Category Archives: Political Economy

Government Oversight of Medicaid: The Shift of Power from Federal Agencies to State Agencies has Been a Disaster for Poor Americans’ Health

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Dave Kingsley

Dismantling of the Federal Administrative State

    President Ronald Reagan said this at a press conference in 1986: “The nine most terrifying words in the English language are ‘I’m from the government and I’m here to help.’” This might have seemed funny at the time but by 2008 when lax federal governmental oversight of the financial services industry led to economic collapse or when in 2020 a deteriorated public health system led to a raging COVID epidemic, the people of America were screaming back to the government these five desperate words: “For God’s sake help us!”

    President Reagan’s quip was a continuation and acceleration of devolution of power from the federal government to the states that began during the Nixon administration. Consequently, the far-right dream of dismantling the federal administrative state has led to funneling federal grants to states as block grants rather than grants-in-aid, which meant less federal control over how states regulated federal-state funded programs such as Medicaid and welfare in general.   

    Some states are more enlightened than other states in how they administer welfare programs.  But during the Clinton Administration, the mistaken notion that people needing assistance for their daily needs – including medical care – would benefit from some tough love like denial of any services after a few years of receiving it.  Aid to Families with Dependent Children (AFDC a grant-in-aid program) became Temporary Aid for Needy Families (TANF – a block granted program with a much more stigmatizing moniker).  By the late 1990s, President Clinton was declaring that “the era of big government is over” – seven very unfortunate words.

    The idea that poor people down on their luck needed some federal assistance for survival was warped into a philosophy that help from the government would induce dependency and that administrative barriers to assistance and forcing people off of aid would somehow be character building.  As has happened since the era of industrialization began, poor people were more intently looked at as irresponsible and the cause of their own plight.  By the turn of the Century, this philosophy had become de rigueur – even in states given to a more empathetic and compassionate approach to the less fortunate (which could be any of us).

How Have States Handled their Increasing Power?

    So, how have states done with the power devolved to them?  Not well.  As an example, consider the prior authorization of Medicaid that I wrote about in my last blog post.  The HHS, OIG had this to say in their recently released report:  “most State Medicaid agencies reported that they did not routinely review the appropriateness of a sample of MCO denials of prior authorization requests, and many did not collect and monitor data on these decisions.”  This seems like very familiar state regulatory behavior to me.  Having reviewed thousands of nursing home cost reports, I have yet to see one properly filled out (in accordance with GAAP/FSAB accounting principles and federal regulations).  Indeed, they are loaded with deceit, misinformation, and what is either profound ignorance or fraud.  And yet auditing at the state level appears to be practically nonexistent.

    There is no point in using nursing home cost reports for research except to raise issues of state incompetence, lack of oversight capacity, and corporate ability to game the system. The same can be said about the giant insurance corporations contracting with states as MCOs.  Indeed, Anthem’s highest MCO denial rate was 34%.  Molina, one of the largest providers had denial rates that ranged from 17% to 41%.  Aetna, Centene, and UnitedHealth denial rates were 5% to 29%, 3% to 23%,  and 7% to 27% respectively.

    The States with the highest rates of denial are Georgia (34%), Michigan (32%), California (29%), Mississippi (27%), New Jersey (27%), Virginia (26%), and Wisconsin (25%).  One can only imagine how difficult and frustrating it is for physicians and Medicaid patients in these states to obtain needed medical care.  None of these states used denial data for oversight.

There is Nothing Funny about Government Help:  We Need it Badly!

    My colleagues and I spend our working hours attempting to ferret out information from states regarding Medicaid outcomes data.  To quote Warren Buffet, “It’s like getting red meat out of a tiger cage.”  But we have been communicating with staff – including auditors – in the OIG’s office and will continue that communication.  Our mission is to fight the state/federal barriers to public information.

    The Medicaid program is nominally a $900 billion federal/state expenditure.  But with tax expenditures (i.e., tax subsidies) for corporations in the business, it is a much larger expenditure in federal and state budgets combined than that. Furthermore, nursing home corporations and the giant insurance corporations contracting as MCOs are extracting immense amount of tax dollars without a correlative investment in a loyal, career-oriented work force, and a medical services infrastructure that welcomes and benefits the people eligible to receive it. 

    Centene, UnitedHealth, and the other large providers are lavishing obscene compensation packages on executives and board members (CEOs are usually receiving about $20 to $24 million per year); they have billions of dollars sitting on their balance sheets, they are paying robust dividends to their shareholders (most of which are asset managers such as Vanguard, BlackRock, and State Street, handling pension, insurance, and sovereign wealth funds); and they have devoted billions to capturing government through lax lobbying and election financing.

    No matter how objective and scientific researchers like to be, this is all about politics.  It’s about what goes on inside the D.C. beltway and in state capitols.  Anyone who thinks they can be politically neutral, purely professional, and outside of politics is sadly mistaken.  Making CMS do its job is a political task and will take political organizing.  The same can be said about making state agencies do their job.  You cannot work within the system and change it that way. 

Does the Attack on Social Security by Conservatives Make Any Sense? Read What One of America’s Leading Experts on Social Security Has to Say.

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Max Skidmore

What About Social Security?

The Social Security Act became law in 1935 and created a system of “social insurance.” Workers pay into trust funds through deductions from wages, and employers match the workers’ contributions. Benefits are calculated on the thirty-five years of highest earnings. The maximum amount of wages subject to Social Security (FICA) tax for 2023 is $160,200. The system began to pay benefits in 1940.

Originally, the Act called only for retirement benefits, but through the years the system expanded to include payments to spouses, survivors, and the disabled. Thus, Social Security now provides life insurance, as well as retirement, and also protects against lost wages resulting from disability before one reaches retirement age.

Roughly a third of Social Security’s checks go to people younger than retirement age; that is, to survivors of deceased wage earners and to the disabled. The elderly are not the only ones who benefit from Social Security. Virtually the entire population does¾either through receipt of benefits, insurance coverage, or being freed from the necessity of caring for their elderly relatives.

Benefits are indexed to inflation, so that purchasing power remains constant through the years. Moreover, benefits continue through the lives of beneficiaries, however long they may live; one cannot outlive benefits.

As limited as the benefits are (and it would be an excellent idea and easily achievable to expand, not reduce, them), most retired Americans receive a substantial portion of their income from Social Security. For the average retiree, Social Security accounts for nearly a third of the total. More than a third of America’s retired elderly, in fact, count on Social Security for half or more of their total income. Substantial numbers of retired people have no income at all except for their Social Security. For millions of Americans, the benefits they receive from Social Security enable them to escape poverty and live in reasonable comfort.

Despite scare propaganda from groups who would profit from privatization, the system’s finances are sound. The highly publicized times for depletion of the trust funds vary from year to year, and are always based on “intermediate projections” from the annual reports from the system’s Board of Trustees. The trustees, themselves, caution in their reports that depletion years are to be considered only as estimates based on a huge number of assumptions. They are not to be taken literally.

Nevertheless, commentators  generally treat them as firm and unquestionable, and mistakenly refer to the trust funds’ impending “bankruptcy.”  This is nonsense. The projections are extremely cautious, and likely are quite pessimistic. “Bankruptcy” is not an appropriate term for a federal, tax-funded, program. FICA taxes in would continue to come in, regardless of trust fund balances. Moreover, the trustees always publish a “low-cost,” more optimistic, projection that tends to present the future of the trust funds as secure in the long run. The conditions that the low-cost options project are just as likely as the Intermediate projections to materialize. If conditions were to become less favorable to Social Security, however, it would be a simple matter to adjust tax rates, lift or remove the cap, etc. Dire warnings about “unsustainability,” are scare propaganda designed to frighten the public in hopes that they will accept unwarranted modifications to the system based on conservative ideology, not finances.

