For a time, it appeared that the GOP health care reform may not have taken it’s last breathe; Mitch McConnell applied the paddles to the chest and Rand Paul despite an avalanche of protests that it was time for a Do Not Resuscitate order, gave his yes as mouth-to-mouth resuscitation, so that the vote to proceed to consider the legislation in the Senate survived for Mike Pence to inject his yes epinephrine into the ventilator tube. The repeal bill was in grave condition.

After a couple of weeks delay where multiple patches and injections were administered, the bill was still being sustained on life support. The BullyPresident weighed in multiple times, the intimidation lunch at the White House, with threats for Murkowski and Collins, the two staunch no votes and jokingly, suggesting to others that they may not remain in the Senate if they vote no. His Tweets switched from let Obamacare fail, to encouraging the Senate vote and back in a matter of 24 hours. When the moment arrived, a chamber flooded with confusion until the last minute about what exactly they were voting for, with exception of McConnell, the bill to Repeal and Replace with tax cuts for the wealthy and hollowing out Medicaid died a quick death. The next victim, a multiple amputee, Repeal now, Replace Later, with the gangrenous parts removed died just as quickly. Despite the lengthy debate aimed at amending the next candidate, Skinny Repeal of the individual mandates and the tax on medical devices, it too died after John McCain drove a dagger into its chest.

It seemed a little surprising. The legislative machinery was well oiled; McConnell has a reputation as a savvy political operator. In retrospect, his accomplishments were leading the GOP in “Just Say No” to Obama and using Senate rules craftily to consolidate his party’s opposition intransigence. And of course, there was the theft of Obama’s constitutional right to appoint a Supreme Court Justice. He has not shepherded a single piece of legislation through the Senate. Perhaps, the dictum that old dog’s can’t learn new tricks presages a bumpy ride for the rest of the Republican Party’s legislative agenda.

In the closing moments of the debate, writing legislation on the fly created the difficulty of building support for it. The arguments boiled down to a few versions of the same theme. We voted for Repeal before, albeit it was a meaningless gesture because presidential veto was a forgone conclusion. We must do it again. It’s a seven year promise that finally brought us to legislative majority, backed by a president who understands the popular will. The party must demonstrate its ability to govern. Let’s just get repeal Obamacare on the record in any form. Then the bill will go to conference with the House, and there we’ll work out an acceptable compromise to address problems in health insurance. The problem with conference was that it would again open the fissures among Republican Representatives that led to passage of their original bill.

That argument suffered when House members called the Senate derelict in performing their duties. Essentially, it was like a diaper dump, with the Senate passing the baby back to the House for a diaper change. Senators were afraid that whatever they passed would become law when the House hastily passed the Senate version without conference. Trump eagerly awaiting, with pen in hand, the triumph of his first major piece of legislation, no matter the content, would sign the bill into law. The baby with the dirty diaper passed from House to Senate and then back, would just be passed onto the American people, diaper now twice as full. Remember, the House passed their bill with the same argument that it would not become law and the Senate would fix it.

Repeal Now; Replace down the road suffered from the unpredictability of what would happen to the ACA in the two year interim before repeal would go into effect and what replacement could look like. The essential dilemma for the GOP is that while they weren’t looking, Obamacare became popular and the idea that health care is a right became widely accepted by the general public. Core conservative principles dictate the opposite, healthcare is a privilege reserved for those who can afford it. Their repeal bills reflected their efforts to extricate the government from the health insurance business, one program at a time, first the private insurance market, then Medicaid. The thunderous outcry to this round of health care reform predicts that the party will need a tremendous propaganda effort to turn the clock back to the Dark Ages when healthcare insurance was controlled completely by the insurance companies. That’s not impossible, the Koch klatch has more than generously funded campaigns that did the same with climate change denial, and well as the “death panel” campaign against passage of Obamacare and the Tea Party’s federal government budget restraints. Their hand can be seen in all the major conservative themes of the day.

In the end there weren’t 50 takers of any offer – Repeal and Replace now or later, or the barebones Skinny Repeal. The BullyPresident has taken to Twitter to badger the Senate to vote again, to let Obamacare fail and attacking the Senate filibuster rule and exhorting McConnell to create a 50 vote majority (as usual, 45 was all over the map; his shaft protruding into every area).

The tragedy of the political debate such as it was is that all the arguments were purely partisan. None actually considered the interests of the American people. Sure, the GOP called up the “failing  Obamacare emergency” as rationale for the speed of the process. Mr Price is fond of saying that he wants to make it possible for people to actually access care, rather than simply insurance. He is probably the best spokesman for the objective “to put care back into the hands of patients and their doctors, not the government”. He uses the exact same phrases every time he speaks, as if repetition will make them true. Repetition does make for a handy instrument to imprint party supporters though. As a physician, Mr Price is perfectly aware that it’s all gobbledegook; health care decisions haven’t rested with patients and doctors since the rise of managed care in the 2000s. Insurance companies are the real arbiters of health care decisions; simply put, medical care is what, and how often they will pay for it; they even control which doctor and hospital. Those facts are true with or without the ACA or any of the current proposals for healthcare reform.

However, the path forward is very murky. Obamacare remains the law of the land. HHS has been engaged in a propaganda war against it, admonishing insurance companies for leaving the market and playing up the “failing” part of the mission. By all rights, Price should make an about face if he actually means to “enforce the law of the land.” HHS used to be cheerleaders for Obamacare. Instead, Price will continue to lead his department in becoming “make Obamacare fail” central.

Republicans in the House and the Senate are talking about a bipartisan approach to healthcare reform, although Senate leadership has said it will move on to tax cuts. Members propose to use the usual legislative route of hearings, committee meetings, industry and public comment to craft legislation. As the ACA demonstrated, this is a lengthy process which conservative Republicans contend will come too late to save Americans’ health insurance. In reality,  it can’t be any worse than the good old days when insurance companies were in charge of the market. The Republicans will have to build a new bipartisan coalition without the Tea Party and libertarians to pass any legislation which could improve the prospects of Americans for obtaining and using their health insurance coverage.

