Monday, February 20, 2017


The newly installed Trump Administration continues to catch New Zealand officialdom by surprise. So MSC Newswire asked Washington insider Scot Faulkner what Wellington’s response should in fact be? Mr. Faulkner was elected the first Chief Administrative Officer of the U.S. House of Representatives. His reforms became a model for the operation of national parliaments around the world.
The New Zealand Foreign Ministry has set up a special focus group solely for the purpose of identifying early warning of new policies promulgated by President Trump, the ones which will have an impact on this country. Can you short circuit this by helpfully forecasting any of these pending surprise policies?
The New Zealand Foreign Ministry’s Trump Task Force will only be of value if it discards long held assumptions and embrace a totally new way of thinking and acting. Trying to predict Trump through traditional means, such as monitoring after-the-fact media, is like using Ouija boards, tarot cards, and horoscopes.
The Ministry’s primary objective should be to move at “Trump speed” and navigate in Trump’s world. Non traditional sources, non traditional methods will be keys to success. Thinking like a visionary risk-taking entrepreneur instead of a politician is the first step into this new reality.
Trump is unique. No one like him has ever been the President of the United States. While a few Presidents had business experience, their main credentials were either the military or government. America usually faced political or military crises. The 2007-2008 economic collapse convinced most Americans that something radical was necessary. So they rallied around a businessman who was known to most as a reality television star. As Trump stated, “everyone else has failed you – what do you have to lose? Try me.”
Trump’s unique background means unique thought patterns and processes. President Trump gets his ideas, news, and validation from places never before involved in governing. He is fearless, non linear. He embraces chaos, acts on intuition, moves quickly, and uses surprise as a strategic weapon. Sometimes only he knows the ultimate objective. He is a student of military history, especially Sun Tzu. That is what gave him the winning edge in business, the Republican primaries, and the 2016 general election.
Trump’s new Administration is already being tested by China, Russia, and a variety of other nations. President Trump’s responses will indicate many things: how fast he responds, how he responds, how he views the challenge and the challenger, how he frames the challenge within his existing world view, how willing is he to vary from stated positions to address a unique situation, how willing is he to escalate, whose advice does he value, who he collaborates with, and who, how, and what does he communicate regarding the challenge to Congress, the American public, and other nations.
New Zealand needs to understand that the next four to eight years has a very different global player. Trump’s approach will be very personal, intimate, intuitive, immediate, chaotic, and against all conventional wisdom, very successful.
All the indications are that the New Zealand diplomatic apparatus in New York and Washington was wrong footed by the Trump ascendancy. This led to falling in line with the Obama era last moment positioning of New Zealand as co-endorser of the UN anti-Israel resolution. Does New Zealand need to backtrack here?
New Zealand should always be wary of being pulled into American politics. Obama’s last minute swipe at Israel during his waning days as President should have been avoided at all costs. Obama’s behind the scenes orchestration of the resolution, which was being delayed until the new Administration, was ill-advised and dilatory. It undermined decades of America being a positive force in the region.
President Trump is a great friend of Israel. He and his team believe that, historically, enemies of America have funded the radical elements of the Palestinian cause.
Trump is committed, heart & soul, to destroying radical Islam and reining-in Iran. His priority is working with those nations that share his view. He sees Israel, and the moderate Arab governments, like Egypt and Jordan, as allies in eradicating ISIS, Hezbollah, Hamas, Al-Qaeda, the Taliban, and their regional and tribal affiliates throughout the Arab world, Asia, and Africa.
Trump and his foreign policy team fundamentally differ from the Neo-conservatives who surrounded President George W. Bush. They adhere more to the Reagan-Thatcher/John-Paul II approach of destroying tyranny, but not trying to second guess centuries of local custom through nation building. America’s role is to inspire, not intervene, in a nation’s journey toward a freer society.
Israeli settlements are far more complex than the media portrays. Palestinian contractors and workers build Israeli settlements. West Bank unemployment soars whenever Israel slows or suspends new settlements. The chasm between peaceful, free, and democratic Israel and violent, oppressive, Islamic failed states in the region is stark. Land for Peace has been a chimera for Israel. De-radicalizing Palestinian leaders and their movement would go further in creating lasting peace than continuing to place the onus on Israel.