Social Security is remarkable, it keeps millions from poverty, provides them with independence, and all the while it operates at far lower expense (less than 1% for administration) than any other income-transfer system. Also, it is off budget. Lowering benefits would not affect the deficit or the national debt; it would merely build up bigger trust funds, while continuing to tax workers, but providing them with nothing for their taxes. It would not provide balance to the budget.

Why, then, is there any opposition to such an efficient and worthwhile system? Why are Republicans such as Senator Ron Johnson urging that the system should require re-authorization every year, or else vanish?

Johnson, of course, will never be considered as among the more able or thoughtful senators. Senator Rick Scott, though, until this November, was chair of the National Republican Senatorial Committee, an official Republican organization. He proposed that Social Security and Medicare be authorized only for five-year periods, ceasing to exist if Republicans gain control and fail to re-authorize them.

Most egregious of all, and openly revealing the obvious betrayal by Republicans of the decades-long consensus regarding the value of Social Security, are the bullying threats from Senator John Thune. Thune currently is number two among the hierarchy of Senate Republicans. It has just been announced that he intends to hold the debt ceiling hostage. That is, he intends to block any elevation of the debt ceiling unless there are cuts to Social Security. This reveals the reckless cruelty of current Republicans. Incidentally, it also reveals that the dangers of the “debt ceiling” that performs no useful function; it saves not one dollar, and creates opportunities to cause chaos. It only permits irresponsible politicians, such as Thune, to create mischief.

Some of the opposition arises from investment bankers and other wealthy groups who might benefit from privatization. Most, however, comes from extreme conservatives who simply do not like government programs, regardless of their many vital functions. Do they not recognize how cruel it would be to slash the incomes of those who count on it, including those of very limited income?

The cruelty is the point. Many conservatives do not ignore the cruelty that they would cause; rather, they welcome it. Ronald Reagan began to redistribute income upward, and his party has since continued to do so with a vengeance. Until recently, they generally kept their intentions hidden. Now, though, they are openly expressing their hostility to the less fortunate of their constituents. Republicans no longer find their motto embarrassing, no longer do they find it necessary to disguise it. It is, “Soak the poor, and reward the rich,” and clearly and overtly is a common theme of their proposals. They recognize few, if any, “deserving poor.” To be poor is to be fair game. Anyone who wants to avoid institutionalized cruelty should just go out and get rich.

As the Herblock cartoon in 1964  put it (portraying the message from Republican presidential candidate, Senator Barry Goldwater), the poor should simply go out and inherit department stores.

MEDICAID IS POOR PEOPLES’ MEDICINE & POOR PEOPLES’ MEDICINE IS POOR MEDICINE.

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Dave Kingsley

The Southern Segregations’ Plan to Institutionalize Racism and Inequality

In a conversation with Lyndon Johnson prior to passage of Medicare and Medicaid, the late segregationist Congressman Wilbur Mills of Arkansas told President Johnson that across town from his mother in Arkansas, “…a Negro woman has a baby every year. He went on to explain that every time he went home, his mother complained that the “Negro woman now got eleven children.  He proposed that welfare should be designed to let “the states pay for more than a small number of children if they want to.”

Joseph Califano, Jr., President Johnson’s Secretary of Health Education & Welfare (HEW) in the room at the time noted that Johnson turned to him after Mills left and said,

 “You hear that good, now.  That’s the way most members feel. They’re just not willing to say it publicly unless they come from redneck districts.”

Most member of congress aside, Mills was not your run of the mill congressman.  He was the influential Chairman of the exceedingly powerful and critical House Ways and Means Committee.  He was a product of Southern one-party politics run by the all-powerful Southern planter class.  Mills and his Southern brethren in the Senate and House had in 1957 signed and issued the “Southern Manifesto” – a protest against Brown v. Board of Education and the civil/human rights enveloped within the Supreme Court decision. 

As I will explain, these segregationists had designed and legislated a precursor to Medicaid into existence. The passage of the Mills-Kerr program in 1960 included the framework of Title 19 of the Social Security Act in 1965 (Medicaid).  Medicaid became Kerr-Mills 2.0.  Designed into Kerr-Mills was devolution of power over federal welfare to states, which would allow them to arbitrarily place onerous administrative burdens on qualified applicants and maintain a lower status for African Americans.  They were successful in keeping Hill-Burton funded hospitals segregated for ten years after Brown v. Board of Education had declared that “separate is not equal.”

The Concepts of Kerr-Mills – Especially the Power of States Over Welfare – Are Barriers to Transforming an Embarrassingly Bad U.S. Medical System

Like the Hill-Burton Act of 1945, which initiated a massive hospital building program across the U.S., Medicaid is funded by the states with federal matching funds.  Administration and regulation of Medicaid funded nursing homes have been left to the states.  Long-term care and skilled nursing operators have benefited from lax oversight and political power in state houses.  As should have been expected, legislatures and agencies have been captured by deep pocketed industrialists and are therefore likely to serve the interests of operators at the expense of ethical and humane medical care.

States and powerful interests have devised ways to siphon off Medicaid funds for the benefit of corporations and special interests.  Consequently, poverty medicine is enriching corporations and wealthy individuals (see previous posts on this blog re: The Ensign Group & Centene Corporation) while the medical care and health of poor Americans have been deteriorating.  For instance, the state of Indiana discovered a loophole in federal law that allowed the state to buy nursing home licenses from for-profit corporations and skim a considerable amount of nursing home funding off for other purposes.  The nursing homes continued to run the facilities and extract their usual cash flow as before.

Having studied cost reports submitted by thousands of nursing home facilities, I can safely conclude that the states shield the industry from exposing cash flow into and out of the system.  If you can complete daunting tasks of gaining access to legally required and public cost reports (or pay a considerable sum for them) you will discover that you are dealing with closely held corporations that are not required to make their financial statements public. Therefore, you can follow the money to a point.  But the pools of payments to their parent corporations’ shell companies are kept secret.  The public cannot see consolidated balance sheets, income statements, and cash flow statements of parent corporations and holding companies.

Without clear and honest financial information, no amount of reform of what most everyone agrees is a bad system is possible.  The industry can and does engage in misinformation and falsehoods to maintain myths that the biggest problem in long-term and skilled nursing care is skimpy government funding.

The “medical industrial complex” is not capitalism, so let’s change the narrative.

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Dave Kingsley

Genuine Capitalist Enterprises are Not Operating in Anti-Competitive, Government Rigged, Systems.

As a proponent of capitalism, I resent the U.S. privatized, government-funded, health care system and the implication that it is a suitable representative of a capitalist system.  It is not.  The system of nursing homes, hospitals, and clinics through which patients pass for care is a financialized[1], corrupt, rigged, system.  Furthermore, some services important to society should not be industrialized under the farcical notion that return on capital will drive quality care.

Reformers have failed to create a narrative to defeat the financiers’ mantra that privatizing appropriate government services will increase quality and productivity.  History has taught us a very clear lesson:  industrialization and privatization of medical care and a host of other government services are unproductive and lead to excess extraction of capital, lower productivity, and reduction of innovation and reinvestment.

You Can’t Shame the Shameless

There is an unfounded belief that exposing bad operators in sensational mainstream media articles will force a change for the better in nursing homes and hospitals.  The misguided view that the medical-industrial complex will be moved by horror stories reminds me of an old T-Shirt in my closet with the following silkscreened on it: “We Don’t Care, We Don’t Have to Care, We’re EXXON.”  You could substitute the words medical-industrial complex, The American Health Care Association (AHCA), Ensign Group,” Welltower Corporation, Centene, United Health, and thousands of other corporate associations and entities for EXXON on such a T-Shirt.

