Monday, July 17, 2017

Responding to Sen. Johnson on Health Care

Sen. Ron Johnson (R-Wisc.) recently penned an op-ed for The Times, “Where the Senate Health Care Bill Fails.” Mr. Johnson’s moral outrage seems fundamentally misdirected, and his understanding of the free market and how it functions, particularly in regards to health care, is wholly flawed.

Rather than focusing on the 20 million people who will lose insurance over the next 10 years or the upward redistribution of wealth through unnecessary tax cuts, he laments the government’s failure in obstructing the forces of the free market and the projected deficit increases that will result from the Senate bill.

A truly moral and compassionate society,” Mr. Johnson says, “does not impoverish future generations to bestow benefits in the here and now.

First, the Reagan-esque tax cuts for the wealthy, which lie at the core of the Senate health care bill, impoverishes future generations to bestow benefits in the here and now to those who don’t need them. Second, the tendency of Mr. Johnson and many of his Republican colleagues to frame the moral component of health care in economic and political costs rather than the costs of human suffering and death is truly stunning.

What’s more stunning is that we Americans have largely accepted the premise that health care markets function like other commodity markets. As a result, we no longer appear to question that in the case of problems like rising premiums and deductibles, to use Mr. Johnson’s words, “a simple solution is obvious. Loosen up regulations and mandates, so that Americans can choose to purchase insurance that suits their needs and that they can afford.”

Health care is not simple, but we’ve been fooled into believing it is because of our national, zealous belief in the power of the free market and a false notion that health operates under normal market rules. I’d like to demonstrate this point by looking at the crux of Mr. Johnson’s argument:

Layer upon layer of laws, rules and regulations have made our health care-financing system a complex mess, separating patients from direct payment for health care. As a result, patients neither know nor care what things cost. We have virtually eliminated the power of consumer-driven, free-market discipline from one-sixth of our economy.

It’s worth noting here that no market is truly free. In his book “Saving Capitalism,” Robert Reich clearly explains how all markets are governed by rules, and those rules are not inherent, but rather set by those in positions of power, often governmental forces. So, while Mr. Johnson asserts that laws, rules and regulations alter the rules of the market, the very same could be said for any repeal of laws, rules or regulations. Each are simply means to alter how the “free” market is governed.

Still, any functioning “free” market operates under certain assumptions, namely the transparency of costs, the ability to make choices based on those costs and the ability to freely enter and exit the market.

Mr. Johnson is absolutely correct that patients are largely ignorant of health care costs. In 2013, Steven Brill wrote an exceptional piece for Time on the inconsistent prices for services set by hospital chargemasters and the lack of transparency regarding the process for setting those prices and the eventual costs billed to patients and insurers.

I’d wager to guess that almost nobody reading this piece could name the cost of a physical, even though many of us get one every year. Even worse, the cost of a physical from Dr. A might be half that of Dr. B even though their offices are only three miles apart. The arbitrary and often secretive nature of service pricing makes it cumbersome if not impossible to comparison shop. Right away, we’ve violated our first market assumption, transparency of costs.

Moreover, this lack of transparency essentially violates the second assumption that we can choose services and providers based upon those costs. But let’s assume by some miracle we all knew the cost of every service and insurance plan available. Even under these fanciful circumstances, choice remains largely an illusion.

Let’s look at insurance plans first. According to the Kaiser Family Foundation, 49 percent of Americans receive insurance through their employers. Typically those plans are far better than those on the individual market. However, your choices are rather limited. An employer might offer three different plans, all of which are packaged with predetermined premiums, deductibles, copays and levels of coverage. Not a lot of choice.

And your ability to choose services might be more limited based on the type of plan you select. Let’s say you have an HMO, which typically mandates you select a primary care physician to address your basic needs and refer you to specialists.

So you select Dr. A, who charges less for physicals than Dr. B. But what happens when you need another service from Dr. A, like an x-ray for a sprained ankle. Sure, Dr. B doesn’t charge as much for that service, but you’re locked in to Dr. A, so you have to pay the higher costs, even if by some miracle you could research those costs an endured the pain of a possibly broken ankle long enough to investigate them.

And this brings us to the final assumption of most markets, namely that we have the ability to freely enter and exit based on cost and choice. Mr. Johnson feeds us an atypical example – all but parroting his colleague Sen. Rand Paul (R-Ky.), an ophthalmologist: “Look no further than how laser eye surgery went from exotic to affordable during the years it was not covered by most insurance.