The Anti-Israel Resolution validated Trump’s view that the United Nations is currently there to promote radical anti-Western policies while wasting vast sums of money. It further proves his wisdom of pursuing America’s interests through bilateral, not multilateral, arrangements.
New Zealand has supported in spirit the US-EU trade embargo against Russia called up by President Obama. Is there a defined timetable to conclude this embargo?
There is no defined timetable for ending or modifying the trade embargo against Russia.
President Trump and his inner circle have a non-ideological practical “America first” world view. It harkens back to the 17th/18th Centuries. During that era, Western nations united to stop the expansion of the Ottoman Empire then competed, sometimes violently, to dominate world trade.
President Trump wants to build relationships with Russia and China for ridding the world of rogue players – radical Islam, Iran, and North Korea. This is why he picked Rex Tillerson, who has strong relationships with Russia as his Secretary of State, and Iowa Governor Terry Branstad, who is friends with President Xi Jinping, as Ambassador to China. This is also why Trump picked a skilled fighter, James Mattis, as his Secretary of Defense.
Trump’s trade and business team is equally ready to help America win in world commerce. Wilbur Ross, Steve Mnuckin, and Robert Lighthizer will aggressively negotiate favorable trade agreements and rebuild U.S. competitiveness.
Russia remains problematic as its adventurism in Ukraine and intimidation of the Baltic States complicates Trump’s desire to be “frenemies”. Tillerson will be challenged to craft the right mix of incentives and punishments to refocus Russo-American relations. The current US-EU trade embargo will be assessed within this context.
The Transpacific Partnership Agreement signed in Auckland last year was No 1 on President Trump’s hit list. Looking at the longer term where do you see the advantages/disadvantages in this?
President Trump is all about building one-on-one personal relationships with world leaders. Bi-lateral relationships were his strong suit in business and will serve him well as President. They allow him more flexibility and agility. He has little interest in multi-lateral agreements or entities.
This is why TPP was in his cross hairs as a candidate and now as President. New Zealand and other TPP nations need to offer their best “value proposition” for trade relationships that will benefit the U.S. as much as themselves. These are the kinds of agreements that will get Trump’s attention and become his priority.
Trump prides himself on the foreign investments in America he has facilitated or promoted. He wants American companies to “come home” to America, and foreign companies to settle in America. Trump’s goal is to bring the best of the world to America to rebuild infrastructure and generate lasting employment opportunities. There is a new world of opportunity for New Zealand investment and partnering in America.
Given the available evidence it is hard not to conclude that officials here have only a threadbare understanding of what is going on in the relevant circles of United States policymaking. Where should they be looking? Who should they be talking to now?
Trump’s tweets remain the best original source. Trump won the nomination and the general election by going directly to the public. Over 50 million Americans follow Trump on Twitter and Facebook. The Washington-New York media have become completely irrelevant to the Trump Administration and to Trump’s America.
President Trump has revolutionized the way policy is created, promoted, and implemented. The establishments within the Federal Government, Congress, media, academia, and policy forums, still do not have a clue about what is happening before their eyes.
America’s post-Cold War drift through four failed Presidents has come to an end.
Reagan won the Cold War by using skills he developed in movies and television to command the world stage. Those skills destroyed the Soviet Empire, relaunched the U.S. economy, and redefined the role of government. Trump is using his business and reality television skills to command the world stage for himself and the United States. Like Reagan, Trump is seeking to defeat tyranny, in this case radical Islam, relaunch the U.S. economy, and not just redefine, but completely reinvent government. The establishment dismissed Reagan until he succeeded. The establishment is dismissing Trump, and will be just as embarrassed should he succeed.
Conservative talk radio speaks for Trump and puts his actions and tweets into context. They aggressively expose the liberal media and the Democrats when they promote fake news and conspiracies about Trump. Trump watches Fox news, listens & calls into conservative talk radio, and avidly follows their social media posts. Each validates the other. The most articulate and insightful conservative commentators are Rush Limbaugh, Mark Levine, and Chris Plante. Washington-based WMAL radio hosts all three.