Nursing home and hospital corporations don’t care about the shaming they deserve because politicians in federal and state legislatures have their backs.  Furthermore, they have captured the agencies charged with regulating them.  The Center for Medicare & Medicaid Services, and 50 state agencies are dominated by the industry and their well-financed lobbying organizations (not to mention the FDA, the FTC, the CFTC, etc.).  You can shame private equity as a business model, scurrilous operators, low wages/salaries, understaffing, and other outrageous practices, but financiers in the healthcare business are, for the most part, shameless. 

For at least a decade, I have been urging advocates to form a narrative and political strategy.  Playing rope, a dope with an industry that has a very well devised, effective, and well-funded narrative will change nothing.  The nursing home industry has a narrative based on falsehoods, which are comprised of frames related to the hardships endured by noble businessmen and investors.  Frames in which the industry purports to be suffering from low Medicare/Medicaid reimbursement, and low net income (profits) are blatantly false and misleading.  Regardless of how unbelievable the frames comprising industry propaganda, they are never seriously challenged by the constellation of nonprofit and government entities representing the elderly.  Furthermore, do-gooder commissions charged with studies of nursing homes, hospitals, and other health care subsystems generally whitewash and paper over the unethical, inhumane, and anti-democratic nature of the entire medical-industrial complex.[2]

Let’s Get Technical

I propose that advocates create frames that can be integrated into and support this narrative: “The privatized U.S. healthcare system is not fair, capitalistic, or ethical.”  Frames accusing industrialists of manipulation of markets, financial machinations, pay offs/bribes to legislators, and covering up corruption through well-funded lobbying entities such as the AHCA (nursing home lobby) are necessary but risky for professionals who want to go along to get along.

Industry moguls and their minions in government know from 70 years of history that their propagandistic efforts work well. They have been able to convince the public that privatized, for profit, services are better than non-profit and government services.  This mantra has gained traction and is embedded deeply in the American zeitgeist.  It will take a concerted effort across a broad array of nonprofit advocacy organizations to destroy a narrative based on industry lies and complex financial maneuvers.

However, before advocates can suitably frame messages for the media and legislators, a considerable amount of research, data collection, and analysis must be undertaken.  Data and evidence related to “rent seeking,”[3] “net operating income,” and “cash flow,” is necessary for debunking the “low net,” “thin margins,” and other hardship frames of the industry.  The nursing home system must be unraveled and explained as a network of capital flows from taxpayers and other sources through Real Estate Investment Trusts (REITs), private equity firms, LLCs/LLPs, and C-Corporations.

It is necessary to show how excessive capital flows through nursing homes and hospitals to investors and executives.  REITs have been existing under the radar and never discussed at legislative hearings (See my blog post: “Real Estate Investment Trusts (REITs) are Big Players in the Nursing Home Industry:  That Should Concern All of Us” February 13, 2021).  We must recognize how the entry of private equity and REITs around 2000 literally transformed the industry.

Advocacy research must include data from cost reports submitted by facilities to CMS and state agencies.  Falsehoods in these reports are pervasive.  Nevertheless, it is important to organize the data to make a case and support our frames pertaining to corruption and excessive extraction of capital at the expense of care.

We Are on It!

A team of people across the U.S. have come together to initiate solid, evidence-based, research.  With some help from the LTCCC and a lot of volunteer work, a group of us have been organizing data from cost reports and digging into financial machinations, ownership, and the flow of capital from various sources (including taxpayers) to investors, executives, and family wealth. 

We want to direct attention to more than horrendous examples of nursing home abuse and neglect.  The industry justifies poor care with a well-honed, richly funded, propaganda campaign. We should not respond to their “woe is me pleas for increased funding.”  Rather we should follow the money and make the trail available to legislators and journalists that we know will utilize it (think Senator Elizabeth Warren).  I don’t want to engage them in their claim that investors in the nursing home industry are suffering.  My only response to that is investors are not stupid.  If returns were no good in public-funded, skilled nursing care, investors would be investing somewhere else. 

[1] By labeling the system “financialized,” I mean that financial maneuvering for extracting cash takes precedence over increased productivity and quality of services.  Shareholder value is the primary mission of most healthcare private corporations.  Stakeholders are of secondary importance.  Often stakeholders suffer for the sake of enhancing and protecting shareholders’ interests.

[2] While COVID was surging in the Spring of 2020, CMS convened an “independent” commission the management of which was outsourced to the Mitre Corporation.  The report of this commission was a whitewash and papered over general neglect by the nursing home industry which resulted in 200,000 patient and employee deaths.  Contrary to suggesting accountability for lack of infection control and no preparation for a pandemic that scientists had been warning about for decades, the final report recommended more financial assistance for the industry.  Recently, a commission under the auspices of the National Academy of Sciences, Engineering, and Medicine (NASEM) in operation for a number of years entitled “National Imperative to Improve Nursing Home Quality” issued a report of their work. This commission tiptoed around the corruption, deceit, and excessive extraction of capital at the expense of quality care.

[3] “Rent seeking” has evolved in the field of economics to describe corporate efforts to extract wealth without a correlative increase in the production of goods and services.  The nursing home, finance, real estate, lobby is constantly hectoring legislators for an increase in reimbursement without any real, scientific, evidence that the cash flow and return on their investment is inadequate.

What Has Reaganomics Wrought?

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Dave Kingsley

“In the Age of Show Business, Public Discourse Has Become Dangerous Nonsense” Neil Postman in Amusing Ourselves to Death

Shareholder Value is the Only Value:  Even the Taxpayer Funded
Life & Death Care in the Healthcare System Has been Reduced to a Matter of
Return on Investment

Welltower, Inc. – one of the major players in the senior living industry – states in its annual report to the Securities and Exchange Commission that the company’s primary goal is to “protect and enhance shareholder value.”  Although Welltower is a dominant force in the taxpayer funded, skilled nursing and long-term care system, nothing is mentioned in company financial reports about a duty to provide ethical medical care to patients.

I consider these nursing home corporations to be no less evil than corporations in the fossil fuel industry, tobacco industry, and the assault weapons industry.  Like big oil, big tobacco, and big firearms, they value people only as consumers with little to no human worth other than parting with their money for the benefit of investors.

Unlike the tobacco, fossil fuel, and gun industries, nursing home corporations earning extraordinary returns from taxpayer funded medical care are excused for their pervasive patient neglect and abuse by carefully selected members – often naïve academics or industry shills – of various commissions (e.g., the recent National Academy of Sciences and the COVID-related Mitre Corporation Commissions).  Without any empirical, scientific, justification, the industry’s propagandistic claims about skimpy Medicaid reimbursement are taken at face value in the media and generally by the public.  The industry has a richly funded a very effective PR machine.

Unquestioned misinformation – whether intentional or unintentional – is creating a crisis in American governance and the well-being of residents.  The anti-vax, anti-science, assault on the public health system during this era of COVID has long been in the making.  What has become known as proofiness (or truthiness) has polluted public discourse.  I have spent untold hours collecting, organizing and analyzing corporate financial reports submitted by nursing home corporations to state and federal agencies.  Much of it is fraudulent, much of it is financial machination, and much of it is laughably ridiculous, but hardly any of it is seriously questioned. So, deadly conditions in nursing homes continue unabated.

“Nihilism, the devaluation of the highest values of Western culture.”  Ashley Woodward in Understanding Nietzscheanism. 

