On Doing No Harm

There’s the Hippocratic Oath – a promise to act ethically. Swearing to some sort of modified form of this oath is a rite of passage for new physicians, although this oath has little to do with medicine itself. This has to do with medical ethics, with doing one’s best and medical confidentiality and all sorts of things, but everyone knows what comes first – “First, do no harm.”

New physicians need to remember that. Given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good. Don’t try something new and unusual, just to see what happens. Enthusiasm kills. Enthusiasm also leads to malpractice suits. Do good things, wonderful things, but first, do no harm.

Politicians should take this oath too. Political power is seductive. Republicans now have the House and Senate and the White House all to themselves, to do whatever they want to do, but they are learning, the hard way, that enthusiasm kills. No one told them that the first order of business was to do no harm, and now they’re paying the price. The Wall Street Journal’s Kristina Peterson and Stephanie Armour report that Republicans have given up on doing anything important in 2018:

Instead, Republican lawmakers are likely to embrace a slimmed-down agenda focused on the basics, including funding the government, raising the government debt limit and striking a deal on immigration, according to GOP lawmakers and aides…

At risk of losing one or both chambers in November, Republicans say they want to avoid controversy over policies that stand little chance of passing the Senate, where most bills need 60 votes to clear procedural hurdles. Voters are especially wary of plans to overhaul safety-net programs, which polls show remain highly popular. Republicans say they are confident the surging economy will help their electoral prospects.

They’re going to hunker down and do no harm, because they know that that enthusiasm, for overhauling the safety-net programs, for handing off Medicaid to the states, where it will die, for turning Medicare into a voucher program and phasing it out, for privatizing Social Security so it finally folds, kills. That would kill them, and Kevin Drum adds this:

Republicans almost literally have no policy positions these days that are popular. Repealing Obamacare polled poorly. Their tax bill is widely detested. No one wants to touch Social Security or Medicare even in a symbolic vote.

The only popular proposal on President Trump’s plate is his trillion-dollar infrastructure project, but Republicans in Congress aren’t interested. So that leaves two things: (a) immigration and (b) avoiding disaster.

Drum sees the irony here:

The weird thing is that a comprehensive immigration deal is actually possible. The Senate could pass one pretty easily, and if Trump then bragged that it was the greatest, toughest, most America-Firstest immigration plan ever, his base would support it and the House would probably pass it. You know, sort of a Nixon-goes-to-China thing. And it would give Republicans another big win going into the 2018 midterms.

Would Democrats buy in? Beats me. But it probably doesn’t matter since there’s no one in the Republican Party these days likely to lead the charge. Marco Rubio won’t do it again. Mitch McConnell has little interest. Trump is clueless and can’t lead anything.

So I guess keeping the government open and paying its bills is all we’re going to get this year. Given the most likely alternatives, I can live with that.

Drum can live with that, and no one dies – neither those in need of the social safety net (literally) nor (figuratively) any Republican politician. It may be better not to do something, or even to do nothing, than to risk causing more harm than good – no one dies.

Republicans are learning that, the hard way, but Donald Trump will never learn that. He doesn’t believe that. He is a man of immense and impulsive enthusiasms, delivered in short provocative tweets that often do cause immense harm. America’s allies are often aghast. Does this man want to start a nuclear war? His own staff despairs. They have to explain that he didn’t really mean what he just tweeted – but that only makes him angry. Then his staff says that this or that tweet was actually brilliant, if you look at it a certain way. Others see the actual harm.

He doesn’t. He doesn’t because his base loves that sort of thing, and they got him elected – but everyone else thinks he’s nuts, or at the very least, dangerous. They seem to maintain that the job of the president is kind of like any doctor’s job – first do no harm. That notion seems to puzzle Donald Trump. He’s enthusiastic. So what? His enthusiasm made him president.

Donald Trump wouldn’t make a good doctor. His patients would die, and the Washington Post’s Philip Rucker and Ashley Parker report on how the White House is handling this:

The White House is struggling to contain the national discussion about President Trump’s mental acuity and fitness for the job, which has overshadowed the administration’s agenda for the past week.