As more detailed information about Russian hacking attempts in our elections has emerged, the question is whether our elected officials at all levels of government represent the choice of the majority of citizens. This is a basic credo of our form of representative government; that each and every citizen should have one vote and the candidate with the majority of voters wins. The elected official is then expected to take into account the interests of the whole community, regardless of whether they supported him/her; to represent all members of the community for the benefit of the whole community. The system has been badly undermined by the dictum that the dollar equals a vote; the interest with the largest pot of gold has the biggest voice. PAC money out shouts the citizen with the result that average Joe and Jane can’t get in a word edgewise. For elected officials, the interests of the whole community has morphed into the interests of my campaign funders, no matter how the general populace feels.  For the Republicans, campaign funders translates to the Koch clatch.

All voting is local. Electoral systems are generally managed by county or state officials. This leads to a voting process that varies from county to county, which can be a strength in defense against an organized attack. In a system that is composed of widely dispersed nonuniform entry points, pinpointing strategic strikes is complicated and requires multiple actions, depending on the desired objective. On the other hand, election agencies are generally poorly financed and staffed, without expertise in internet technology or internet security; polls are staffed by older volunteers with even less IT savvy. They are underfunded, with aging equipment and software that will require a major infusion of cash and security expertise that many cash strapped state budgets can little afford. This may leave the voting process vulnerable in this day of sophisticated computer hacking especially because of the hyper-partisanship that surrounds every issue.

While not wanting to contribute to the generalized anxiety surrounding the US voting process, it is a fact that Republican party dirty tricks at the polls over the last decade have significantly changed the political landscape, quietly disenfranchising millions and millions of voters across the country. The influence of those purged voters, overwhelmingly minorities, could ultimately have affected the 2016 electoral college totals because numerous narrow state margins propelled Trump to victory. This is extraordinarily important because unlike Russian interventions, we can take action against this kind of activity to reclaim our democracy. Americans are free to make dumb mistakes and if a legitimate majority of the country is satisfied with the Trump administration, then so be it. At the same time, future candidates who oppose Republicans must have an equal possibility of winning electoral office in a fair fight.  

Let’s first look at Moscow’s cyber hacking adventures. The FBI reported in August 2016 that hackers had been probing voter registration databases in almost 15 states. Georgia was not one of those states, although there is probably no way to know that given poor security safeguards and the state’s refusal to allow outside review of the system or assistance from Homeland Security to investigate or assist with security enhancements. Georgia’s story is instructive because it uses paperless voting machines like several other states which are both old, circa 2002 and known to have serious security concerns. However, state voting system officials are regularly asked to educate other states and even foreign countries.

Georgia uses a single model of voting machine throughout the state, unlike most states that use multiple different models. These touch screen machines, made by the now defunct Diebold become Premier Election Solutions, have been in use since 2002. The company also made the associated software for the state’s ExpressPoll poll books which are the electronic devices used by poll workers to verify that a voter is registered before allowing them to cast a ballot. Additional software maintains the databases for the GEMS servers that are used to prepare paper and electronic ballots, tabulate votes and produce summaries of vote totals. The software version currently running on machines was last certified in 2005 and is running on Windows 2000 that hasn’t been supported by Microsoft for at least 5 years. In addition, unlike most states where management of elections is decentralized in individual counties, Georgia’s system is centralized to a center which manages balloting and machines for all the counties.

That center is the Kennesaw State University Center for Election Systems which is responsible for testing and programming all the voting machines for the state of Georgia. The Center is responsible for maintaining the machines and the software used by the machines as well as providing the support for the GEMS servers also distribute the electronic ballot of definition files that go into each voting machine before elections. These files tell the machines which candidate should receive a vote based on where a voter touches the screen. If these files were altered, the machines could record votes for the wrong candidate. Since Georgia machines have no paper trail which could allow voters to verify their choices before ballots are cast and could also be used to compare against electronic tallies during an audit, officials might never know the machines recorded votes inaccurately. There is no way that officials would be able to determine if this has ever happened, according to computer security experts. The Center has remained a staunch advocate of Premier/Diebold voting machines despite numerous reports by computer security experts over an extended period time including a 2007 video showing how to introduce a virus into the voting machine.

One other software system the Center uses is content management software, Drupal. Drupal is a significant problem; the Center is running an ancient version, which had not been updated, despite a well known critical software vulnerability known since 2014. The patch to prevent attackers from easily seizing control of any site had been available for over 2 years, but gone unused by the center despite the widely known existence of automated hacker scripts to attack the Drupal vulnerability.

Much of Georgia’s voter machine security depends on absolute separation from the internet. The system operates on a series of separate servers that, at least in theory, cannot be connected to the internet and therefore can not be hacked. The ExpressPoll poll books are delivered to workers on CDs, a process that could have easily been compromised when one county officials car was vandalized and the CDs stolen. The state contends that no data was stolen although they gave no details on the methodology used to determine that.

When Homeland approached the secretaries of state with the news of Russian meddling, Georgia’s secretary of state Kemp was naturally one of those who reacted badly. So when news broke of a data breach at the Kennesaw State Center in March, he accused the FBI of maliciously attempting to hack Georgia systems. An investigation did reveal an intrusion, in which state officials wrongly reported that millions of voter records were stolen. In reality, it was a second intrusion to check on whether there had been any security changes after an earlier one in August 2016. At that time, a curious cybersecurity researcher interested in voter system security after the FBI reported hacking in multiple states accidentally downloaded 15GB from the center’s website using a simple script to explore the site. The files were supposed to be protected by a password protected firewall but the center had misconfigured the server so anyone could access them from the root. That 15G included registration records of 6.7 million voters, instructions and passwords for election workers to sign in to a central election server on Election Day and software files for the state’s ExpressPoll poll books, the electronic devices used by poll workers to verify that a voter is registered before allowing them to cast a ballot as well as databases for the GEMS servers that are used to prepare paper and electronic ballots, tabulate votes and produce summaries of vote totals. This was evidence that the wall between the internet and the voting system had been breached at some point, even if they were not continuously and currently linked.  

When the researcher approached the Kennesaw Center director before the November elections, he simply blew him off. Merle King, the executive director of the Center, thanked him and said he would have the server fixed but threatened him not to reveal the information to anyone, especially the media. King never informed Kemp’s office and took a piecemeal approach to the repair, leaving the unencrypted http version of the Drupal still vulnerable, as a friend of the researcher later discovered in March 2017.  