Ronald Reagan Propelled a Destructive Economic & Social Philosophy Forward Through Government Policy:  Trumpism is the Apotheosis of Reaganomics

The previous post by Kent Comfort chronicles the economic revolution that commenced with the Reagan Administration. This post addresses the values wrought by the economic superstructure described by Kent.  A deep dive into philosophical movements that seeped into the American zeitgeist along with Friedman/University of Chicago radical free market nonsense is beyond the purview of this post.  Suffice it to say that Ayn Rand’s philosophy of selfishness, dog-eat-dog capitalism, and Nietzschean ubermensch (John Gault) seeped far deeper into the American zeitgeist than is readily apparent to most observers.  Along with the Randian virtue of selfishness, the nihilism and rejection of Enlightenment values of the postmodernist philosophical movement became de rigueur among intelligentsia – eventually on the right of American politics.

The changes we’ve seen entrenched in U.S. culture over the past 40 or more years can be characterized as the triumph of self-interest over public interest and community, the prevalence of wealth and power over equality, and the weakening of science engendered by disregard of and disrespect for reason and objectivity.  We are in a post-truth age characterized by deceit, manipulation, and cheating without accountability.  Any claim based on pseudoscience is deemed legitimate – especially if it is legitimated by journalists, politicians, and influential voices in academia.

In the winner take all, survival of the fittest, milieu, it is OK to spout falsehoods and engage in practices that would have been otherwise unethical and unacceptable in the pre-Reaganomics era.  Lying, cheating, stealing, and preying on the vulnerable and weak can be justified by absolutist beliefs in abstract principles.  In its most extreme form, Reaganomics is conflated with Christian fanaticism and right-wing, proto-fascist political movements.  Furthermore, extreme principles of the movement include total deregulation and dismantlement of the administrative state except insofar as it can further a free-wheeling corporate state.

In post-truth America, shareholder value as the highest value of business enterprise, doesn’t need to be justified scientifically as beneficial to the American people in general.  Universal human rights of equality and fairness handed down to us from the Enlightenment have been devalued while the powerful and wealthy leverage their power to degrade democratic processes and direct more and more economic resources from the middle- and low-income classes to themselves.  In the long run, we will see an increasing amount of tragedy and farce detrimental to the future of the planet and all living things.

Thank You For Your Service! Now Go Rot In A Veteran’s Nursing Home!

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Dave Kingsley

As a veteran myself, I find the maudlin, mawkish, displays of affection for military personnel hypocritical and disgusting. Flyovers at football games, the shallow emotional “thank you for your service” cliché, and phony, baloney outpourings of appreciation through little privileges (first in line to get on an airplane) are no-sacrifice forms of super-patriotism that keep the real sacrifice of our troops out of sight and out of mind.

Elderly and disabled veterans in state run nursing homes are certainly out of sight and out of mind these days. We don’t know how many of these places are deplorable and full of neglect and abuse. However, I was initially alerted by family members about conditions in a very large state run veterans’ facility in New York. It appears that that their loved ones are not well treated, nor are they as family members. We are looking at COVID data in that facility and what we are finding is alarming. However, given the resistance of any state to come clean with the information advocates and family members need, we will need to keep fighting this out so that we can find out what really happened.

I’ve been reading the inspection reports for the Kansas Soldiers’ Home in Fort Dodge, Kansas. The staffing levels, condition of the facility, and treatment of patients are shocking. In the state of Missouri, we can’t see the inspection reports online. Missouri veterans’ facilities aren’t on Nursing Home Compare. We are told that we have to go into the facility and ask to see reports for those facilities.

We will stay on this issue. This is just the beginning of our investigation into what is happening to veterans in America’s nursing homes. Let’s not overlook the $788 billion defense budget that sailed through the Senate this week, which doesn’t even include the VA and military retirement benefits. Nor does it include the nuke stuff in the Department of Energy. Can’t we spend an adequate amount on veterans’ in nursing homes in a $trillion military budget?

Watch this blog. We will keep investigating and writing about how our veterans are treated.

This Country Simply Does Not Care About Old And Disabled People: We Are Expendable for the Sake of Profit

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Dave Kingsley

At Least 150,000 COVID Deaths in Nursing Homes & The House Select Subcommittee on the Coronavirus Crisis Doesn’t Even Bother to Mention It.

On any given day in the United States, approximately 1.5 million Americans will be patients in nursing homes. Throughout the year, 3 million people will either be permanent (long-term) or short-term rehabilitation patients in government-funded, long-term care/skilled nursing facilities. During the past two years, these institutionalized individuals have accounted for at least 150,000 of the 800,000 U.S. COVID deaths. Hence, nearly 20% of COVID fatalities occurred in one institutionalized group comprising less than 1% of the U.S. population.

Yesterday the House Select Select Subcommittee on The Coronavirus Crisis under the leadership of Chairman James Clyburn released a report of the committee’s oversight hearings regarding the COVID pandemic. The report entitled “More Effective More Efficient More Equitable: Overseeing an (sic) Improving and Ongoing Pandemic Response” (https://coronavirus.house.gov/news/press-releases/select-subcommittee-s-year-end-staff-report-highlights-oversight-work-releases) makes no mention that I can find of the largest mass fatality occurring in any institutionalized population in U.S. history. Not even the troops during WWI suffered as large a fatality rate from the flu pandemic as have elderly and disabled patients in U.S. nursing homes during the COVID pandemic.

Lack of the public’s interest in accountability for 150,000+ preventable deaths is a signal to the elderly and disabled that we are not valued as human beings. Politicians are acting like “nothing to see there.” The press, the public, and politicians, are ready to move on like “that didn’t really happen.” “Did it?” The nursing home system is sickening and disgusting as it is. But for a society to seemingly not care much about the failure of a very profitable, taxpayer funded industry to properly care for patients in their charge and agencies like CMS failing to make them care amounts to euthanasia by neglect.

I’m outraged that “aging enterprises” aren’t raising bloody hell about the disaster brought on vulnerable, unprotected, aging and physically challenged people. These organizations claim they represent the elderly, but their silence is deafening:

  • American Geriatrics Society (AGS)
  • American Society on Aging.
  • Leadership Council of Aging Organizations (LCAO)
  • National Association of Area Agencies on Aging (N4A)
  • National Council on Aging.
  • Justice in Aging.
  • Alzheimer’s Association.
  • Senior Medicare Patrol.
  • Administration on Aging.
  • National Center on Elder Abuse.
  • AARP
  • Kansas Advocates for Better Care
  • And Many Others

That the boards of these groups and their paid professional staffs haven’t come together in a coordinated effort to hold accountable a very profitable well-rewarded, industry and the agencies of government they have captured (e.g. CMS, KDADs, etc., etc., etc. …… .) is shameful. Congressman Clyburn and other politicians need to hear from organizations purporting to advocate for the elderly and disabled.

Congresspersons and Senators have certainly heard from the nursing home industry. Congressman Clyburn and Speaker Nancy Pelosi both received $10,000 from the AHCA PAC. Indeed, Democrats are beneficiaries of two-thirds of AHCA PAC money. They don’t need to buy the Republicans – they are on board with whatever corporations want. Any hearing, any report, any statement, from a politician regarding the elderly are of dubious value when the politicians involved are taking money from the industry.

I’m afraid that aging enterprises and paid professionals have fallen comfortably into the good ole boy and girl networks operating inside the Washington, D.C. beltway and all of the state capitols. Speaking truth to power is a risk that might get them marginalized and ousted from the group.

Capitalism Can Only Thrive in a Robust Democracy. As Democracy Weakens, Capitalism Rots

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Dave Kingsley

Democracy is becoming weaker in the United States and the economic system is becoming increasingly corrupt and inefficient. 