Friday, January 13, 2017



Trump’s first news conference since the November election vividly displayed how he has turned the media world upside down.  His unprecedented campaign and transition points to an Administration committed to solidifying a media revolution that began decades ago.

The media, especially the 95 percent liberals within the media, are in free fall in audience and credibility.  A recent Associated Press survey reported that 96 percent of Americans no longer trust the “mainstream media”.  The media elite are still in denial that their world of unaccountable privilege and bias has vanished. 

How the media elite respond will determine whether anyone listens to them ever again.  The latest Buzzfeed/CNN promotion of false Trump trash is further evidence that the elite are on a different planet from the real world.

American media was “middle of the road” and patriotic until the mid-1960s.  At that time the older generation of media moguls retired or died, ushering in activist liberals.  Media liberalism became radical with the Vietnam War and Watergate.

Accuracy in Media (AIM) was founded in 1969 by Reed Irvine to expose this new liberal media bias.  AIM’s documentation remained within conservative circles until Vice President Spiro Agnew used their research in boldly partisan speeches during the 1970 elections.

Americans were held captive by three broadcast networks and Public Broadcasting until CSPAN cable television entered the scene in 1979.  Conservative Members in the House of Representatives used CSPAN to conduct guerrilla theater.  Using large photos, graphs, and models of Soviet Airplanes, House conservatives began to directly educate the public about big government and the Soviet threat.  It was the first breech of the liberal media filters.

In April 1980, two senior news editors, Arnaud De Borchgrave and Robert Moss, published “The Spike” a novel exposing communist influence within the American media.  As importantly, they exposed how the liberal media perverts reality as much by what they don’t cover as what they do - “spiking” stories.

The media revolution really began in 1987 when the Federal Communication Commission (FCC) eliminated the “Fairness Doctrine”.  For the first time since 1949 radio stations could feature editorial content in their normal programming.  On August 1, 1988, Rush Limbaugh launched his radio show.  Now all Americans had access to non-liberal perspectives. 

The liberal media fought back.  Talk radio hosts and news reporters were denied press credentials to cover Congress until the Republicans took over the House in January 1995.  Even credentialed, talk radio was shunned.  The liberal media elite branded it unprofessional and trafficking in conspiracy theories.

Starting in May 1995 (Netscape), the Internet devastated the liberal media citadels.  Website news began to supplant broadcast and print media.  Social media, along with internet access on mobile devices in 2004, ignited an historic information revolution. 

Conservative voices were unleashed by these upheavals.  Liberal media elites could no longer “spike” stories or present their bias unchallenged.  Even their own audience favored getting their news from social media and shows on Comedy Central.  The media establishment sped its own demise by succumbing to fake news from its reporters like Jayson Blair, and trafficking in false news like “hands-up don’t shoot’ and “a video caused the Benghazi attack”.

All the elements of a liberal media cataclysm were in place.  Trump’s blunt talk and his supporters’ contempt for the media brought the status quo crashing down.

Trump understands, more than any other politician today, that he can render the media irrelevant.    Pew Research and other studies show that 62% of Americans get all or part of their news from social media.  Facebook posts 510,000 comments and 136,000 photos per minute. 2.4 million emails are sent every second.  Fifty percent of Millennials check out Facebook when they first wake-up.

Trump does not need to have his message filtered and interpreted by Democrat operatives posing as journalists.  Chris Matthews and George Stephanopoulos were Democrat flacks long before they took on the trapping of journalists.  Dozens of reporters and “on air talent” are married to Obama Administration officials.  Trump’s response is to go over and around them.