When news of a system intrusion at the Center surfaced 6 months after the cyber researchers discovery, the Kennesaw University IT Services, the secretary of state’s and governor’s offices and later the FBI all launched investigations. In the course of investigation, it became clear that the Center had been operating its networks outside the scope of the university and secretary of state’s office for years, essentially unaligned with any larger security strategy. In addition, although the Center had separate public and private networks, a public network jack sat in the closet with the private network, opening up the possibility that workers could have connected the private network system to the internet. Workers had also installed their own wireless access point in the office, a potential entry point into the network for hackers. The evidence pointed to a knowledge deficit on the part of the center’s small staff, some of whom are non-technical students at the university. The presence of the GEMS files on an internet connected server is a significant piece of evidence that points to previous connections between the private and public systems. All indications suggests that Georgia’s voting system is extremely vulnerable to hackers of all descriptions and that the integrity of the state’s vote is in serious jeopardy.

Georgia’s secretary of state Kemp insists that the Premier/Diebold machines met federal standards, adopted under 1990 federal guidelines, when it was adopted in 2002. Kemp says that when the system met 2015 certifications it met requirements under state law although new federal guidelines have been issued. Security experts say the certification is too old and that the combination of two different certifications is outside the norm. The machines are regularly tested before and after elections, but here again, a security expert knowledgeable about the machines suggested that state testing is a bit like asking the machine itself if it’s results are accurate without any outside corroboration. He has been able to corrupt machines in the lab with malware that would be almost undetectable during regular operation.

Kemp also seems to have an aversion to security experts. Georgia was one of two states to reject the offer from the Department of Homeland Security to assist states with securing their systems. In fact, he accused the FBI of nefariously hacking into Georgia’s system. The previous secretary of state, Karen Handel who is now the 6th district Congresswoman, ordered a security review of the voting system to fulfill a campaign promise. The Georgia Tech team found a number of security concerns, even though they were denied access to the Kennesaw Center network or review of its security protocols. Handel who did not insist that the Center’s comply with requests for access to the Center, did insist that the report itself state that they did not have enough information to evaluate security safeguards. Even with that, she buried the report. The obvious conclusion is that the secretary of state and the center are hiding something, and it may be more than just security. For instance, there was the “glitch” in some Cobb county precincts memory cards in the recent 6th district special congressional race. But when the issue was supposedly resolved, Ossoff, the Democrat, fell from 53% of the total vote to 49% and stayed there, setting in motion the runoff with Handel, the Republican. In the absence of paper ballots, there is no way to know if votes were changed or categorized as “inconclusive” or thrown out.

Here are some examples of voting system vulnerability. If hackers were to delete voter names from the database stored on the center’s server or alter the precinct where voters are assigned, they could create chaos on Election Day and possibly prevent voters from casting ballots. This is not idle conjecture; in 2016, a glitch in the ExpressPoll software led some voters in Fulton County to be told that they had arrived at the wrong precinct but when redirected to a different one, they were told to return to the original precinct. Beyond that, a rogue memory card or unsophisticated poll workers could introduce malware from phishing emails in individual machines which is likely to go undetected under current security operations.

To summarize, voting machines throughout the state of Georgia are controlled by a small university based center with lax security and no indication that they have any interest in changing that. They are unlikely to try to remedy a problem that they refuse to acknowledge. The voting machines are 15 years old, using multiple outdated software systems running on an outdated operating system without the capability to use the latest security safeguards. The Center has refused to update the systems with known security patches. The absence of any paper ballots makes it impossible to verify election results or investigate reports of voting irregularities. The pretense that these ancient computer systems running on outdated software can be made secure against sophisticated hackers is clearly absurd. Officials have also demonstrated a lack of will to create a secure system and a propensity to resist any independent expert assessment and improvement in security, let alone the ongoing security watchfulness required in these days of advanced hacking. That may reflect the mindset of state officials where large swatches across the state lack wireless access. The optimal solution is to upgrade the whole system, with voting machines with paper ballots and current generation software and management systems. If Georgia is an ideal model, our election system demonstrates a partisan pigheadedness to remain vulnerable to multiple threats, not just the Russians.  

It’s worth examining to a fuller extent federal knowledge about the Russian electoral interventions in the 2016 election. On a primary day in June 2016 in Riverside County, California the district attorney’s office fielding a lot of complaints that their registrations had been changed without their knowledge from people attempting to vote, sent investigators to polling places. Most had cast provisional ballots. In the following days, there were more people who came forward with the same complaints. Investigators concluded that the changes had been made by hackers using private information like social security and driver’s license numbers to access the central voter registration database for the entire state. Unfortunately, the state system did not capture the IP addresses of the computers that had made the changes so the trail went dead. Opposing political responses were predictable; the Republicans thought the Dems were trying to suppress GOP votes in the overwhelmingly Democratic state. The Dems thought their opponents were trying to excuse their losses. And there it was; public faith in the electoral process had been dented and as it dawned on federal investigators later, that was the point.

Cybersecurity experts considered it a test run to see what kind of election day havoc could be generated. Riverside was the first evidence that the Russians were mounting an aggressive campaign to undermine Americans’ faith in their own democratic process. The Obama administration struggled to craft a response while unearthing the full extent of Russian efforts. After resistance at the state level to federal investigation and assistance with improving system security, the hyper partisan reaction of Republicans threatening to politicize the election convinced Obama, probably mistakenly, to back away from announcements to the public. With their hands tied, officials decided there was nothing they could do to prevent the cyber activity and settled on a plan to react to cyber incidents on election day that would first defer to the states, but included armed federal law enforcement agents to polling places if voting was completely blocked and to call out military and national guard forces as requested in the presence of violence. For up to 3 days after the voting, an interagency force would address any further internet intrusions including “planted stories calling into question the results.” Proof of Russian success are Gallup poll results that only 30% adults were confident in the honesty of our elections and 69% were not.

Current Russian attacks on elections extend back to at least 2008, when both Obama and McCain campaigns were hacked. But the attacks used to be ephemeral, with the culprits quickly exiting the systems. The summer of 2016 saw more attacks in Arizona and in Illinois, a hacker uploaded a malicious code that allowed access to all 15 million past and current voter files for the previous 10 years; he/she stayed for 3 weeks, without being detected. When Illinois discovered the cyber intrusion in July, the FBI Cyber Action Team (CAT) was able to determine that 90,000 files were stolen, the majority of which had social security and driver’s license numbers. But more importantly the hackers tried to change/delete information in the voter rolls. The techniques and digital footprints convinced the FBI that this was the work of Fancy Bear, an arm of Russian military intelligence (GRU).