    The primary hallmarks of a well-functioning capitalistic system are competitive free-markets, disruption of stagnant companies and industries by innovative startup companies, widespread opportunities for entrepreneurship, and a government with the political will to regulate the economy and business on behalf of the people and the general welfare.  These characteristics have been alternatively strengthened and weakened in the United States over the past 200+ years.

    Currently, the super-rich, and major corporations representing a burgeoning oligarchy have plied their increasing share of the wealth to government capture. Consequently, the U.S. government and a large proportion of the corporate world have settled into a destructive, money-driven, relationship.  Over the past few decades, the amount government largess channeled into corporations, their shareholders, and executives has accelerated. It is important to recognize this as one major underlying cause of what may be the twilight of American democracy and a free enterprise system.

We Cannot Overlook the Role of Religion in the Rise of Anti-Democratic Corruption

    I believe that a major cause of deteriorating democratic systems in this country is the money washing over elections and office holders. Our seriously corrupted political system is due in large part to dominance of the Supreme Court by a Christian-theistic-fascistic movement which has a propensity to throw its weight behind a strongman leader and a conservative, wealthy, white, elite.   For instance, Citizens United is merely a convoluted decision handed down for the purpose of legitimating the purchase of legislators by oligarchs and entire industries.

    Recent world history has taught us that major elements of modern Christianity are prone to collaboration with fascist autocrats.  Examples of Christian leadership’s deference to and support of strongmen abound.  The most recent example of course is the Christian white nationalist movement’s strong backing of the vile Donald J. Trump. The Catholic Church has a well-known history of providing comfort and aide to fascists throughout Latin America. 

    During the fascist-Nazi movement of the 1930s, the Catholic church was all too often willing to place its imprimatur on German, Italian, Spanish, (European) Nazism, and fascism.  Following the Holocaust, ratlines set up by Catholic priests helped shuttle war criminals such a Mengele and Eichmann to Latin America.

    Most Christians and Christian leaders in the United States are opposed to the vicious, vile politics of Donald Trump and today’s Republican Party.  Unfortunately, they are far too passive, unorganized, and quiet.  I say to them: “Please do not underestimate the organization, money, passion and commitment of the proto-fascist Christian white nationalists promoting Trump and Republican candidates.” 

    The Wasteful, Corrupt, U.S. Healthcare System is a Symptom of a Sick Political System

    There is a reason Americans pay two to three times per capita for healthcare than peer countries in the advanced, industrialized sphere of the global economy:  corruption.  How many ways can we document the claim that corruption is at the root of the wasteful, inefficient, U.S. healthcare system?  In so many ways that they are too numerous to mention in one blog post.  I will discuss some in this post and many more in future posts, but I first want to say as a capitalist that privatization and healthcare are not compatible.  Medical care cannot be reduced to an industrialized, free market model and at the same time optimize the health and wellbeing of the U.S. population.

    As dark money as well as money right out in the open began to flood into the political system, the American people were conditioned to believe that traditional government programs on behalf of the general welfare were necessarily wasteful and inefficient.  We were sold the myth that private enterprise is more competent than government bureaucracy.

    Actual practice – for instance in the case of the military, infrastructure, Social Security and Medicare – belie this deceit.  Nevertheless, practically every facet of the public domain supported by taxpayers has been handed over to private corporations.  That includes the publicly funded healthcare system.  The mind-boggling amount of capital that has flowed from the pockets of ordinary, non-wealthy, Americans into the holdings of the 1% is so excessive that it will be difficult for those hardworking, every day, Americans to grasp.

    Officially, healthcare accounts for $5 trillion or 20% of the U.S. economy.  I think it is more than that due to the generous tax reductions gifted to corporations, boards of directors and executives in the healthcare industry.  In my view, practically all revenue streaming into corporations providing medical services is coming from government sources – taxpayers – such as Medicare, Medicaid, the VA, and Obamacare.  At the same time, lobbying and campaign contributions keep costs spiraling up while care deteriorates and shareholders, boards, and executives pocket immense amounts of dividends, stock-growth, and compensation.

    The Finance-Insurance-Real Estate (FIRE) lobby, Big Pharma, device manufacturers, physician associations, the nursing home industry, and other powerful representatives of industries benefitting from corruption and excessive payouts can see the limitless government largesse available to them and have their representatives crawling all over our Nation’s capitol and the legislatures of the 50 states.  Legislators of both major political parties have become dependent on campaign contributions from the medical-industrial complex.

    In future blog posts, we will be documenting the inordinate corruption overtaking the government funded U.S. healthcare system.  See the coming post regarding 1Health Healthcare and the Centene Corporation.  Two of a very large number of scandalous and yet typical cases of healthcare rip offs at the expense of “we the people.”

The Dysfunctional U.S. Political System: We Didn’t Get Here Overnight

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The Editors

As the American people stand before the precipice of disaster on a scale they cannot imagine, a minority of elected officials in Congress are bending the Nation’s legislative will toward special financial interests with no regard for the public interest and future generations. One party, the Republican Party, has become totally debauched, decadent, and beholden to a tiny wealthy elite and white supremacists.  The other party, the Democratic Party, has within its ranks a few so-called “moderates” who are catering to the financiers and believers in the myth that the U.S. – the wealthiest Nation on the planet and in the history of humankind – cannot afford to care for its poorest citizens on a scale befitting an enlightened, advanced, society.

The “Blue Dog Democrats” blocking President Biden’s attempt to pass a budget designed to ameliorate economic injustice and forestall an environmental apocalypse are anything but moderate.  They are in fact reactionaries who refuse – along with the Republicans – to recognize this country’s racist past and are failing to support programs for rectifying four centuries of brutality perpetrated on African Americans.

Furthermore, Senators Manchin and Sinema and Blue Dogs in the House such as Abigail Spanberger and Kathleen Rice are looking away from the increasing discrimination and investor exploitation of programs for the less abled (elderly and physically less abled) in so-called nursing homes. They seem to be insensitive to the lack of access to health care for 30 million of their fellow citizens. They are turning a blind eye to the need for solar, wind, and other energy alternatives to fossil fuels before catastrophic failure of the environment makes the planet unlivable.  They appear to place interests of the greedy over the public interest.

We did not arrive at these crossroads of democracy versus autocracy, interest of the greedy few versus the public interests, and enlightenment versus dystopia overnight.  As distinguished Professor Max Skidmore writes in his post today, the Republican Party has been evolving toward its almost unbelievable state of debauchery for some time.  This is a chapter in a coming book, which will be one of many written by Professor Skidmore – a highly admired presidential historian.

The Democratic Party Blue Dogs now selling out their fellow Democrats are also the result of decades of political propaganda propelled into dominance by Ronald Reagan and Margaret Thatcher.  The belief that privatizing publicly funded programs in the public interest would lead to a better society was foisted on the American people and reinforced by inordinate amounts of cash from financiers.  A propaganda machine was cranked up for the purpose of conditioning the public to believe that poor people – especially African American poor people – are untrustworthy and lazy.  We’ve been put upon by propagandistic institutions with unlimited money for convincing us that government is bad and corporations are good. 

If we fail to correct decades of misinformation and disinformation and what they have wrought, the Blue Dogs will be long-remembered – but not fondly.

The Relationship Between Donald J. Trump and the Republican Party: Less Sudden than it May Appear

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Max Skidmore

It may appear as if Trump, a demagogic and bombastic outsider and political newcomer, suddenly seized one of America’s two major political parties, shaped it according to his whims, then dominated it entirely. The reality, however, is less dramatic. The Republican Party for years had implicitly been seeking such a figure as Trump.

Republican Senator Barry Goldwater’s 1964 presidential candidacy led to one of the greatest defeats in American history. Nevertheless, his support for “extremism” (which, Goldwater said, was not a vice) led to an increasingly hard-right party. His campaign, and the highly public support it received from a former film actor, Ronald Reagan, laid the foundation for the corruption and deterioration that today is so obvious.