While Mr. Johnson’s statement regarding the decreased cost of laser eye surgery is technically true, it’s incredibly misleading. Market rules actually do apply to this sector of health care, unlike most others.

I happen to wear to glasses, and I am a prime candidate for corrective laser surgery. Eye surgeons are relatively transparent about the price for this procedure, and I can easily evaluate my options and thus make an informed decision based on price and expertise. Moreover, I can choose to enter and exit this market at will because, regardless of how much I may want the surgery, I don’t need it. My glasses work fine. It’s this very fact that I don’t need the surgery now that affords me the time to comparison shop.

However, let’s look at other sectors of the health care market, namely emergency care. Let’s say I’m at home and I have a heart attack. I’m in the health care market now, and you can bet I didn’t choose to be.

I call an ambulance to take me to the hospital. Many rural and small town Americans are serviced by a single hospital, so if these folks have heart attacks, that’s where they go and they pay the prices set by the hospital at a rate negotiated by their insurance. Again, little choice.

But I’m fortunate. My town has three hospitals. Let’s say against all odds I actually know the cost of heart surgery at each of them, and in the throws of cardiac arrest, I manage to instruct the EMT to drive me to the cheapest one. Even in this most unlikely of scenarios, that’s still not going to happen, as most EMTs are required to take patients to the nearest hospital, for obvious reasons: I’m more likely to live if I’m treated sooner.

This is a perfect example of why free market policies don’t align with the reality of health care in this country. Costs are secretive; even if we learn those costs, we’re limited in our ability make choices based upon those costs; and we can’t choose to enter and exit the health care market.

Admittedly, some of those issues could and should be addressed. Health care providers should be regulated to keep the cost of services down and relatively equal within certain medical sectors and geographic areas.

However, any insurance system that remotely resembles our current one will necessarily limit choice, as the only way to control costs is to collectively bargain, meaning most of us have to sign on to limited numbers of group plans. Regardless, the unpredictable nature of illness will always prohibit free entry and exit of the health care market place.


Mr. Johnson’s longing for free market solutions to health care may appeal to our ideological sensibilities, but in a practical sense they will never work because health care does not operate like most markets. Addressing America’s health care problems will require inventive solutions based in reality, not rhetoric, the latter of which appears to be all Mr. Johnson can provide.

Tuesday, June 13, 2017

Owning Our Leaders in the Time of Trump

The current, Republican-led, U.S. federal government is an unmitigated, bipartisan shitshow. And by bipartisan, I don't mean both sides of the aisle are to blame. I mean that from an objective viewpoint -- or at least as objective as one can muster -- we're staring at a dumpster fire here, one that's going to burn for at least two years, and possibly eight.

The most obvious offender is President Donald Trump. My personal list of complaints against Trump is longer than...well, it's long. But my focus here isn't on his effort to undercut liberal policies: his failing travel ban, his undermining of progress on climate change (which is a partisan issue for some reason), his push for financial deregulation, or his proposed budget cuts to vital programs in the social safety net. Idiotic as I believe these ideas are, I recognize that to some degree they're simply an extreme version of normal arguments between Republicans and Democrats over ideological priorities.

But much of Trump's failings have nothing to do with partisan issues. First, let's look at Russia. We know that the Russians attempted to influence our 2016 presidential election -- and in favor of Trump. They even attempted to tamper with voting machines. We know Trump officials have connections to Russia in various capacities. It's unclear if Trump or his aides colluded with Russia in any way, but there are concerns about conflicts of interest and blackmail, and Trump's reluctance to release his tax returns (a custom dating back to the 1970s) only raises suspicions.

Those suspicions were magnified over Trump's decision to fire FBI Director James Comey, a decision Trump admits was influenced by Comey's continued Russian probe. The day after Comey's firing, Trump held an oval office meeting with Russian Foreign Minister Sergei Lavrov and Ambassador Sergey Kislyak, where he admitted that Comey's departure relieved a great deal of pressure; then he went on to leak information gathered by Israeli intelligence to the Russians at that same meeting, just for good measure.

Last week, we learned from Comey's testimony that he felt pressured into a patronage relationship with Trump, prompting Comey to record his encounters with the president and to subsequently leak those memos in the hopes of forcing the appointment of a special prosecutor. Yesterday, we found out Trump is considering dismissing that same special prosecutor.

Trump's failures extend far beyond the Russia mess. Trump has yet to fill 553 key, Senate-confirmable positions; what's more, he hasn't even put forth a nominee for 89 percent of those openings.