Trump currently has over 50 million Facebook and Twitter followers.  Millions of Trump supporters repost or retweet his quotes on countless social media pages.  128 million Americans posted or liked Trump content on Facebook during the campaign.  No one has ever been so pervasive in communicating and mobilizing.

Trump is the master of this new media reality.  He understands that 140 characters on Twitter or a pithy comment or compelling image on Facebook shapes the media cycle.  This is all before he becomes President, with all its additional resources and reach.

Liberal media in the Trump era is fast becoming as credible and relevant as horoscopes. 

Thursday, January 12, 2017


[NOTE: The Martinsburg Journal, specifically reporter Jeff McCoy, covered this highly divisive issue fairly.  However, earlier this week, perhaps under pressure, McCoy was reassigned and this letter was never published.  Once again outside developers are undermining our community and civic culture. Here are some of McCoy’s articles for background:

Harpers Ferry is at war with itself.  Not since the Civil War has the community been so divided.

Neighbors no longer speak to each other.  Threats of physical violence spring up on social media.  Public hearings degenerate into tears and shouting.  Armed police keep order at meetings.  Petitions and counter petitions circulate.  One lawsuit is now before the West Virginia Supreme Court of Appeals.  An injunction has just been filed in the Circuit Court.

What is going on?

Harpers Ferry is at a crossroads. Harpers Ferry is consistently listed as one of the most historic and scenic small towns in America.  Over 300,000 tourists, and numerous movie production companies, bring revenue to the town every year.  Even with this success, the area is missing a core element that symbolized it as a tourist mecca for decades.

The Hilltop House Hotel was a defining presence in Harpers Ferry since Thomas S. Lovett, an African American businessman and hotelier, constructed the hotel in 1888. The Hotel’s breathtaking views, great food, and service became a magnet for America’s elite. It was the Presidential summer retreat before Camp David. Alexander Graham Bell, Mark Twain, Carl Sandburg, and Pearl S. Buck were among the notables who stayed at the Hotel. In 1946, Hilltop House hosted the preliminary meetings which led the establishment of UNESCO.

Those glory days are long gone.  A series of owners let the Hotel deteriorate until it became a decrepit reflection of its storied past.  In 2007, SWaN Investors purchased the hotel and its adjoining properties, promising to restore the facility. 

What has happened since SWaN’s arrival depends on one’s perspective.  Is SWaN a savior or a nefarious “Harold Hill” preying on citizens’ naiveté turning the “Music Man” plot into a horror story?

Harpers Ferry’s historic district is protected by layers of town ordinances complying with West Virginia Law and guidelines from the National Trust for Historic Preservation and the President’s Advisory Council on Historic Preservation.  This regulatory environment is intended to maintain the architectural integrity. Townspeople must submit detailed forms and drawings, sometime waiting up to two years to alter a rain gutter or doorway. 

Larger projects, and new construction, must fit into Harpers Ferry’s comprehensive plan.  For projects not fitting, the town has the ability to issue a “Conditional Use Permit” that grants specific waivers in the face of a compelling community interest.

This is where the current civil war began.  SWaN refused to follow the town’s ordinances. SWaN refused to go through the Conditional Use Permit process.  SWaN demanded that a new “overlay district” be created, providing them the flexibility to do build what they wanted as big as they wanted. 

Town officials, desperate for a new Hilltop House complex, bent to SWaN’s every whim.  Local citizens raised concerns: will SWaN actually build a hotel or flip the property to a buyer who could build a casino, luxury condos, or something else on the site?  SWaN did little to calm the fears, requesting that requirements for a business plan, and even the requirement for a hotel, be stripped from the draft overlay ordinance.

Town officials went further.  Instead of asking SWaN for proffers, town officials promised SWaN public resources like expanded water and free police protection.  The town has not issued citations for the eighty police incidents on derelict SWaN properties, while townspeople are cited for unmowed lawns.

This unequal treatment has raised concerns that something else is going on.  It is public record that SWaN’s owners have wined and dined town officials.  Rumors swirl of other favors or pay-offs.  Private meetings occur with SWaN.  Townspeople’s public comments are limited to 2-3 minutes while SWaN representatives are given unlimited time.