In 1968, only four years after the Republican disaster, the party’s candidate, Richard Nixon, won the presidency. That year also saw the openly racist campaign of Alabama governor George Wallace, who was running for president as a minor-party candidate. Wallace’s racist appeals, both overt and coded, were lessons for Republicans, and added considerably to their repertoire. Wallace, of course, was not and had never been a Republican, but his mainstreaming of open bigotry provided inspiration for Richard Nixon’s “Southern Strategy.” That Nixonian strategy, continuing as it did¾even intensifying¾with Reagan, successfully re-oriented the Republican Party away from its civil rights heritage and toward the prejudices of the racially segregated south. Decades later, Donald Trump (another actor, of sorts, from reality television) was merely the culmination of the increasing “southernization” of the Republican Party.

Although the party might have been expected to heal over time as its message and preferences came to be more inconsistent with the changing views of an increasingly educated America, it did not. Instead, its deterioration intensified, increasing until it created a vacuum within itself that only the least principled and most unrestrained power seeker could fill.

In stepped Donald J. Trump. Whatever it seemed, it was assuredly not Trump capturing and corrupting a party; rather, it was a shameful party offering itself without reservation to the shameless Trump. Ultimately the party’s outrageous choice led to an actual insurrection¾completely Trump instigated¾that attempted to overturn the election that overwhelmingly turned him out of office. The rest is history; it also was tragedy as Trump and the bulk of the Republican Party unhesitatingly overturned America’s great tradition of peaceful regime change that dated back more than two centuries to John Adams who relinquished the office to Thomas Jefferson, honoring the result of the 1800 election.

The Republican Party of the United States had emerged in 1854, during the furor over slavery. That furor had led to the effective dissolution of the short-lived Whig Party, and of assorted minor parties. The founding principle of the new party was opposition to the spread of human enslavement into the territories. With astonishing speed, the new party became one of the two major political parties in the United States, electing a president, Abraham Lincoln, only six years after its founding. From then on, the Republican and Democratic Parties were the bases of America’s two-party system. In the 1880s, the term “Grand Old Party,” or GOP, referencing the Republican Party, began to appear in print. It was another century before the term took on the irony it carries today.

The Democratic Party¾then, for a time, often called simply “The Democracy”¾pre-dated the Republican Party for two decades or so, and had become the other major party. It had emerged from the presidency of Andrew Jackson. Although ostensibly devoted to the interests of workers and recently-enfranchised groups, and although there certainly were anti-slavery Democrats, (and pro-slavery Whigs) the party as such was the party of slavery. To a large extent, it was committed to southern interests, and thus became almost a sectional party during the Civil War, only to expand across the country, still generally supportive of southern segregation, in the decades to follow.

The early Republicans tended to be devoted to human rights, as reflected in Lincoln’s statement that they favored both the man and the dollar, but for the man over the dollar in cases of conflict. It was no accident that the Republican Party, during the Civil War, adopted the first income tax in US history, nor that it favored widespread education, conservation, and popular land ownership (the latter, to be sure, to the detriment of Native populations). Quickly, however, the party also was to become aligned with financial interests, after which it came to reject Lincoln’s preference for human over property rights.

Although the Republican Party developed an energetic progressive movement in the early 20th century, it could not maintain its progressive orientation. The 1920s saw the party become identified almost completely as the party of business, and the wealthy. When the Democratic New Deal under Franklin D. Roosevelt absorbed progressive elements in the 1930s and on the whole adopted progressive programs, Republicans tended to become even more devoted to what Americans call “conservative” policies: exaggerated patriotism and nationalism, isolationism, limited government, favor toward business, extreme protection of property, hostility toward programs crafted to benefit the people or anything they could describe as “socialism,” minimal economic regulation, and minimal taxation of wealth (this American version related only tangentially, if at all, to classic European “conservatism”). At the same time, Republicans became authoritarian: favorable toward the regulation of social conduct, despite their adoption of individualist, libertarian, rhetoric. The “individualism” that came to characterize Republicans, tended to be limited to economic matters; the freedom to accumulate wealth, and to use it with little or no restriction.

Following World War II, when Democratic President Harry Truman advocated fair housing, de-segregated the military by executive order, and proposed a national health service Republicans became more oriented toward policies of the south. This was the height of irony, in view of the anti-slavery commitment that had motivated the party’s founding. The two parties then shifted orientations fully after Lyndon Johnson worked for, and signed, the Civil Rights Act of 1964, and the Voting Rights Act of 1965.

Outraged by attacks on their “way of life,” southerners, as LBJ had predicted, shifted their politics. The “Solid South” no longer was solidly (or at all) Democratic. Bigoted southern Democrats en masse became bigoted southern Republicans. The Democrats had become the party of civil rights and human rights¾insofar as one existed in American politics¾and the Republicans had become ideological “conservatives.” As they did so, they came more and more to operate on a cult of personality that motivated so many autocracies in the world, summed up by Hitler’s Nazis as the Führerprinzip. Over and over, after Reagan’s presidency, Republicans who sought their party’s presidential nomination, claimed to be “more like Ronald Reagan,” than their opponents. Reagan worship continued undiluted until the advent of Trump as a Republican absorbed all the oxygen from the Republican room, so to speak, and superseded¾and far surpassed¾Reagan as the cult figure to dominate all things Republican.

By the 1960s, the Democratic Party had come to reject the explicit racism and the policies of white nationalism that until the early 20th century had been at its core.  The party then accepted the civil rights movement that sought to end racial discrimination and segregation. This caused the Republican Party to embrace the least humane principles of American politics, those that dominated the south, and most often (especially until after the Wilson administration, 1913-1921) had been associated with the Democratic Party.

Both parties, nevertheless¾after the Democrats’ defeat in the 1860s when they pursued the policies of secession and treason that brought about the Civil War¾were parties devoted to the “rules of the game,” and both generally supported the idea of self-government based on generally understood principles of democracy. They worked to ensure the most effective functioning of the legal system that the Constitution demanded, and that the political system enacted; even if a party had opposed a given law, its members generally cooperated with the other to make it work for the good of the whole.

As the latter part of the 20th century dawned and Republicans began to take away from the Democrats their most unsavory motivations, though, they also began to become less committed to democratic norms and to the “good of the whole;” even less committed to any political party’s most vital function: the very act of governing; this should have been expected.

 Republicans recognized that they were in trouble because of their devotion to the wealthy, to property as opposed to human rights, and because of their harsh disregard for the country, for democracy, and for the bulk of its people. Their orientation had progressively less appeal to those people. Nevertheless, they stood firm in their rejection of what at one time they had professed to accept as democratic values.

Instead of modifying their goals to make them more appealing to the people, they became more strident and more open in their “conservative” policies.  Following the example set by their post-Reconstruction ancestors, the architects of Jim Crow, they set about crafting ways to prevent majority interests from taking control. Ultimately, they discarded any guiding principle other than pursuit of power. This led them away from their previous professions of patriotism, and toward violence, dictatorial rule, and even subservience to foreign meddling if they saw it as aiding their cause. For elaboration, and documentation, see my Common Sense Manifesto.[1] Descriptions of a few of the outrageous Republican actions follow.