Trump publicly waded into the debate spawned by a new book, “Fire and Fury” – Michael Wolff’s inside account of the presidency – over the weekend by claiming on Twitter that he is “like, really smart” and “a very stable genius.” In doing so, the president underscored his administration’s response strategy – by being forceful and combative – while also undermining it by gleefully entering a debate his aides have tried to avoid.

And still, Trump sees no harm:

Trump privately resents the now-regular chatter on cable television news shows about his mental health and views the issue as “an invented fact” and “a joke,” much like the Russia probe, according to one person who recently discussed it with him.

Okay, go with that:

So far, Trump’s advisers have adopted a posture of umbrage and indignation. Rather than dignifying questions about whether their 71-year-old boss is fit to be president, they attack the inquisitors for having the gall to ask.

In an emailed statement Monday, White House press secretary Sarah Huckabee Sanders slammed what she called “ridiculous reports from detractors” and described an “outpouring of support from a totally indignant staff.”

But that won’t do:

Some Trump allies voiced frustration that the White House does not appear to have implemented a full-scale crisis communications plan.

“When you raise an issue like the mental acuity of the president, there is no organized effort to push back,” said one ally, who spoke on the condition of anonymity to talk candidly. “How do you disprove a fallacy?”

Kevin Drum has an answer to that:

Actually, fallacies are disproven all the time. That’s why they’re called fallacies in the first place. In this case, it would be easy to disprove that Trump is a moron, and in a spirit of bipartisan magnanimity I’m going to reveal how to do it free of charge…

Have Trump give a live TV interview in which he addresses policy issues in depth and shows that he has actual, demonstrable knowledge of a variety of topics. Points will be deducted for every meandering mention of (a) Hillary Clinton, (b) fake news, (c) his record-breaking election victory, (d) the FBI, (e) the unfairness of the Russia investigation, (f) his IQ, (g) collusion between Democrats and Russia, (h) how he personally turned around the economy, or anything else that’s so off-topic it’s not even in left field.

A bright high school senior could do this, so the bar is set pretty low. You don’t need a full-scale crisis communications plan. This is all it would take.

That’s not a bad idea. In fact, as Ashley Parker and Philip Rucker (again) report, the White House actually tried that:

He acted the part, listening intently and guiding the conversation with the control of a firm but open-minded executive. He spoke the part, offering a mix of jesting bon mots and high-minded appeals for bipartisanship. And he looked the part, down to the embroidered “45” on his starched white shirt cuff.

In short, President Trump on Tuesday tried to show that he could do his job.

The results were mixed:

With his afternoon immigration meeting with lawmakers – into which he invited the press corps to watch for nearly an hour – Trump sought to definitively answer the question that has been nagging at him for the past week: Is the 71-year-old mentally fit to be commander in chief?

And for the 55 minutes that the scene unfolded on television, the president demonstrated stability, although not necessarily capability. In trying to erase one set of queries (is he up for the job and a “very stable genius,” as he claimed on Twitter), he inadvertently opened another: What, exactly, is going to be in that immigration bill?

In the end, no one knew:

The former reality television star made the unilateral decision to allow journalists toting cameras and audio recorders into the West Wing’s Cabinet Room to watch him talk with lawmakers about one of the most in­trac­table and polarizing issues facing the government – what to do with the nearly 700,000 young undocumented immigrants known as “dreamers.” Their work permits are set to expire March 5 because of Trump’s decision to revoke President Barack Obama’s Deferred Action for Childhood Arrivals, or DACA, program.

And while Trump offered captivating television drama, he also muddled through the policy by seeming to endorse divergent positions, including simply protecting the dreamers or a plan contingent upon funding for his long-promised wall at the nation’s southern border.

He wanted to sound reasonable but ended up sounding disengaged:

“I think my positions are going to be what the people in this room come up with,” Trump said. “I am very much reliant on the people in this room.”

So pliant was Trump that when Sen. Dianne Feinstein (D-Calif.), one of the most liberal members of the chamber, asked if he would support “a clean DACA bill” that protects the dreamers with no other conditions, the president sounded amenable.

“Yeah, I would like to do it,” Trump said.

