, led by Lewandowski, and then Manafort, both since dismissed, there was not a real budget advisory group, except for leaning it toward the Heritage Foundation budget. Trump’s economist, Prof. Peter Navarro, had never met Trump personally. We don’t know whether RNC Chairman Reince Priebus had any input, especially since he had to remain neutral between 18 competing candidates. Congress seems to have had no input. The Trump team had not grown until after he was elected. None of the exact figures in the budget were given during the campaign.

Since Trump’s election and swearing in, only heads of Departments have been given inputs to seek budget cuts, which remained secret, except for DOE and the EPA leaks. Based on the lack of Congressional response, they were not included in the budget formulation.

How much respect should there be given to such a film-flam skinny budget?

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Trump on NIH: Not Making Americans Safe Again

Trump on NIH:  Not Making Americans Safe Again

Trump is gutting the domestic budget by 10.5% to boost the military budget by 9%, or $54 billion.  But strangely, besides attacking climate science and clean energy, he has focused on the National Institute of Health, cutting it 18%.  Besides the nation’s external threats, all of us face our own internal threats of medical problems.  The NIH carries out its own research in top notch institutes, as listed in the previous article, and gives out grants to top hospitals and universities to carry out research on improving medical knowledge and treatments for Americans.  Making drastic and unjustified cuts to the NIH is not improving Americans’ safety.

In case you haven’t thought about it lately, the USA is surrounded East and West by two vast oceans.  On the North is friendly Canada, and on the South, friendly Mexico.  Foreign adventures have not turned out well for a long time.  Yet as we all live and age, we have to protect ourselves from diseases and the decay of our own bodies.  Medical research has made extraordinary strides during our lifetimes.  It is an attack on ourselves and our progeny to not safeguard our health by the best research and treatments available.

Medical advances is a very productive and job creating field.  The US now has the slowest annual growth rate in medical research among North America, Europe, and Asia, at 1.0%.  China leads with 16.9%, Australia has 9.3%, Japan has 6.8%, Canada has 4.5%, Europe has 4.1%, and other Asian Countries have 20.8%.  The rate of approval for submitted grant requests at the NIH has fallen to 17.5%.  To throw an almost 20% cut on top of this is ridiculous.

President Trump surrounds himself with healthy people.  We don’t see anyone in his cabinet, among his press representatives, in the industrial leaders he invites to conferences, even in his family, who have any visible disabilities.  While he is the oldest person to enter the White House, his doctor guarantees us that he is the healthiest.  House Speaker Paul Ryan is 47 and a workout advertisement, OMB director Mick Mulvaney is only 49, and First Lady Melania Trump is only 46. In an old article, Trump used to fire any non-beautiful people at his country clubs.  This is the Trump brand.  He does not hang out with anybody that is not so rich that they cannot fund their own healthcare.  He may not feel this way four years from now at 74 when he runs for re-election, but we are concerned about the here and now.

Even those who are young now and can afford their own healthcare, will still greatly benefit when they need it by research advances that can be achieved now.

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Trump on Health: Not Americans First

Trump on Health:  Not Americans First

The steep cuts to the National Institute of Health, and the hordes of Americans that will lose their healthcare by the Republican’s American Health Care Act, show that President Trump is really attacking American’s health, in favor of increasing military spending, and providing tax cuts to the wealthy.

Apparently, the slogan “America First” meant being first in winning in both trade deals and military deployment around the world, as well as winning wars again.  It certainly didn’t mean being First in healthcare for Americans.  First, the proposed and already hated American Health Care Act (AHCA) will in the first year make health care unaffordable to 14 million Americans, but also eventually drop 24 million Americans from healthcare.  The White House had even a larger estimate of 26 million when they endorsed the Ryan proposal, even before the CBO presented their better number.  Unfortunately, the drops fall most heavily on the poor elderly, by raising their cost differential from 3:1, to 5:1. 

While Trump promised us utopian, universal health care at less cost, it is not even clear that the White House proposed anything to the AHCA, or asked to make changes to it before completely and totally endorsing it, and insisting that all Republicans accede to this unvetted plan.  Certainly, most Republican Congressmen, Democratic Congressmen, Medical Associations, Patient Organizations, and the public were not consulted before the plan was 100% endorsed by House Majority Leader Paul Ryan, President Trump, and the White House.  Now that there are objections to the plan by the public, the White House has declined the label “Trumpcare”.  Whatever happened to “Extreme Vetting” to protect the American public?