As the Harpers Ferry’s civil war begins its ninth year many wheels are turning.  2017 may see prosecutions over town finances, court rulings to enforce the rule of law, a voter revolt against the town government, and SWaN leaving.  SWaN’s supporters, which include the town’s elected officials, are hoping the new year brings them victory with the sounds of dynamite blowing-up the overlay district, clearing the way for a 450 car underground parking ramp, and a massive building project.

[Scot Faulkner has been a resident of the Harpers Ferry area since 1987].

Wednesday, December 28, 2016


Revolutionary change is waging war on the status quo.  It is about victory in the initial assault and winning heart and minds to institutionalize the new order.

Throughout history, military geniuses have articulated the philosophy of victory.  Their proven approaches to winning resonate through the ages and beyond the battlefield.  They can guide Trump’s “commanders” as they take to the field.

Sun Tzu’s “Art of War” is the most timeless of guides for those battling in military, political, or business environments. 

Trump has already mastered one of Sun Tzu’s maxims: “As the voice cannot be heard in battle, drums and bells are used.  As troops cannot see each other clearly in battle, flags and banners are used.”  Through social media, and turns of phrase, Trump has sent out vivid signals of what is to come and what must be done.  As President, Trump will need to continue his messaging to keep his troops focused on the outcomes most important to Making America Great Again.  He is implementing the most ancient of rules in the most cutting edge ways.

Sun Tzu also explained, “Thus a victorious army wins its victories before seeking battle”.  Preparation is everything.  That is what Trump and his Transition are doing.  January 20, 2017 is a day for celebration, but also a day for action.  Trump can do what Reagan famously did – delay the post-swearing-in Congressional Luncheon to sign Executive Orders.  Given the volume of Executive Orders needed to end the Obama era and begin the Trump era, the most newsworthy ones could be signed in the Capitol, leaving others to be signed at the White House between the parade and the balls. 

General Ulysses S. Grant and Rear Admiral David Dixon Porter showed the world that the best way to achieve victory was overwhelming your opponent. On April 16, 1863, Porter’s naval fleet ran the gauntlet of Confederate guns along the Vicksburg bluff. Risking the entire Union Fleet on the Mississippi River in one bold act assured victory.  Confederate batteries could not fire fast enough to hit every vessel.  The speed and surprise of the flotilla rendered the enemy ineffective. 

President Trump must move swiftly and broadly to change Washington.  One reform or one piece of legislation at a time gives the forces of the status quo time to mount an effective opposition.  The so-called mainstream media can only report so many stories a day.  Democrats in Congress can only make so many speeches a day. Trump must strike fast and hard and overwhelm the Establishment. 

General Douglas McArthur, and Admirals Chester W. Nimitz and Bill “Bull” Halsey Jr., proved that you do not have to fight every enemy confronting you.  They won World War II in the Pacific by leap frogging Japanese strongholds, isolating them and letting them whither through lack of supplies. 

President Trump should be inspired by how America won the Pacific War.  The Executive Branch is vast.  Many have likened previous reform and budget cutting efforts to “attacking Antarctica with an ice pick”.  Trump and his team need to find key “islands” to assault and leave protected “sacred cows” or programs and personnel to wither.

On August 5, 1864, Rear Admiral David G. Farragut led the Union fleet in attacking and ultimately capturing the key Southern port of Mobile, Alabama.  The Confederates attempted to divert and disperse the Union fleet by launching small torpedo boats into his fleet.  Farragut famously ordered his commanders to “damn the torpedoes, full speed ahead!”  The timeless rule is to not let intermittent issues get in the way of your primary mission.

Trump’s Administration will confront bureaucratic “torpedoes” from the first day onwards.  The most effective way government agencies and programs survive change is to draw incoming political appointees into longstanding tactical squabbles over turf, resources, and ego. 

The career establishment prays that newly confirmed Presidential Appointees will plunge into tactical morasses.  Once pulled in, the original mission is lost.  Valuable political capital, and revolutionary zeal, vanishes before the new Administration realizes it. 