The FBI worried about a nightmare scenario in which Russians would actually be able to affect elections results.  Ed Felten, the voting machine expert well acquainted with the susceptibility of touch screens, could foresee a compromised poll worker, possibly through phishing, providing outside access to machines before election day. That process would be extraordinarily tedious way to impact a final result, without information about which precinct would be critical to the results. It is worth noting that Jared Kushner could theoretically have been a critical connector in his role overseeing campaign media communications. Knowledgeable experts have marvelled at the campaign’s precinct level pinpoint accuracy use of targeted social media. The campaign is known to have used Cambridge Analytica, a consulting firm funded by ultra conservative billionaire Robert Mercer, which specializes in strategic communications using data mining. Access to those kinds of data, either through consent or through stealth could have easily improved Russian efforts. Kushner’s testimony is high stakes, but, given the family history, unlikely to be truthful.

How did the Russians get so good is a real question. A few years ago, John Podesta was a mystery to them and they had no knowledge of the DNC. No one on Capitol Hill took the Russians seriously; they were considered among the most ineffective lobbyists in Washington because they didn’t know who to approach and when. Fast forward to 2016, when they were coax voters in Ohio and Indiana into watching stories on Russia Today, a state owned Russian TV network and strategically target districts in Florida with anti-Clinton propaganda. Ultimately, the steady drip of fake news that discredited Clinton- she has Parkinson’s, she has pneumonia, she’s tied to sex trafficking in a pizza shop, etc – exploited perennial suspicions that she was duplicitous and could not be trusted. These efforts probably continued to depressing voter turnout for Hillary except for those who were anti-Trump and didn’t want go the independent route. How did Moscow know when and where to release different pieces of information?

The FBI team did create some possible intrusion scenarios that would not appear obvious but could be disruptive. Simply flipping a letter in every voter’s address would mean that every voter in a swing county would have to use a provisional ballot, creating panic which could then be exploited by a propagandist questioning the election result, or in the current climate, suggesting that one of the parties intentionally tried to manipulate results. Even less complicated, a YouTube video showing the hacking of a single voting machines with dialogue that claims it was one of only 10,000 without actually doing it even once – real fake news- could create panic in every precinct, trigger investigations and undermine any final vote count.

The DNC hacking and Wikileaks email release provided political fodder for the CelebrityCandidate to exploit across the media, including his appeal to Russia to hack Clinton’s email server, in part to distract from the first report of Russian hacking. In classic Trump form, he accused the Dems of what he thought the reports of Russian hacking implied; that the elections were rigged. Even in those early days, a core of Trumpophants were willing to believe whatever he said, no matter how contradictory or implausible. So when Homeland Security Secretary Jeh Johnson approached state election officials in a conference call on August 15 about declaring elections part of US critical infrastructure, he was surprised that some states called foul over the “overreach of the federal government” rather than patriotic indignance at the threat from a hostile country he expected. The designation would have given the feds access to state-level voter information. The Pavlovian Republican response was State Liberty or Die!

The White House had already seen partisan political pushback from Congressional leaders. In closed meetings, the Democrats reacted with patriotic dismay and wanted to explore responses. Mitch McConnell had the completely opposite, self interested reaction and threatened to broadly politicize the accusation as an attempt to undermine the Trump campaign. He wanted to use “Russians are helping Trump” as chum in the water to attract the sharks at Trump rallies to bloody the race through the conservative right Breitbart-radio-blogs-Facebook+ Twitter fake news sphere.   

Obama, always careful to weigh the pros and cons of each position, conjectured that an aggressive countermove against Russia could have been met with an outright cyberwar and domestically, exacerbated raging anti federal government sentiment now interpreted as partisan maneuvering for Clinton. In the interim, Moscow had stepped up its game, with intrusions in Florida, New Mexico, Tennessee. Before the election, they had meddled in 25 states and had tried to hack all 50. By July of this year, an NSA report confirmed that Russian hackers had employed an extensive phishing campaign to hack election officials as well as targeting voter registration systems. Bloomberg also reported that hackers had targeted voter registration systems in 39 states and had tried to delete or alter voter data in at least one state. They had also accessed software used by poll workers to verify voters at the polls similar to the type used in Georgia.

After Obama had a harsh word with Putin in China, it seemed Moscow may have simmered their attacks while some states were trying to beef up their security, some even used assistance from Homeland. There were a few cyber incidents, but no large coordinated Soviet effort, at least none that was detected. The FBI worried that they were only detecting the clumsiest of Russian hackers and the more adroit were going undetected. But in October, the Russians hackers attacked the company that provides election software and machines for 8 states, using that to create an email for a phishing campaign against elections officials nationwide. So, the intelligence agencies fell back on a modified response plan and kept their fingers crossed. Admittedly, much of the investigative work done by the FBI was delayed until after Clinton had lost the presidency. Still the response of the Republicans, jubilant in victory, was to follow the lead of their fearless leader in complete denial until a growing amount of evidence has now forced them to acknowledge the Russian threat as they try to exclude the possibility of campaign collusion. Denial is firmly embedded in GOP DNA safeguarded by a refusal to allow investigation, as is apparent in Georgia which is probably more vulnerable than other states that are more decentralized. (Read the Time magazine article “The Secret Plan to stop Putin’s election plot” at http://time.com/magazine/)

Donald Trump has promised to restore the country’s faith in elections, a faith that he was instrumental in destroying during a campaign where he consistently insinuated that the results would be rigged if he lost. He went as far as suggesting that he might not accept the elections results. Strangely, he concluded that the electoral process was indeed intact when he won, but his win, history making in his mind, was tainted by 3 million illegal voters who all voted for Clinton. Of course this fit neatly into Republican propaganda that has been charging voter fraud since Obama’s stinging victory in 2008, as a pretense for machinations that would restrict voters to those who support their party. Their instrument has been state voter IDs laws, literally written from templates distributed to state legislatures by The American Legislative Exchange Council (ALEC), a conservative organization financed by the Koch brothers. Legislatures have targeted minorities, the poor, the elderly and the young, groups that typically vote for Democrats and voted overwhelmingly for Obama in 2008 (oleblacklady/It turns out voting is a privilege).

Trump’s new commission, voter rolls in hand, will likely create evidence of fraud – fake facts- and roll out a blueprint for states to further disenfranchise minorities. But behind the published results, they may create an infrastructure that will allow Republicans to purge voters quietly from voter rolls or invalidate votes at the polls, much like they did when Bush 43 signed the Help America Vote Act, which required all voting to be electronic.