This shortfall in staff might partially explain the hollowness of his economic policy. Writing for the the Atlantic, Derek Thompson summarized Trump's economic policy well: "There is no policy." Virtually everything Trump has done on this front has been all sizzle, no steak. Last week's infrastructure signing ceremony was simply Trump sending a memo to Congress requesting they act. His proposed tax plan is less than a page long and scant on detail. His budget only balances if the GDP growth doubles the forecast -- and if you double-count that growth, as his budget folks did, resulting in a $2 trillion math error.

Additionally, in his brief tenure, Trump has show complete disregard for ethics. Hiring Ivanka Trump and Jared Kusher ignores antinepotism norms, and potentially laws. He's also requested an unprecedented number of ethics waivers allowing former lobbyists to oversee the very industry sectors for which they lobbied (so much for draining the swamp). Recently, Maryland and D.C. have filed a lawsuit against Trump alleging that he has used his position rather egregiously for his own financial gain.

The Republican Congress, which is meant to check the president's power, has tripped over itself in rather pathetic attempts to defend Trump. Speaker Paul Ryan's excuse: "The president's new at this." Really?
 
Still, Sen. Lindsey Graham's backhand-compliment defense is perhaps the most succinct summation of the Trump White House: "
He doesn't believe he did anything wrong with the Russians, and I tend to believe him. He can't collude with his own government. Why do you think he's colluding with the Russians?"

In attempting to stand by Trump, the Republican Party leadership has in actuality undermined him. When Trump's best defense is that he's either to inexperienced or dimwitted to be guilty, it raises the question of whether he's to inexperienced or dimwitted to be president.

But he is president. And he will continue to be. And it's because voters are often stupid and always tribal.

This morning, I read an op-ed in The New York Times about the Senate's handling of the Trumpcare bill. Essentially, it looks like Mitch McConnell and the Republican leadership will attempt to ram something through by early July. The leadership is constructing the bill in secret, with no scheduled hearings or attempts to compromise with Democrats -- a particularly infuriating move seeing as that was their main complaint against Obamacare. (And a false one at that. Obamacare was debated in open sessions for a year, with several Republican amendments added, effectively killing the public option, among other proposals.)

Heres how the article concludes:

Republican leaders seem to think they will gain a tactical legislative advantage if they can negotiate a deal behind the scenes and then suddenly spring it on the full Senate. Those gains will quickly evaporate when voters learn what they have done.

The NYT editorial board seems to believe voters will revolt against policies that negatively affect them and support politicians who act to their practical benefit. In my estimation, this is a rather naive view, and the 2010 midterms bear this out. 

President Obama signed the Affordable Care Act into law in March 2010. Though imperfect, it was a vast improvement over the existing system: more Americans are insured, premiums have stabilized, and job growth hasn't suffered. In part, that may account for steady increases in support for the ACA since it's passage (54 percent of Americans approve of the ACA, while only 32 percent approve of the proposed replacement).

What did the Democrats get for those efforts? They lost six governorships, six Senate seats, and 63 seats in the House.

The lesson? Perception is more powerful than the reality and tribalism is more powerful than common sense. Obamacare wasn't a government takeover of health care, nor was there ever any attempt to institute death panels to kill your grandmother. But that's the false narrative that confused and misinformed voters relied on to oust the Democrats from power.

The ideological spin of the narrative of events was more crucial than the practical results of the events themselves -- and it will be again. 

Obamacare was and is a private sector reform passed through bipartisan negotiation. In many ways it's more Republican than Democratic. But Republicans couldn't support it because Obama did it. American politics now operate on one rule above all others: Better to deal a defeat to the American public than allow a victory for the other team. 

And the fragmented media environment that offers each of us our ideal augmented reality makes it possible to reframe each blow to the average American as somehow the other guy's fault. In reality, it's our own.

At the outset of this post, I feel I laid out a fair account of the facts in the case against Trump's general competency and the case for his possibly illegal behavior. But Trump is and will likely remain insulated from any meaningful consequences up to and including impeachment. To impeach a president, a majority vote in the House is required. Then the president is tried in the Senate, and removed only if a two-thirds majority elects to do so. Currently, to remove Trump would require 22 House and 19 Senate Republicans to vote in favor, assuming Democrats and Independents all do. Not going to happen.