President-Elect Donald Trump values military prowess in his appointments.  These military best practices will also be valued as he changes Washington, DC.

Friday, November 25, 2016


President-Elect Trump can revolutionize governing as he revolutionized campaigning.

Trump is uniquely positioned as the first nonmilitary, nongovernment, person to ever be elected President.  His mandate for change will overwhelm those wanting an ever expanding and dysfunctional government to prevail. 

The Washington Establishment defends the status quo by asserting: “we have always done it this way”; “you can never run government like a business”; “we are unique”; “we have already cut what can be cut”, and “cutting anything will harm Americans”.

Trump is already doing things his way, breaking new ground as he goes.  The media and the Establishment were against Trump since he announced his candidacy and were consistently wrong about everything relating to Trump and the 2016 elections.  They are now foolishly attempting to second guess Trump, hold him to some arbitrary transition schedule, and giving him unsolicited advice.

These unrelenting, but always wrong, voices ignore that President-Elect Ronald Reagan named his core cabinet on or after December 10, 1980, thirty-six days past his landslide election.  They also refuse to mention that none of Trump’s appointments can be confirmed until the new 115th Congress convenes on January 3, 2017. The first Senate confirmation hearings cannot take place until that first day of the new Congress.  Trump can take his time and get things right from the start.

Trump is crafting his own way of governing.  His only requirement is to seamlessly transition to power.  Think of a relay race where one runner is completing their segment while the other is beginning theirs.  Ideally, both runners achieve stride for stride coordination until one passes the baton to the other.  America’s civic culture is tested and proven strong every time this peaceful hand-off occurs between opposing parties.

Once the “baton is in hand” President Trump will end the Obama era.  Ronald Reagan took time, immediately after his Inaugural Address, to sign Executive Orders ending the Carter era. Trump should move this decisively.

Realigning and mobilizing the Executive Branch to achieve his top priorities will be the first test of Trump’s ability to lead. 

Trump must instill a “sense of urgency”. November 8 was a massive Taser blast to the heart of the Washington Establishment.  They remain stunned, dazed, and confused.  Trump must move swiftly to achieve his goals before the Establishment awakes. 

Revolution’s worst enemy is delay.  Trump is an intuitive thinker and doer. He must act aggressively on his instincts and not let over analysis paralyze his cause.

The federal government is ridiculously huge.  Its size and growth are unnecessary.  In its first 129 years, America became a world power, the leader in technology innovation, and an industrial juggernaut, with only six Cabinet Departments.  All Cabinet Departments, except Treasury, fit into the Old Executive Office Building until World War I.  The door knobs in the building still display the Departmental seals.

Rethinking the role of government can be Trump’s greatest contribution to America.  Private initiative makes America great, so government should only exist when an overwhelmingly compelling case can be made.  Even then, incentives and sanctions through regulation, taxes, or fees, should be exhausted before a new government program is created.  Except for Coolidge and Reagan to varying degrees, no incoming President has ever conducted such a fundamental review.

Much of what sent America over the fiscal cliff were the actions of President Lyndon Baines Johnson in the 1960s. LBJ cynically established the modern welfare state to entrap large swathes of the electorate in an ever expanding federal leviathan. LBJ’s “great society” programs drove millions into voting for Democrats and drove America trillions into debt.

Trump knows government growth can be reversed. Personnel and costs can be dramatically cut.  Agencies can be abolished, like the Civil Aeronautics Board.

Under President Reagan, the General Services Administration invoked a hiring freeze and radical reorganization that reduced employment from 34,000 to 12,000 in three years.  Costs plummeted while the quality and responsiveness of services skyrocketed.  Under Speaker Gingrich, all non-parliamentary and non-security operations were consolidated within a new Chief Administrative Officer. Aggressive outsourcing and business based operations cut employment in half.  Once again, costs plummeted while quality and responsiveness of services skyrocketed.