So Trump has decided nonwhites are the new threat to fair elections, but the actual threat to voting, Russian cyber intrusion, he has not fully acknowledged, even in the face of evidence from every other European democracy, presumably not Clinton allies. As the secret Russian contacts multiply across the Trump campaign and administration, it is increasingly difficult to continue to give the benefit of a doubt to the Donald. Trump may indeed be a Manchurian candidate. As I’ve said before, we are living with the damage done in the last election and Putin has Trump eating out of his hand internationally. Moscow may just call off future interventions. What else does Putin need? So far 45 exacerbated voting system vulnerabilities by trying to defund the EAC; the Democrats have responded by introducing a Senate bill to both refund the agency and provide additional state funds to improve and protect election infrastructure. The catch lies in mostly Republican secretaries of state refusing to concede their security flaws and opting out of increased security precautions. Like Bella, begging for Edward’s vampire bite, they’re asking to be taken advantage of.

 

Russian collusion has exposed a deep fissure in our democracy. Where is the wave of defense for America, land of liberty and justice for all? Why is nobody standing in defense of our nation against the attack by the Russian government at the heart of our democracy, free elections. Why the blind curtain over the most obvious threat to the country; larger than ISIS, larger than a nuclear Korea? Why has there been no clarion call? Ironically, The America First president’s staunchly nationalist stance is fatally flawed by a blindspot for Vladimir Putin’s nation. In rallies draped with giant American flags hanging from every rafter, a red capped Trump exhorts the crowd to defend America against hordes of foreign immigrants by building solid walls, now covered with solar panels, and walls of visa and passport documents. The electronic gates, however, are to be left invitingly wide open to a foreign government seeking democracy’s demise.

Apparently, the patriotism of 911 was squandered by the revelations of the Bush 45 WMD fraud, the invisible, long lingering wars in Iraq and Afghanistan and subsumed by anger over the economic collapse, bank bailouts and widening inequality of income. The drumbeat of identity politics left a white majority stinging over the usurpation of their dominance in the culture, increasingly alienated from what it saw as the highjacking of their America. For the first time in US history, white male primacy seemed doomed by a projected 2020 nonwhite majority. Their American flag stood for something very different – family, God and church, and their individual freedom as seen through their myopic eyes. America bifurcated into a conservative one and the other one.

Mysteriously Trump and the conservative right wing media have rotated their supporters 180 degrees from staunch defenders of the flag to 80% support for the Russian bear. Certainly, an important component is limited information; people never well versed in the history of Russia or Sino-US relations, are spoon-fed biased analysis of misconstrued facts, endlessly repeated within their self-contained media bubble. A consistent diet of anti-intellectual propaganda has buttressed the ascendancy of “belief” over “facts or scientific evidence”, a process reinforced by the perception of bicoastal liberal intellectuals who see themselves as superior to “fly-over country”; who scoff at religion. Trump supporters have placed blind faith in the man, not his words or his deeds or his political positions or his behavior or even his party, but in the man himself. They are true believers in ways that are reminiscent of Hitler’s mesmerization of Germany. [Although Hitler is often used as a pejorative, in this incidence, he is exemplary of a masterful propagandist who transformed the worldview of a nation]. At this time, when truth has become relative, there can be no rational argument, particularly from beyond the self-contained conservative media bubble.  So crying “The Russians are coming” as Paul Revere warned of the British has fallen on deaf ears.

Trump continues to resist definitive FBI reports that the Russian government used multiple intrusive weapons to interfere in our elections. In the latest installment from Donald Jr, the interventions were named as governmental support of the Trump campaign. (oleblacklady/This is Everything) A concession at one or two points is reversed with multiple denials at others. If our Commander-in-Chief says it didn’t happen, there can be no reason for concern, his Trumpophants think. His continuing efforts at minimizing the significance of Russian interventions and normalization of behaviors for which Obama would have been lynched or would have been unthinkable 10 years ago have coached his followers into somnolent inattention. The patriotic response we saw to 911 has sputtered out.

The Hillary monkey on Trump’s back has poisoned the information well with supposed parallels that are wholly askew, a holdover from the pervasive mistrust that is the Clintons’ legacy since Bill won the White House. Trump has gone as far as reverse the narrative, telling evangelist Pat Robertson that Putin wanted Clinton to become president because she would have weakened the US military and increased energy prices in the US. An absurd fiction. It is well known that Putin shares the CelebrityPresident’s obsession with Hillary. Putin believes that Clinton, as Secretary of State, supported Russian protests during his last election campaign, an intervention from the US government in Russia’s “free” elections. His interventions for Trump were supersized vengeance against Hillary. The prospect that Trump would also be a disrupter of government, based on Russian intelligence research, was even more enticing.

The Hillary obsession has created other strange twists. Comments from conversations  with some conservatives sound strangely left leaning. “Hasn’t the US interfered in numerous foreign government elections” presumably referring to the John Foster Dulles decades of establishing puppet anti-communist regimes and excluding numerous outright CIA coups. While those US policies were wrong, American elections are inviolate, a foreign assault unimaginable…until it happened. Impregnable to ho-hum in the blink of an eye. Do two wrongs now make a right? Another conservative commenter wished that Democrats would be as fixated with Hillary’s emails as they are with Russian collusion.  Secretary of State Clinton with a private email server has nothing in common with Russian hackers except that they were both working for their respective hostile government. Besides, after millions and millions of dollars spent on FBI investigations, what else is there to know about those damn emails, unless Alex Jones has some nefarious conspiracy theory about them. Actually, he probably does but I’m not a fan of nonsense, no matter how loudly it’s shouted.

It is ironic that I, an African American who has been systematically excluded from American liberty and justice for all, should be raising questions about the absence of flag waving patriots. Even old stalwarts like John McCain have uttered only whimpers. GOP leaders have been unable to raise their heads out of Trump’s ass, preferring to concentrate on propping up their failing legislative agenda. They are far too busy taking care of the country’s pressing needs, like cutting taxes on the rich, eliminating health insurance for millions and ravaging Medicaid benefits.