An initial break with standards of acceptable conduct came with the Nixon administration. Although this appears to have been largely forgotten, President Nixon, primarily through his henchman, Vice President Agnew, launched a campaign against the press. Nixon had long been known for his attacks on reporting that failed to support his actions, but his attacks became more strident, and more telling, when he weaponized his vice president.  Effectively blunting accurate reporting, Republicans began a mantra of “the liberal media.” So successful was this theme, that ever since, the term “liberal media” in public discourse¾untrue though it was¾became commonplace; much like “damnyankee” once was in the south. The culmination of decades of repetition was the even more powerful attack on accurate reporting by Trump, who popularized the term “fake news” to describe any coverage that failed to praise him adequately. Trump regularly blasted the news media as¾note the rhetoric borrowed from totalitarian tyrants¾“enemies of the people.” Both Nixon and Trump, one should remember, were haters, and both maintained “enemies lists.” Only the more simple-minded Trump, though, appeared to be in awe of totalitarians, and of totalitarianism itself. Nixon was too intelligent, and—although this is not a word that springs to mind when thinking of “Tricky Dick”—had too much decency compared to Trump, to be similarly taken in by foreign dictators.

The first known political maneuver in modern American politics suggesting that even overt treason might not be a deterrent foreshadowed ominously the direction the Republican Party might take in years to come. Candidate Nixon’s henchmen at his direction sabotaged the 1968 Paris peace talks in a deliberate effort to prolong the war in Vietnam. The purpose was to avoid an “October surprise” of peace that might swing voter support to Democrats, and their candidate, the sitting vice president, Hubert Humphrey. This was known earlier, but not finally verified, until 2016,[2] and was a clear indication that at least some powerful Republicans were willing to continue bloodshed and death in order to advance their own political fortunes.

There is considerable evidence that the Reagan campaign did something similar during the 1980 race for the presidency, when his henchmen dealt with Iranian officials, promising them arms and the like, if they would not release the American hostages during the campaign. Reagan and his campaign feared release would boost President Carter’s chances of being re-elected. The hostages were indeed held longer, and were not freed until the very instant of Reagan’s inauguration. The “Iran-Contra Scandal” included this, as well as other actions that also were virtually treasonous. To be sure, the deal to delay the hostage release has not been completely verified. Republicans saw to that by blocking funding for the investigation. There is full verification, though, that the Reagan administration did supply arms to Iranian terrorists who then did turn those arms against Americans. Reagan’s successor, George H. W. Bush (who had been Reagan’s vice president), subsequently pardoned Iran-Contra figures, making it impossible ever to secure their testimony.

During the administration of the younger Bush, the office of Vice President Cheney, leaked the name of Valerie Plame Wilson, an undercover CIA agent working in the Middle East, to conservative columnist, Robert Novak. This put her at risk, although she made it home safely. Her vital work on nuclear proliferation, however, was destroyed, her contacts disappeared (almost assuredly, executed), and her career was ended. This destruction of American interests, and its overt betrayal of America’s friends, took place because of outrage at her husband, Ambassador Joseph Wilson, who had demonstrated that Saddam Hussein had not secured nuclear materials from Africa, as the Bush administration had charged. It now has been verified that the G.W. Bush administration, and that of the Bush ally, British prime minister Tony Blair, presented false information to justify the Iraq War. Even worse, both administrations knew that they were committing their countries to war based on lies.[3] The resulting legacy has been tragic.

Uniquely among American presidents, Donald Trump always had refused to commit himself to abiding by election results. Even in the 2016 election, he said clearly that he would accept the results¾if he were to win. Even winning, he openly resented the greater number of popular votes that went to his opponent, Hillary Clinton. He considered an election to be fair and valid only if he won, but even that was not sufficient; he judged an election to be valid not merely if he won, but only if he were to have won by a huge majority.

There were legitimate concerns in 2020, that Trump would refuse to accept any other result. Of course, a losing candidate is not required to concede a loss, and the winning candidate wins, despite what the losing candidate says, or does. Trump, though, set about attempting to undermine public confidence in elections, which meant confidence in the entire process of political selection. That was profoundly undemocratic, profoundly subversive, and profoundly threatening to the continued existence of the United States as a democratic republic.

While still holding office, the “lame duck” president (one whose term had not yet ended, despite having lost in his efforts to achieve re-election), frantically sought to reverse the results of clear and fair elections. Trump and his henchmen brought numerous lawsuits attempting to use the legal system to achieve what he failed to do electorally: win the election. Time and again, these baseless lawsuits failed. Trump called repeatedly for violence, alleging that real Americans needed to “stop the steal.” Finally, Twitter and other social media banned him because of his flagrant lies, thus effectively shutting off the only way he knew how to communicate widely. Nor did he cease when he left office. As of late September, 2021, when this was being written, he still, nearly a year after the election was settled, continued to pressure some state election officials to reverse their certification of his loss. He seemed to harbor the deluded notion that he still might somehow be reinstated; an impossibility under the Constitution.

Ultimately, while he still had his platform, Trump urged his supporters¾fanatically committed, yet decidedly in the minority¾to march on the Capitol in Washington and “fight like hell,” to intimidate members of Congress and prevent them from counting the electoral votes, a process that had been set for January 6th. Thousands did so. They stormed the Capitol, threatening members, fighting with Capitol Police, and retreating only when the District of Columbia Metropolitan Police joined the battle with the threat of troops from National Guard Units. For the first time since the Civil War, America witnessed a violent insurrection, explicitly designed to reject the votes of the majority¾and even the electoral college¾and install the loser. That the coup failed does not minimize its threat to the country’s foundations. No democratic republic can survive as such if enough of its people seek to undermine it, and Trump did everything possible to undermine the very system that had installed him, a system that even ignored the majority’s vote, and installed him as a minority-vote president.

Right-wing extremists attempted another potentially violent demonstration on 18 September in Washington, D.C., but the effort failed, and was even anti-climactic; so few came that they were outnumbered by law enforcement officials.  The purpose of the demonstration was ostensibly to demonstrate support for the “patriots” who had been indicted for participating in the coup attempt in January. Trump, of course, expressed his support for the “political prisoners”—demonstrating how little he cares for the foundations of the United States as a democratic republic.

This was another in a long succession of Republican failures. It would seem as though Republicans might have to expect failure has a matter of course. Consider that Trump lost his re-election bid, and that the popular vote against him was enormous. Democrats retained control of the House, and gained control of the Senate. Consider also, the tragic record of Covid deaths when Trump was in office and his disclaimer of any responsibility for national health policy. At the state level, the same dynamics play out causing the huge death tolls in Florida, Texas, and other states where there are Republican governors and legislatures.  As a rule, there will be stubborn, ignorant, and vicious refusals to mandate protections against viral spread.

In 2021 alone, not only did the January insurrection and its September sequel fail, but so did the Republican effort to recall California’s governor, Gavin Newsom. There was a massive vote in the election on September 14 to retain Newsom as governor. In Arizona, there was a group of Republican state senators that forced a new “audit” of the 2020 vote in the state’s large Maricopa County. The effort was a fiasco, leading one of the Republican senators who had supported it to express his regrets, saying it made them look like idiots. Indeed.

Nevertheless, Republicans around the country thought the Arizonans had a good idea. In several other states, they announced plans to conducts their own “audits” of their states’ votes in 2020. In Pennsylvania, Republican state senators demanded complete information of all voters, including partial Social Security numbers. The state’s attorney general said “no.” In Texas, hours after Trump sent a letter to Governor Abbott demanding that Texas conduct its own audit of Democratic counties, the governor, of course, meekly ordered such “audits.” This, even though Trump had carried Texas, and could have gained absolutely nothing from such an effort.

The Arizona “auditors” had taken seriously the preposterous suspicion that Arizona ballots had been routed to, or corrupted by ballots from—of all places—China. Betraying their racism, they examined the ballots for “bamboo fibers,” assuming that anything from China had to contain bamboo, and apparently assuming that bamboo existed only in China. They found none.