The AHCA also includes tax breaks for the very wealthy by eliminating the present Affordable Healthcare Act (AHA) tax on the wealthy to subsidize the extended Medicaid program.  It also gives wealthier Americans twice the tax deduction than poorer people get.  The AHCA will save $337 billion over ten years, or rather, deny Americans that much in needed healthcare, for no apparent reason.  The savings are presented as applicable to reducing the debt, again, not something needed as much as health care is.  The argument has been that preventative health care saves money in the long run, increases productivity, and saves States from picking up the costs for those without health care.  It is also humanitarian in keeping people healthy, free of painful and debilitating problems, and giving them longer life spans.

In the carefully balanced and not increased skinny budget proposal, there is no room for Trump’s promised tax cuts.  Obviously, the $337 billion savings from dropping health care coverage will be hungrily eyed for tax breaks for the wealthy, and not for deficit reduction, which in practice, Republicans never hew to anyway.

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NIH Funding Cuts in the Trump Budget

NIH Funding Cuts in the Trump Budget

The NIH is under the Department Health and Human Services. H&HS in the OMB’s “America First, Make America Great Again” Budget is scheduled for a 17.9% cut of $15.1 billion down to $69 billion. H&HS got the usual two pages in the skinny budget. The NIH budget is to be reduced $5.8 billion to $29.5 billion. Despite NIH being 43% of the H&HS in the skinny budget, it is only given one small paragraph in the write up.

The paragraph calls for a major reorganization of institutes to focus resources on the highest priority research and training. That is a mouth load of bureaucratese. The institutes are already organized by areas of physiological health and medicine, which was already determined by evolution or by God. You can’t mess with that. Also: consolidating the Agency for Healthcare and Quality within NIH.  This evaluates medical procedures to find out which are useful.  Rebalance federal funding to research. Hidden plans beneath this garbage, or just business school 1A?

The only institute spelled out in the NIH is the Fogarty International Center which trains medical people in foreign countries to do research on issues relevant to them. On their webpage, they cite Ebola research, and a family with Alzheimer’s that could lead to more understanding of this. Remember how Ebola dominated the news for weeks? Obviously, to Trumpians, this looked like a form of foreign aid. People have forgotten the fact that we are really not healthier than the poorest people on earth. The kicker: the Fogarty Institute budget is only $70 million, or 1/1,000 of the H&HS budget.

From the NIH.gov website:  The NIH does $32.3 billion in medical research.  80% of their budget goes to 50,000 competitive grants to 300,000 researchers at 2,500 universities, medical schools, and research institutes, including every state.  The straightforward 18% cut would nullify the research of about 54,000 medical researchers, and probably end the research careers of many of these very well educated doctors and medical technicians.  The NIH uses 10% of its budget to fund 6,000 scientists in its own labs in Bethesda, Maryland.

I was going to list the NIH institutes that applied to myself and my family. Since that turned out to be almost all of them, I will just list all of the institutes. Most of them have already cojoined several medical areas.

• National Cancer Institute
• National Heart, Lung, and Blood Institute
• National Institute of Dental and Craniofacial Research
• National Institute of Diabetes and Digestive and Kidney Disease
• National Institute of Neurological Disorders and Stroke
• National Institute of Allergy and Infectious Diseases
• National Institute of General Medical Sciences
• Eunice Kennedy Shriver National Institute of Child Health and Human Development
• National Eye Institute
• National Institute of Environmental Health Sciences
• National Institute on Aging
• National Institute of Arthritis and Musculoskeletal and Skin Diseases
• National Institute of Deafness and Other Communication Disorders
• National Institute of Nursing Research
• National Institute on Alcohol Abuse and Alcoholism
• National Institute on Drug Abuse
• National Institute on Mental Health
• National Human Genome Research Institute
• National Institute of Biomedical Imaging and Bioengineering
• National Center for Complementary and Integrative Health
• National Institute on Minority Health and Health Disparities
• John E. Fogarty International Center
• National Library of Medicine
• National Center for Advancing Translational Sciences
• Office of the Director