So far, with every daily headline, Putin must be high fiving subordinates. His nefarious espionage is repaying him in spades. Internationally, Trump ushered  Putin, a pariah for Ukrainian actions and European electoral invasions, back into the bosom of the G-20. His 2 hour meeting even delayed Trump’s meet with Theresa May, elevating the Russian leader over a staunch ally. Although it may have been that no other leaders wanted to spend time with the Donald, still, the additional after dinner chat later in the evening doubled down on the impression for the other countries of Trump’s reverence and Putin. A singsong snub that translates as “I am better than you are, I am better than you”. That helps Russia’s global brand enormously, especially with smaller countries. Trump has seeded a solution to the Syrian civil war to the Russians as well.

The icing on the cake came from 45’s Poland speech, where Trump effectively adopted Putin’s view of global conflicts. Trump transformed the traditional message of America and it’s allies defending democracy against the threat of Islamist terrorism into defense of western traditions of family, church and God. The post Soviet Russia fits neatly into that tradition; the country’s ancient Russian Orthodox Church has risen like a martyr on the wings of state capitalism. The Russian defense of family is officially being secured by persecution and violent attacks on gay and transgender people as well as anti-LGBTQ legislation attests. (oleblacklady/The Putin Mild Meld)

Domestically, chaos in the GOP has left a government completely controlled by one party mired in infighting. The government is still handcuffed, just as it was when the party stonewalled Obama at every turn. The president is a buffoon, more enamored with pretending to drive trucks than government. He consumes Russian “fake news” planted in cable TV from the online conservative media bubble and happily tweets it to the world. He deems Fox News a more credible source than US intelligence agencies, an opportunity for Putin to outmaneuver his blindfolded foe across the globe. A massive cloud of distrust hangs over our electoral process, Democrats convinced that ignored, Russians will continue to sully our electoral process. Republicans, embarking on a quest fired by the fake news of voter fraud, will quietly continue to limit the pool of eligible voters to those who will maintain their regime in power as they have been doing at the state level since 2000. (oleblacklady/It Turns Out Voting is a Privilege Not a Right Parts I & II) Their efforts are buoyed on the shoulders of true believers, yawning over the flood of information that is so alien to the day-to-day issues of living, that inattentively, support whatever Trump may do. Yes, things seem to be breaking Putin’s way. America First is America Defenseless.

“This is everything”, Donald Trump Jr said to Sean Hannity in an interview designed to open the airwaves to the denial propaganda minimizing the significance of his email interchange setting up the meeting with a Russian lawyer to obtain campaign dirt on Hillary Clinton. He said it was just normal opposition research that all election campaigns conduct. He contended that it was so insignificant that there was no reason to remember the 20 minutes that yielded no information, just talk about Russian adoptions. Hannity didn’t inquire about the email references to support from the Russian government or the failure of other participants to report the meeting or Jared Kushner’s third revision of his security clearance documents made a month before Donald Jr remembered this meeting. No matter, his dad said, junior was being transparent. Trumpophants don’t know about those things and if they did, they think they’re Democratic propaganda to attack their President. They believe Russian collusion is “fake news”.

“This is everything” until it wasn’t. Drip…there was someone else in the meeting; drip…they brought a file to the meeting; drip…

One additional person named in the meeting so far, outside of a translator or maybe two, was Rinat Akhmetshin, a Russian with dual American citizenship, who served in the Soviet army while working for KGB counterintelligence to ferret out spies in the military. He is a long time Washington lobbyist for Russian and former Soviet states. Akhmetshin, adamantly denying any relationship with the current Russian regime, said he was in the meeting because Ms Veselnitskaya asked him to attend. But the web of Russian connections is often convoluted. He lobbies for a nonprofit, the Human Rights Accountability Global Initiative Foundation, which is affiliated with Russian businessmen including Denis Katsyv. Katsyv is, in turn, represented by Ms Veselnitskaya. Coincidentally, the foundation registered to lobby Congress about the Magnitsky Act and adoptions only 2 days after the meeting with Junior.

That Russian businesses are intertwined with the Kremlin should come as no surprise. The Russian government can best be described as an authoritarian oligarchy, meaning all successful businessmen in Russia have some ties to the Putin government or they could not have achieved their success. Many in this group have ties to the KGB, Putin’s home before being catapulted to the head of the Russian government. Putin rewarded this group with economic favors precisely to consolidate and retain his political power. The group is relatively small but extremely loyal to their benefactor, strongly motivated by poverty with a fall from grace or alternatively, the threat of death for failure to comply. Thus any Russian businessman big enough to be doing business in the US have some links to the Kremlin.

Similarly, Veselnitskaya, who denies being a Russian government lawyer, has lobbied around repeal of the Magnitsky Act, part of sanctions against Russian action in Ukraine. Putin was rumored to be so incensed that he prohibited Russian adoptions by Americans in response. Given Putin’s iron clad control and his intense interest in this issue, it is unthinkable that he would not be familiar with a government lobbyist in the US. She probably became the lobbyist because of already established tied with other businessmen with ties to Putin, etc. No doubt, she was hoping to get a quid pro quo exchange of dirt of Hillary for repeal of Magnitsky. Enter the “folder” in question, a tease of what was to come or nothing that interested the Trump campaign or …. next drip

So much for that transparency that made Papa Trump proud. Junior is about as transparent as a reflective sunglasses. If Jared’s lawyers knew about the meeting early enough to alter Kushner’s security clearance declarations in June, why didn’t Donald Jr come clean at that point in what he called the “Russia-mania”? In truth, he was prodded to introduce the meeting into the public arena because NYTimes reporters contacted him for comment on their story about Trump campaign contacts. His first response to the Times admitted to a meeting with Veselnitskaya and Goldstone, Kushner and Manafort to talk about Russian adoptions and by the next day, he amended his response to say it was initially to get information on Hillary Clinton. A couple of days later, the NYTimes literally shoved Junior’s finger onto the tweet button so he could send out his emails before the newspaper released them 20 minutes later. Transparency by cattle prod. Now, we have the other two people at the meeting and the folder and probably more.

Unanswered questions just keep popping up. Why so many meetings with Russians during a presidential campaign? If the meetings with Russian officials were so innocuous, why all the subterfuge? When the Michael Flyn and Kushner meetings around the establishment of a backchannel using Russian embassy communications came out, what were they trying to hide from US intelligence? Is there a relationship between Junior’s meeting and candidate Trump’s announcement that he would make a major speech about Hillary Clinton and Russia? And later the Wikileaks releases of DNC emails? Was there some coordination between Kushner’s  management of the Trump campaign media and Russian memes, fake media and Twitter accounts? Was there a Russian data link with the campaign’s data consultant with voters information?