Oops:

Trump’s apparent concession so alarmed House Majority Leader Kevin McCarthy (R-Calif.) that he interjected himself, although he was careful only to gently contradict the president, who in the past has referred to him as “my Kevin.”

“Mr. President, you need to be clear, though,” McCarthy said, leaning over from his perch to Trump’s left. “I think what Senator Feinstein is asking here – when we talk about just DACA, we don’t want to be back here two years later. You have to have security.”

Later, again attempting to nudge the president back on track to a more conservative plan, Sen. David Perdue (R-Ga.) made a similar pitch for precision. “We have to be very clear, though,” Perdue urged.

It seems that Donald Trump’s immense and impulsive enthusiasm is a problem for everyone:

Later, when Trump offered a clarification – “We do a Phase 1, which is DACA and security, and we do Phase 2, which is comprehensive immigration” – a relieved-looking McCarthy all but leaped from his seat, pointing at Trump like a teacher whose promising student, after several false starts, finally has alighted on the correct answer.

Yet the president’s plans were so nebulous that as the confab wrapped up, Sen. Mazie Hirono (D-Hawaii) was still pressing for more specifics. “You want $18 billion for a wall, or else there will be no DACA. Is that still your position?” she asked. “And can you tell us how many miles of wall you’re contemplating? Whether it’s $17 million or $13 million or whatever is – can you tell us?”

Trump then said he was flexible. The details didn’t matter. Everyone else in the room could work out the details. He’d sign into law whatever they came up with, which he seemed to think would make him a “winner” or something, but the whole thing was a bit strange:

Trump staged the meeting as a showcase of his desire to cut a deal with Democrats. He cast himself as a bipartisan statesman, saying he’d had a similar gathering the previous week with only Republican lawmakers and was eager to add Democrats to the mix.

Originally, there was no plan for a photo opportunity, let alone a 55-minute one, a White House official said. Trump’s daily schedule listed the meeting as “closed press.” The lawmakers also were not expecting any media coverage.

Trump sat at the table’s center, between two Democratic leaders who have been outspoken advocates for the dreamers – Senate Minority Whip Richard J. Durbin (Ill.) and House Minority Whip Steny H. Hoyer (Md.) – and set the tone at the outset by calling for “a bill of love.”

That was a bad choice of words, sixties hippie-words:

The president’s bipartisan bonhomie sparked immediate backlash on the political right. On Breitbart News, a conservative website that positions itself as the mouthpiece of Trump’s base, coverage of the meeting featured a photo of Trump reaching out to high-five Jeb Bush – the former Florida governor who has been pilloried by the party’s grass roots, as well as by Trump, for his support of immigration reform – under a headline that blared “amnesty.”

Kevin Drum was right that this sort of event would reveal all:

Lawmakers left the meeting encouraged if confounded.

“This was the most fascinating meeting I’ve been involved with in 20-plus years in politics,” Sen. Lindsey O. Graham (R-S.C.) said in a statement.

Before leaving the White House, Durbin told reporters he had enjoyed a “unique meeting” in a “positive sense.”

“My head is spinning,” the Democrat said.

But this was no more than another Trump reality show:

During the meeting, Trump repeatedly broke the fourth wall to address the fourth estate, acknowledging his real audience beyond the members of Congress.

“I like opening it up to the media because I think they’re seeing, more than anything else, that we’re all very much on a similar page,” Trump said.

Typically, reporters are let in to such meetings for only a few minutes at the beginning. But the president sometimes has remarked afterward to aides that reporters missed the best parts, according to one top White House official.

As he excused the press corps, Trump said: “I hope we’ve given you enough material. That should cover you for about two weeks.”

Trump was right about that, and Aaron Blake adds this:

For a moment, Democrats thought they had struck an unexpected deal with President Trump. Trump had previously insisted that any deal protecting “dreamers” – undocumented immigrants brought to the United States as children – should also include border security and/or a border wall. But he now says that he would support a “clean” bill protecting dreamers, and then take up comprehensive immigration reform later.

“What about a clean DACA bill now, with a commitment that we go into a comprehensive immigration reform procedure?” asked Sen. Dianne Feinstein (D-Calif.). Trump responded: “Yeah, I would like to do that. I think a lot of people would like to see that.”