As President Trump reshapes the Federal Government he needs to take to heart the immortal words of two of America’s most successful Presidents.  Calvin Coolidge directed his appointees to “Trim wherever you can”.  Ronald Reagan had a sign on his desk that inspired his team, “It CAN be done".

Tuesday, November 22, 2016



Obamacare causes 8,000 deaths per year, because of penalties it puts on hospitals The penalties started in October 2012. Death rates from heart failure have risen ever since, because hospital treatment for heart failure has fallen.

Obamacare fines hospitals when they treat Medicare patients for heart failure, if the patients need another hospital stay within a month. Hospitals need to avoid the fines, so now they treat 20,000 fewer patients for heart failure, compared to four years ago, before the penalties.

Do patients survive the loss of treatment?

No. CDC says death rates from heart failure rose after 2012, though these deaths had fallen every year from 2000 to 2012. Higher death rates in 2013 and 2014 mean 7,200 and 9,600 more people died from heart failure in these years than would have died if the 2012 death rate had continued.

The term "heart failure" is also called "congestive heart failure" or cardiomyopathy. It refers to weak pumping because of muscle deterioration, stiffness, leaking valves, etc. It is not the same as a heart attack or heart stopping. It is a major cause of death in the US.

These are the latest national figures, but five earlier studies from 2010-2014 also showed that hospitals which had fewer re-hospitalizations had more deaths, especially among heart failure patients.

Medicare said in August 2012, "We are committed to monitoring the measures and assessing unintended consequences over time, such as the inappropriate shifting of care, increased patient morbidity and mortality, and other negative unintended consequences for patients." They have not reported any of these monitoring results in 4 years.

Re-hospitalization penalties give hospitals an incentive to treat fewer seniors. Medicare even gives hospitals an online tool to predict re-hospitalization risk for each potential patient.

Hospitals can avoid penalties by any mix of the following:
·         Avoid admitting the sickest Medicare patients with heart failure ("There's not much we can do for you. Treatments are risky. You're better off at home.")
·         Treat as many as possible of the least sick outside of hospitals
·         Improve subsequent care for those admitted, to reduce re-hospitalizations
It is easier to give less care than to improve it, though hospitals certainly are doing both. And the result we see is that death rates have started to rise.

The figures here count hospital admissions in July 2008-June 2011, compared to July 2012-June 2015. These are the oldest and newest comparable data available. Medicare released the older data in a comparable form in May 2013.

Re-hospitalization penalties are large. Hospitals get $6,000 for treating a Medicare heart failure patient, but pay a $27,000 penalty for each re-hospitalization within 30 days, above the national average rate. So every hospital tries to be below the average, driving the average down and the risk of penalties up every year. There are also minimal adjustments for the mix of patients each hospital serves.

Penalties total $71 million this year, down from $76 million last year, because hospitals treat fewer Medicare patients for heart failure. The only way hospitals as a group can reduce their penalties is by treating fewer patients. And they do.

The penalties apply to patients treated under Medicare Part B. Hospitals which face the re-hospitalization penalties now admit 5% fewer Part B patients for heart failure than four years ago, even though the total number of seniors covered by Part B increased 12% in the same period.

There are also penalties for re-hospitalizing patients after coronary bypasses. The penalty is $188,000 for each one above the national average rate; penalties began October 2017. Penalties after elective hip and knee replacements are $239,000 and began October 2014. The penalty calculations are written into Obamacare. It is too early to see if the number of people treated has fallen, but the American College of Surgeons warned Medicare that treatment would be cut: "the potential that these hospitals will decrease their care for such patients, thereby creating an access issue."

One state is exempt from the penalties: Maryland, where Medicare has its headquarters, and where many of its retirees live.

Medicare penalizes all unplanned re-hospitalizations, even if they are unrelated to the original care. The law only lets Medicare penalize readmissions related to the initial care, but Medicare found that law, "difficult to implement." So they decided not to follow the law. Obeying the law would help, but penalties would still discourage treatment of frail seniors, who have above-average risks. The law and the penalties themselves are wrong.