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Science Cuts in the Trump Budget

Science Cuts in the Trump Budget

Reporters, commentators and analysts somewhat understand Trump’s politically motivated attacks on climate scientists. Yet, it is not at all clear why Trump is attacking biologists and medical scientists at the NIH. Even if the military needs newer equipment, caring for the security of Americans should include exploring what advances could be made in medicines to keep them healthy and living longer. The NIH is being cut $6 billion, or 18%. The 2016 NIH budget was $32 billion.  I will have a separate article on the NIH.

The Department of Energy (DOE) Office of Science has been cut $900 million, which is 18% of its $5 billion budget. This eliminates ARPA-E on advanced energy projects with $300 million. The Office of Science supports 300 universities and 10 national labs, distributed around the country. That’s a lot of congressional districts that will be affected by the cuts. The entire DOE was cut $1.7 billion to $28 billion, or 5.6%. The DOE contains the Nuclear Security Agency that manages our nuclear arsenal, and has been 65% of the DOE budget at $18.5 billion. That NSA will grow by 11.3%, while the rest will shrink by 17.9%.

The NSF was not directly included in the skinny budget.  However, since the skinny budget  has the complete total, it is included under “Other Agencies”.   Other Agencies suffered a summed loss of 9.8%, where the present $29.4 billion is reduced by $2.9 billion to $26.5 billion.   We do not know how that may be redistributed.  The Continuing Resolution NSF budget is $7.5 billion.

NASA, at $19.5 billion, will only be cut 1%. But $100 million of the earth sciences program on climate related missions will be cut. Specific cut satellites are: the Orbiting Carbon Observatory-3; the Plankton, Aerosol Cloud, and Ocean Ecosystem Program; the Deep Space Climate Observatory; and the CLARREO Pathfinder.

The EPA $8.2 billion budget will be cut by 31%. It’s Office of Research and Development will be cut from $483 to $250 million.

It’s not clear what will happen to current work on the budget extension for 2017 that expires on April 28. I’m sure that congress would prefer to just pass another continuing resolution. But Trump-Bannon is anything but predictable. They already have a hiring ban, and still have hundreds of top level political positions that they have not filled in all agencies.

While the climate scientists are working for the federal government, they are not allowed to politic. But once dismissed, they will be hired by universities, private industries who can market their analyses, or use it as agricultural and food companies, insurance companies, and state, county and city governments. In such positions, they can still write and appear on news programs, and work with environmental NGOs. Each muted government agency fired will become a thousand points of dissidents. Or, it’s like dropping a beehive. Their knowledge will also propagate through their companies or organizations.

Sources for this information were the NY Times, the Washington Post, the Huffington Post, the LA Times, the E&E News, Nature, Science, and the original Office and Management and Budget budget.

Posted in Clean Energy, Climate Change, Climate Science, Congress, Donald Trump, Energy Efficiency, EPA, Politics, Trump Administration, Trump Budget, Trump on Climate Change | Leave a comment

Trump’s Oil Soaked, Stingy, Skinny Budget

Trump’s Oil Soaked, Stingy, Skinny Budget

The skinny budget clearly tells us who Trump hates: old people who aren’t rich and are declining, poor and minority youth, smart scientists, and anyone who researches or wants to act on climate change.

As with backing House Speaker Paul Ryan’s healthcare, which raises seniors cost ratio over starters from the present 3 to 1 to the higher 5 to 1, the Trump budget is even going after Meals on Wheels. Meals on Wheels covers a million seniors, keeps them out of nursing homes, and the government only contributes one third of the cost. I will hopefully later write a defense of seniors, and all that they have contributed over their lifetimes.

Trump is cancelling all sorts of small, perhaps trial, programs because they are not big enough to be in his grandiose federal budget and he can’t show them off, or because they found disfavor to the Koch brothers, and appear in their Heritage Foundation’s list of picky-uny. The skinny budget always gives several reasons to drop these, such as they are duplicated, and they can be funded by state, county, city, or churches. The physicists Feynman used to say that you give a lot of reasons when you don’t have one good one.