Why not come clean about all the other meetings when the investigation started? Trump has the base so mesmerized, they don’t care. The GOP is so attached to Trump’s ass (and by extension his base), they don’t care. They are all willing to forget that Trumpian decorum is not normal business as usual, even veteran politicians who can be forgiven for selective age-related memory loss of standards of conduct. Their sense of patriotism has been fatally wounded, as the America First wall seems riddled with Russian bullet holes. 45 could have put this whole hullabaloo behind them, and then moved their legislative agenda forward. Now the “Russia-mania” is sucking the legislative agenda dry.

Dad seems to have taken over the defense, while Junior may be listening to his legal team. (He could be making the conservative media circuit, but that’s outside my purview.) Given the Trump track record for honesty, the only way the public will learn the whole truth, in advance of the special prosecutor’s conclusions, is if someone involved agrees to an immunity deal. They will all troupe before Congressional committees, but because Trumps see themselves as above the law, neither oaths nor truths apply to them. There should be no reason to take the Fifth because the clan contends that it has done absolutely nothing wrong to be incriminated by. The always silent Kushner might be a good candidate to deal, perhaps spurred by bad memories associated with his own father’s incarceration. The Times will keep digging, but the people in the room (rooms) are the only ones who know what happened and they will do their damndest not to tell.

Unless there is a tape …

Drip…drip…drip.

As unveiled in the Senate, the latest version of the Health Care bill has been snipped and patched in an attempt to win over opposition from Republican moderates and conservatives. The newest addition to pacify the opposition is the Cruz amendment, which the Senator spent the recess explaining in as many media outlets as would listen. Cruz contends his amendment will lower premiums by allowing insurance companies to offer a range of policies that cover fewer services. He was less forthcoming about the part where insurance companies would be allowed to use people’s health status to determine premiums, sounding suspiciously like pre-existing conditions. In addition, the bill would allow small businesses to buy less comprehensive plans through associations of similar businesses. These plans would be exempt from state oversight. In the past, many of these plans were financially unstable, causing them to fail without adequate funds to cover customers’ medical bills. And one other thing, outside the state’s regulatory purview, they were less than transparent, misleading buyers about the extent of coverage.

Why, Cruz asks, should healthy people pay premiums that cross subsidize the sicker people who are using more medical services and forcing the insurer to pay out more money? From the beginning, Cruz accepts that people will get less for their money, much less than what they have now. As a corollary, in the hands of insurance companies, people will find themselves in far more precarious circumstances, the direct result of the removal of protections that federal regulation provide. That is the legacy of glorification of big business. Regulations are the enemy of the corporation, not the consumer.  

Cross subsidization is a fundamental principle of insurance, otherwise known as shared risk. Simply put, everyone pays into a pool from which payment for medical services is paid. The premiums are based on the assumption that a significant number of people paying into the pool will use few or no services, an amount less than the sum total of the premiums they paid into the pool. The remaining surplus after services have been paid and company overhead covered becomes the insurance company’s profit, to the tune of $15 billion for the industry last year, distributed to investors as dividends or reinvested in the company. In the days of pre-existing conditions, premiums were calculated on the likelihood of individuals to need medical services; higher for people with more medical problems who will consume more services and lower for healthy adults, who tend to need almost none. Pre-existing conditions as determined by insurers, not by medical professionals, included minor benign events like ovarian cysts which are frequent and not associated with risk of cancer or a single abnormal pap smear. Conditions were viewed from the perspective of whether payment for an office visit was required, not if they represented clinical disease.  The advantage of prohibition of pre-existing conditions based premiums under  Obamacare could only be accomplished by recruiting enough young healthy people into the insurance pool to generate enough money to cover the costs of other people needing medical encounters. This was the rationale for the mandate so dreaded by conservatives.  In fact, that did not happen and so premiums increased.

That is, of course, an oversimplification. Overall, enrollment in Obamacare was slow initially which threw a wrench into calculations. Another wrench, more newly insured people sought care that they had delayed, broader benefits meant that people took advantage of preventive care like annual exams, mammograms, pap smears and prostate exams. Prescription coverage meant women could finally afford the contraceptive method of their choice, not just the cheapest one. Parents could have their children vaccinated. But insurance companies also increased premiums in the first few years simply because they could; they had only to complain that they were losing money, but that’s another issue; hint, balance sheets can be manipulated in numerous ways to give the impression of losses, a practice that insurance companies are well versed in.

So right out of the gate, the Cruz amendment proposes people make do with much less, a standard in the Republican pantheon. Except the amendment, seemingly contradictory to insurance 101, presents an unworkable subterfuge served up by a politician to masquerade for both colleagues and the public as a reasonable compromise. The accumulation of healthier people buying limited coverage plans leaves the people remaining in the fuller coverage pool with a higher overall risk and therefore higher premiums; the “normal” pool becomes a kind of less-than-high-risk pool which would be in addition to the other proposed high risk pools being batted about in discussion of the bill. If Obamacare is any indication, even with the mandate, young healthy people chose to go without insurance. Without the mandate, more will forego coverage and the people buying the limited plans are more likely to be those who will need to get medical care but can only afford incomplete coverage. They’ll do a Hail Mary and hope that the plan can cover most of what they may need.

Senator Cruz tells us his amendment will move away from the “one size fits all” constraints of Obamacare, apparently leaving us securely in the hands of insurance companies, trusted friends of the common man. In fact, the whole bill is pretty much summarizes by the Republican core message: people have gotten bloated off the government’s teat and the supporters who elected them have been screaming to Repeal Obamacare for 7 years. They have moved forward to cut dependence on an overreaching government with a supersized  federal bureaucracy that constantly meddles in our lives. In this case, it boils down to even though you’re paying a lot, for far less,  you will be better people for it. Sicker but spiritually purified.

Wouldn’t it be great if you knew what life held in store. But life is not always predictable. People with limited insurance coverage are playing probabilities. If a woman or couple find themselves pregnant and have not purchased a policy covering prenatal or pregnancy care, they may find themselves with huge out of pocket costs, higher because patients without insurance are charged on a higher scale by both physicians and hospitals than those with insurance whose carriers often have pre-negotiated discounts. In addition, some policies may be restricted to use at only designated facilities. Similarly, cancer diagnoses and heart attacks are almost always unexpected; policies that don’t cover cancer therapy or cardiac care units with rehabilitation services will leave the family wishing they were old enough to qualify for Medicare.