In 67 metro areas, Medicare has a second way to discourage hip and knee replacements, especially for the frailest patients who may need them most: hospitals must pay nearly all medical expenses for 90 days after treatment, though they have almost no control over these costs. After coronary bypasses next year, hospitals will similarly have to pay for 90 days of costs. Fewer hip and knee replacements and coronary bypasses, when Medicare patients need them, condemn seniors to reduced activity and faster decline.

Medicare and Social Security do save money when patients die sooner, but that is not how the country wants to save money. 

Monday, November 14, 2016


The Washington Establishment is betting on Trump faltering.  Trump can triumph by not letting any of them subvert from within.

The well proven maxim, people equals policy, should be Trump’s driving force.  Trump can gain inspiration and insight from Reagan’s earlier victory over the Establishment.  These lessons can assure Trump’s tenure achieves historic change.

The Reagan Revolution almost did not occur because the Republican Establishment did everything it could to co-opt it.  Reagan’s transition planning team was hijacked by technocrats who had no understanding or desire for revolution.  Legions of moderate Republicans, who fought Goldwater in the 1960s and Reagan in the 1970s, poured into Reagan’s transition teams in the weeks following the 1980 election.  Former Ford appointees, derisively called “retreads”, filled the short lists for government executive positions.

It took the aggressive intervention of Reagan’s Kitchen Cabinet to clean house and get his revolution back on track.  Reagan’s closest friends, including Joe Coors and Bill Wilson, arrived in Washington, DC in early December 1980 and personally took charge of the transition.  Their clarity of purpose and unwavering devotion to Reagan and his agenda, assured that Americans got the change they so clearly wanted.

President-Elect Trump has not waited until early December.  Trump’s Veterans’ Day Transition realignment was bold and effective. His top associates, family members, and key operatives are now the rocket boosters to propel the Trump Administration into a sustainable orbit.

There is one advantage that Trump in 2016 has over Reagan in 1980 - the Washington Republican Establishment openly and vehemently opposed Trump throughout his campaign.  The usual post-nomination unity was hindered by the “never Trump” forces.  Many anti-Trump Republicans openly boasted about voting against him in countless social media posts on Election Day. 

This disloyalty and outright sabotage must be remembered.  It clears the field for new blood to serve Trump.  It is far easier to “drain the swamp” when the K Street crocodiles have exposed themselves. 

Those who knifed Trump in the back are waiting for the day he “comes to his senses” and sells out his “Deplorables”.  Many observers are smugly musing that Trump will have to scale back his revolution and make peace with the Establishment.  Otherwise, they declare, Trump will not have enough capable people to run the Executive Branch. 

Trump can once again prove his detractors fools.  The private sector has a vast array of corporate change agents. These top executives have successfully run enterprises larger than most federal agencies.  Those who profitably navigated the post-2008 economic collapse are “battle” seasoned and proven innovators.  Those who remained profitable in the face of global competition have mastered the upheavals of the 21st Century.  Many will heed Trump’s call to join his crusade to Make America Great Again.

Trump can tap Republican governors who have turned around the governments and economies of their states.  Their dramatic successes have earned them re-election or assured a Republican succeeded them.

The Republican governors were successful because they unflinchingly fulfilled their campaign pledges, and kept their focus on bettering the economic wellbeing of their citizens. They were also successful because they hired highly effective lieutenants to run their state agencies.   These successful change agents bring a record of vanquishing public sector inertia.  They can be paired with private sector leaders to become an unbeatable team for “Trumping” the Federal Government.

Many rallied to Trump within weeks of his announcing his candidacy.  These included policy experts and strategic thinkers who helped in the Reagan and Gingrich revolutions.  Reagan alumni stood firm with Trump by courageously endorsing him while enduring ostracism from the Washington “powers that be”.  Hundreds of retired military and national security leaders, many of whom helped win the Cold War, stepped forward to offer Trump timely and critical support.

Trump’s “Deplorables” are counting on him winning for them and America.