During the campaign, Trump promised his usual wonderful and amazing programs for inner city youth. He or his budget writers are cancelling all of these, with reasons as those above. He is continuing funding for Historically Black Colleges and Universities, though, at $492 million.

Trump is killing the National Institute of Health, NIH, with an 18% cut. This is part of a 16% or $12.6 cut at Health and Human Services. This again is an attack on seniors and programs on their health problems, especially considering that over 40% will get cancer sometime in their lives. Obesity is also a growing problem, even for younger people. Researchers already have to apply for many grants to get one, since they are very limited.

We might relate this to Trump’s health problems, or lucky lack thereof. As much as people wonder about his taxes, his health may prove more important, especially with the aging effects of the Presidency, and his own invented additional controversies. He is the oldest President to take office. On the other hand, he is also the most healthy president to take office, according to a note his doctor was forced to write in five minutes. You see how little we really know about his physical health. Everyone makes their own conclusions about his mental health.

The reason that “oil” is in the title is of course because of his total dominance by the oil oligarchs. He is cancelling all restrictions that he can on oil, coal, gasoline, and natural gas pollution, and the budgets to enforce these. He is killing all clean energy research and programs. At the same time he is killing all climate research and their satellites, even the ones that are already orbiting. He will undoubtedly fire all of these invaluable scientists.

Even ex-Exxon CEO and now Secretary of State Rex Tillerson had to admit that emissions had some effect on the climate, but the science was not pinned down yet. That would motivate honest, concerned, government officials to continue this important research. Instead, Trump’s administration is conducting a thorough purge and inquisition against climate research and knowledge. They are essentially burning all of the information on the government websites about this. The House Science committee says that they will require the administration to at least keep all useful databases on this subject. I think Trump should acquaint himself with Savonarola and the Inquisition. Savonarola is not well regarded by history. He is infamous, rather than famous.

Posted in Affordable Care Act, Climate Change, Climate Science, Donald Trump, EPA, Greenhouse Gas Emissions, Oil, Politics, Trump Administration, Trump on Climate Change, Trump Taxes, University Funding | Leave a comment

Trump’s Unconvincing Military Budget

Trump’s Unconvincing Military Budget

In discussing the budget, we have to address the $600 billion gorilla all over the world, the US military budget increase of $54 billion, that is cutting all of the worthwhile programs in the non-military discretionary budget. This large 9% increase, was not originally justified when it was sent to the Pentagon, for them to fill in some justification. Much to my surprise, in the skinny budget, the $600 billion budget was just given the same two pages as those agencies whose budgets are a tenth to a hundredth of the Department of Defense. And while cheap, earth observing satellites are being canceled by name, there is not a single item mentioned in the DOD budget justification. It is what is called a blank check. Yes, the military equipment is old, as are our bridges, schools, airplanes, etc. Military equipment does not have to be new, bright, and shiny gold, as a Trump tower is. That is not what it is used for, in the environment of beaches, mud, and desert with camouflage, where it will be used.

The only war or theater that the skinny budget described was in the war against ISIS. Mosel is already being liberated, and the buildup for the attack on Raqqa is being prepared. It may well be over by the time the budget is passed. The largest estimate of ISIS strength that I recall was 30,000 soldiers. If we slightly inflate the $54 billion to $60 billion, that comes down to $2 million per ISIS soldier. Why don’t we just buy them off and send them home?

I, and Trump’s followers, thought the phrase “America First” meant to do what is best for Americans, building and rebuilding the USA. Now Trump is switching that to “Winning” wars. More aircraft carriers and tanks do not add to America. As usual, Trump is being secretive about what military ventures he wants to launch in grand opening surprises. If you think our government had trouble convincing us that Vietnam was important, see how much trust and belief Trump can engender, by calling a new “Wolf” every week.

The contrast to the military winning, is the winning negotiation.  The Obama state department made a successful nuclear non-proliferation treaty with Iran that worked.  No loss of life, no military expenditures, no deployed troops.  And yet Trump continually calls it a bad deal and cut the State Department budget by 32%.  He has also not filled the under-secretary positions.

Posted in Donald Trump, Middle East, Military Budget, Trump Administration | Leave a comment