They did, however, for some strange reason, take ballots out of the state, reportedly hiding them in an isolated location, hundreds of miles distant, in Montana. Regardless, after months of delay, on the 24th of September, they issued their final report.

Contrary to Republican beliefs, the voting machines had performed as intended. Moreover, their own report indicated that Trump did, indeed, lose legitimately. It said even that Trump’s loss, in fact, was somewhat greater than the official count had shown.

In the serious insurrection attempt on the 6th of January, not only had the Trump-inspired seditionists sought Democratic Speaker Pelosi to assassinate, but they had set up a gallows on the Capitol lawn, and chanted their desire to find and hang even Republican Vice President Pence. His offense was that he had not followed Trump’s demand to steal electoral votes and thus overturn the recent election. Happily, their thirst for vengeance remained unslaked.

Immediately after the riot, even Republicans, still frightened and in shock, condemned the insurrection. A number even blamed Trump, himself, for his obvious instigating role¾remember his shouted urging of the mob to march on the Capitol and “fight like hell.” Within a few days, though, most Republicans denied that they had ever been in danger, that anyone else had, and that there had even been an insurrection. This after the entire world had seen the violent assault on the Capitol and its police guard. Rather, there had been merely a “peaceful tourist” assembly in the (vandalized) Capitol building, some said absurdly.

These acts of malfeasance and many other Republican actions of the last few decades, would have been sufficient throughout American history to bring down administrations, and to destroy political careers. So degraded has the party become, however, and so outrageous were Trump’s actions, that no revelation, and no verification, seems sufficient any longer to shame Republicans. They readily deny painfully obvious facts, or even to recognize them, but to say, “so what”?

The Trumpist Republican Party now has thrown all pretense of “conservatism” aside, along with any attempt to be consistent. Actions a Democrat does, however benign, they will condemn; the same action, or even a violent and treasonous one, by a Republican¾especially Trump¾they will applaud. The frenzied, out of control, insurrection had put all members of Congress in danger, even Republicans. Still, though, they closed their eyes (and minds) to reality.

The Party, as indicated, no longer even pretends to devote itself to conservatism. An examination of Republican policies demonstrates that the party now operates in pursuit of a few basic principles, most of which simply are cynical efforts to please their “base;” some examples are:

The GOP opposes all measures to regulate or reduce the proliferation of firearms. When a mass murder takes place, as one does frequently, they are likely to say, “now is not the time to politicize the issue.” Instead of policy, they rely on “thoughts and prayers” for the victims. They were never content to rely on “thoughts and prayers” to keep out of the country those they opposed; rather they sought a huge, expensive, and futile wall.

The party seeks to eliminate all abortion. Republicans often are equally hostile to contraception. Thus, despite professing to favor limited government, and “freedom,” they would empower government to take full control of all women, or girls of childbearing age. Ultimately, this presupposes required regular medical exams to ascertain whether or not they are pregnant. Republicans ignore the fact that a government has to be powerful to forbid abortion, and that a government sufficiently powerful to forbid abortion will also be powerful enough to require it, or if they so choose, to require pregnancies. The result of an effective prohibition of abortion is the enslavement of women, subjecting them to government dictates regarding their own bodies. Quite clearly, the motivating factor is misogyny. The Texas approach that other authoritarian states are admiring is to empower citizens to spy on one another, and to reward them if they follow the demands of the state. A police state is just around the corner, if the anti-abortion fundamentalists continue to have their way.

The party elevates a warped version of “religious freedom,” to overwhelm personal privacy. It seeks to ensure “religious freedom” for corporations to regulate the conduct of their employees. All this presupposes that the religion in question is one that possesses official approval. The party actually has two components: one that consists of Christian fundamental evangelicals, and the other that is relatively secular. The former openly seeks a theocracy that is rigidly authoritarian¾even totalitarian. The latter would be content with a secular dictatorship that maintains them in power, but it cooperates gleefully with the religious fanatics. The two groups use one another for the purpose of securing and maintaining power. The characteristics of the resulting government otherwise are of less concern to them.

Republicans seek to have a minimum of immigration, and no influx of refugees.

They favor opinion over fact, and deny the role of scientific findings in public policy, even in the face of mass death from a pandemic.

There is little indication that the party actually cares about the substance of these issues. Republican leaders seek solely to secure and maintain the support of their hard core voters. What gets serious and sincere Republican attention, is an effort to subvert majority will. Republicans generally recognize that their actual policies have no broad public appeal. Instead of pursuing support, however, they seek to diminish, or even to eliminate, votes that would turn them out of office. At the same time, they attempt to hide their real intentions. As they make it more and more difficult to vote, they lie in state after state that they are making it easier to vote, merely making it harder to commit fraud (which they know is virtually nonexistent in modern America).

Republicans go to extreme efforts to draw district boundaries so that they maintain power, regardless of their minority status. They also make voting as difficult as possible in areas in which they have less than majority support. These usually are districts with voters who reflect the interests of people of color. This has led to the greatest suppression of votes since post Reconstruction days when Jim Crow policies became solidified.

Worst of all, Republicans have succeeded in controlling governments in numerous states. There, they are adopting measures designed to empower them to overturn the results of elections when they dislike the outcomes. They are avidly developing mechanisms to permit them to disregard and overrule the will of the voters. At the same time, they charge “liberals” with being “elitists.” The clear Republican intent here is to make it impossible for them to lose elections, regardless of how large Democratic majorities may be. In other words, they are openly plotting to end even the possibility of rule by the people.

This, then, is the relationship between Trump and the Republican Party. The Party reflects his will, and supports his whims. Regardless, it is not the case that he corrupted the Party. Rather, the corruption was endemic, and of long duration; it prepared the party for one such as Trump. Sadly for the country, and the world, such a person was available, and eager to fill the pernicious role that the Republican Party had been crafting for him.

No one can say with certainty what ultimately will happen. One thing, though, is certain. Things as they currently exist cannot continue. No democratic republic based on a two-party system can long survive if one of its major parties refuses to honor and abide by accepted principles of restraint, popular government, and peaceful changes of political power. The current court system has been systematically corrupted by stolen seats, and decades of ideological appointments by right-wing Republicans. The Senate retains its archaic rules that permit the minority to thwart majority rule.

Thus, there are two major reforms needed urgently. The Senate must change its procedures, including elimination of the filibuster, which empowers and encourages a minority to thwart the will of the majority. Also, the Supreme Court must be expanded by four seats, to enable it to counteract rulings protecting the extreme right.

Examples of such rulings are those protecting virtually unlimited financing of politics by the wealthy; those that sacrifice public health and create physical dangers by giving preference to a narrow and extreme version of “religious liberty”; yet others that permit states virtually to outlaw abortion, thus reducing women to the status of slaves, in what would seem to be a clear violation of the Thirteenth Amendment.  Ultimately, the worst of the rulings suggests that the Court accepts Republican measures to make it impossible for them to lose elections, regardless of what the majority of the voting population desires.

Finally, if the Republican Party does not truly cast off its current extremism and accept restraints on its conduct, it must fade from importance¾even existence¾and be replaced by another party that will conduct itself within democratic norms. As things stand, unless it reforms itself dramatically, either the Republican Party will vanish, or the United States as a democratic republic will do so.

[1] The Common Sense Manifesto (With a Nod to Thomas Paine, Not Karl Marx), Washington: Westphalia Press, 2020.

[2] See John A. Farrell, Richard Nixon: The Life,New York: Doubleday, 2017, quoted in Skidmore, Common Sense Manifesto, pp. 4-7.

[3] See Marcia and Thomas Mitchell, The Spy Who Tried to Stop a War, Sausalito, CA: PoliPoint Press, 2008; see also Skidmore, Common Sense Manifesto, p.25.