The problem? Trump didn’t know what “clean DACA bill” meant. House Majority Leader Kevin McCarthy (R-Calif.) quickly interjected and made clear that Trump believes a “clean” bill would include border security. Except that’s not at all what a clean bill is; that’s a compromise bill. A clean bill, by definition, only has one component to it.

By the end, Trump sought to clarify things. “I think a clean DACA bill to me is a DACA bill, but we take care of the 800,000 people,” he said. “But I think to me, a clean bill is a bill of DACA – we take care of them, and we also take care of security.”

Blake says that Trump was faking it:

If anything, the whole mess showed pretty vividly just how utterly disengaged Trump is in the finer details of policy discussions – which is exactly the perception that he has recently fought against.

Asked by the New York Times late last month about this perception, Trump bristled. “I know the details of taxes better than anybody – better than the greatest CPA,” he said. “I know the details of health care better than most, better than most.”

The problem is that every public indication gives us the opposite impression. Trump almost continually moves the goal posts on what he wants, shifts the terms of the debate, and misstates what’s actually contained in the legislation that is before Congress.

That’s who he is:

Even by the end of the meeting, Trump seemed to indicate that the border wall isn’t necessarily a must-have for him – becoming just the latest iteration in a dizzying series of back-and-forths on what he wants in a DACA deal…

If you are a Democrat hearing those words, it’s pretty clear that Trump isn’t wedded to his position on, well, anything. The border wall seems more like an opening bid. If Trump has shown us anything, it’s that he just wants to sign bills and make sure the base doesn’t hate him for it. So as long as he can plausibly say he fought the good fight for the border wall – even if he didn’t – it seems he’s ready to just get it over with and claim a legislative win.

Trump, in his way, may have been trying to do no harm, but he did harm:

Presidents needn’t dirty their hands with all of the sausage-making that happens down Pennsylvania Avenue. Congress produces the bills, and the president decides whether to sign them. But Trump has repeatedly assured us that he knows this stuff better than almost anyone and that he’s the world’s preeminent negotiator. What we saw Tuesday was neither of those things.

And then there was this detail:

President Donald Trump said Tuesday said Democrats and Republicans should consider bringing back earmarks to make passing legislation easier.

“Maybe all of you should start thinking about going back to a form of earmarks,” Trump said, leading many of the lawmakers to laugh.

Of course they laughed:

The Senate voted to force members to disclose requests for earmarks in 2007. The measure passed 98-0.

The House banned the practice six years ago after they became a target of ire among conservatives.

House Republicans, after considering bringing back earmarks earlier this year, put a stop to the conversation at the behest of House Speaker Paul Ryan, who successfully lobbied his Republican colleagues to postpone a vote to bring back the measures.

“We just had a ‘drain the swamp’ election,” Ryan told members at the time, according to a GOP source in the room. “Let’s not just turn around and bring back earmarks two weeks later.”

Now conservatives are up in arms and panicked. Trump is betraying them. Liberals are confused. They have no idea what Trump is offering, if anything. Trump, however, thinks he’s being reasonable, and presidential. Let others work out the details. He’ll sign anything they pass – and Kevin Drum is probably giggling. A bright high school senior could do this. Trump couldn’t.

Someone needs to sit Trump down and talk to him. Mister President, first do no harm. Say nothing. Do nothing. We’ll all live longer.

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About Alan

The editor is a former systems manager for a large California-based HMO, and a former senior systems manager for Northrop, Hughes-Raytheon, Computer Sciences Corporation, Perot Systems and other such organizations. One position was managing the financial and payroll systems for a large hospital chain. And somewhere in there was a two-year stint in Canada running the systems shop at a General Motors locomotive factory - in London, Ontario. That explains Canadian matters scattered through these pages. Otherwise, think large-scale HR, payroll, financial and manufacturing systems. A résumé is available if you wish. The editor has a graduate degree in Eighteenth-Century British Literature from Duke University where he was a National Woodrow Wilson Fellow, and taught English and music in upstate New York in the seventies, and then in the early eighties moved to California and left teaching. The editor currently resides in Hollywood California, a block north of the Sunset Strip.
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