What is often lost in these larger political debates is that the realities of actually getting medical care are shaped first by the regulations that HHS will devise and then the ultimate arbiters, insurance companies. Anyone who’s had to find a doctor will recall plowing through long lists of physicians listed on the insurance company’s webpage. Those physicians have contracted with the organization and agreed to accept the company’s reimbursement rates. Similarly, the hospitals listed have negotiated contracts with the insurers for specific reimbursement rates. The larger the hospital, the more leverage it has with the insurance company, part of the reason for the evolution of larger and larger hospital groups, a trend matched by mergers among the largest health insurance corporations as a counterbalance. Physicians, in turn, need to apply for medical staff privileges at the hospitals included in the insurer’s network. These arrangements can leave a person, unable to be seen at a hospital one block from their home, travelling miles to one in their insurance company’s network.

Any good Republican will pass these situations off as opportunities for choice, like which hospital, the close one that I’ll have to pay for myself or the one that’s 20 miles away, where I’ll only have to pay the deductible and the co-pay. Or, after I pay food, rent/mortgage, car loan, household expenses, I can take the money I’m saving on a bare bones policy and plow that into a health savings account, so if I really do get sick and need an MRI or CT scan, I might be able to pay for it. Or I barely have enough money to pay routine costs of living so I’ll just cross my fingers and toes and refuse to get sick and opt out of insurance. All choices we’re dying to make, pun intended.

The Cruz amendment was merely penciled into the newly released Senate version, kind of like a trial balloon to see how many members would jump on board. But the bill remains essentially the same – the Medicaid cuts are still there, but a $40 billion drop-in-the-bucket fund for opioid addiction care has been added, as if the harm done to the children, elderly and disabled who will lose their coverage is assuaged by continuing a few more addiction programs. While the bill remains a tax cut bill at its core, two of the taxes on individuals with high income from Obamacare have been retained. The Net Investment Income Tax and the 0.9% Medicare surtax on incomes over $200,000 would continue.  Because of that change, the remaining tax cuts are less regressive. Upper income households will still get the largest dollar amount of tax cuts, with the tax bill for those in the top 1% decreased by $2900 or 0.1% of their after-tax incomes, but middle income families, $54,000-$93000, will pay an average of $280 less or 0.4% of the after-tax income. And $70 billion has been added to stabilize insurance markets. But the other major objective of the bill, to restructure Medicaid, a dreaded “entitlement” program long in Paul Ryan’s sights, remains unchanged.

Outside the restructuring of Medicaid and tax cuts, it’s important to understand that the insurance core of the bill is focused on individual insurance, a relatively small part of the health insurance market. Over 54% of nonelderly adults are insured through employer-based insurance, although that proportion continues to shrink as employers have stopped offering plans and more people have become entrepreneurs, self employed, consultants and part-time workers. Admittedly, that was part of the objective of Obamacare, to create more portable insurance that would allow people to switch jobs more easily. Adults over age 65 are primarily covered through Medicare. And low income people are covered by Medicaid and many middle income adults are now covered by the expansion of Medicaid under Obamacare. Somewhat less than 10% of adults are buying insurance in the individual market.

The outcry is building. Senator Susan Collins from Maine has publically announced she won’t vote for it. Rand Paul is still saying no and trying win others over. He thinks it’s still “Obamacare Light”, retaining the subsidies and many of the regulations. He doesn’t believe the government should be paying subsidies to an industry making $15 billion in a year. (Seems like a valid point.) That leaves only one lone wolf who can desert the pack if the bill is to pass. The governors, the AMA, various physician groups, American Hospital Association, and BlueCross BlueShield and insurance industry groups have all panned the bill. And the popular view is a resounding 17% of the public favor the bill. That should call for a Senate pause; apparently the outcry to Repeal Obamacare doesn’t actually exist. Obamacare may be failing (it isn’t but that is part of the GOP mantra), but people would rather have that than this bill. They did not ask for  tax cuts for the wealthy at the expense of restructuring Medicaid. It’s difficult to recall an outcry across the country for Medicaid restructuring; in fact Trump promised during his campaign that he wouldn’t touch Medicaid and enough people voted for that to get him to the White House. Like most Trump’s statement, that one proved ephemeral; recently, he tweeted that Republicans should pass the bill. But that could change.

Will the vote to vote happen after the one week delay to allow John McCain to recover from surgery? Mitch McConnell seems determined to move forward, using the weight of party destiny to exert maximum pressure on Senators. By forcing the vote, he wants it on the record if the bill fails, so the party traitors can be targeted by the conservative PACs and new candidates rounded up to oppose the incumbents who dared to stray from the Koch led billionaires’ cabal mandate. These days, that’s the cost of voting for the people rather than with the corporate feudal lords.

When the dust clears, outside of the tax cuts and Medicaid restructuring, all of the Congressional finagling over healthcare is about 10% of the medical insurance market. That is phenomenal, to have so much attention focused on such a small part of the population. Of course, the Republican plan is to massively grow that proportion with people on Medicaid expansion based insurance by “allowing them the choice of moving into the private market”.  

However, as the debate moves forward, the central problem of healthcare in the United States has been ignored completely: the cost of healthcare. Medical care is expensive and gets more expensive every year. If the cost of care is rising, the cost of insurance will also rise. If, as Republicans contend, the cost of premiums under Obamacare are in a death spiral, how will any legislation being considered halt that spiral?

Despite the Republican contention that the much exalted “free market” is the answer, it has no solution for controlling the cost of medical care. An argument can be made that free market conditions do not prevail in the healthcare market. Pricing and quality of medical services are about as transparent as a paper bag. Consumer information about patient outcomes, physician competence, hospital quality of care metrics, physician and hospital charges, and how those charges are set are just some of the factors that are necessary for patients to make an informed decision about where consumers will want to seek care. Even if that information were available, consumer choice is straightjacketed by insurance company imperatives. Free flow of information is integral to the functioning of a free market; information about products and services drives competition by allowing consumers to choose on relative merits. Unless structural changes in the healthcare delivery system are carefully considered, not a process that is best done in Congress where legislators lack the expertise in  health system complexities and the special interests with the largest pockets win the day, affordable health care in this country is the real death spiral.