Why? Trump's approval rating. Yes, Trump's is historically low. According to Gallup, as of June 11, 2017, he sat at a meager 37 percent. But if you look deeper, you'll notice an unprecedented partisan gap: only 8 percent of Democrats approve of Trump, but 83 percent of Republicans back him. So for senators in conservative states and representatives in conservative districts who are routinely elected without having to win over many -- if any -- Democrats, there's no incentive to move on Trump, especially considering Democratic turnout in midterm elections is abysmally low. That could change, but if there's little threat of losing one's seat, there's little to gain in checking Trump.

Since Trump's election, I've heard many of my fellow liberals claim he's not their president. Yes he is. And it's important to remember that he is. It reminds us of the agency we have as citizens and voters in a representative republic and the responsibility we have to uphold its values.

But I'm not naive. I know it's Team R vs. Team D. I'm firmly on the latter side here, so it's easy for me to throw stones at our president. It's not fun to admit when your guy is wrong, but sometimes he is. Obama was wrong on many occasions, from the strengthening of the surveillance state, to the expansion of drone use without oversight, to his noncommittal stance on Syria, to his lie that you could keep your plan via the ACA (though there's a lot of nuance on last one).

Now we're at a point where Team R needs to step up. Trump is a failed experiment on what happens when a novice is drafted to the big leagues. He's not capable enough to do the job, nor intellectually curious enough to ever become capable. He's placing himself above the law, or at least positioning himself outside it. His willingness to ignore every democratic norm, to violate any principle, and to lie and con for his own personal gain are affronts to public service in its most basic terms.

These should be egregious offenses in the eyes of all Americans, not just Team D. In fact, I know they are, but we've become too tribal to face an obvious and objective threat. And for the folks on Team R, what do you gain for this erosion of the American soul? A bag of empty promises and a cheap red hat, probably made in China. So much winning.

Tuesday, February 28, 2017

Secretary DeVos doesn't understand what I do

As a university professor, I was profoundly disappointed in Secretary of Education Betsy DeVos' remarks at CPAC regarding higher education. Speaking directly to the university students in attendance, she said:
The fight against the education establishment extends to you too. The faculty, from adjunct professors to deans, tell you what to do, what to say, and more ominously, what to think. They say that if you voted for Donald Trump, you're a threat to the university community. But the real threat is silencing the First Amendment rights of people with whom you disagree.
Everything about this statement, from the assertions made to the manner in which those claims are presented, is utterly false.

The goal of any reputable university is not to tell students what to think. It is to teach students to think critically and to think for themselves.

In my admittedly young career, I have worked as an instructor, lecturer, and assistant professor at three universities in three different states. That goal has always been the standard: How do we mold the next generation of young people into thinking, critically engaged adults ready to enter civic life and prosperous careers?

We wrestle with this every day. We literally lose sleep over it. And we don't always have a ready answer to this question given the delicate environment we face.

Generally speaking, college professors are a liberal bunch, oftentimes more liberal than our students. But we know that. And we also know that we exercise influence over our classrooms by virtue of our position.

With these considerations in mind, I've had numerous conversations with diligent and thoughtful peers and mentors about how we may temper our personal biases. We strive to avoid anything resembling indoctrination and work to maintain a free flow of ideas through honest debate.

We try to engage with students regarding current events and controversies in ways that allow students to express and debate a multitude of opinions. Oftentimes that means checking our own biases at the door, playing devil's advocate, and ensuring that oftentimes heated discourse among students remains civil so all feel confident that their voices will be heard and respected.

But remarks like those from Ms. DeVos and the underlying attitudes about ivory tower elitism make an already difficult task that much more so.

Professors and lecturers have in many cases become so fearful of accusations of undue influence that they actively avoid discussions of politics or any controversial topics for that matter. Such an approach is antithetical to the very idea of what education should be, and it has dangerous consequences for our democracy.

You can determine the quality of your education by answering a simple question: Was I ever made to feel uncomfortable? 

I spend most of my days as a professor making students uncomfortable. I challenge their worldviews, regardless of what they are. That makes them uncomfortable. I ask them to explain why they say what they say, or think what they think. That makes them uncomfortable. I don't reward students for simply having opinions, but demand they justify their stances. That makes them uncomfortable.

A good educational environment allows students to test ideas in the marketplace, to learn that they are sometimes right and sometimes wrong, and to refuse to accept any statement or truism without reason or evidence. Depriving students of this opportunity creates a form of self-indoctrintation, where we all view ourselves as correct and the ultimate arbiters of truth because we never questions ourselves or others. 

This insidious effect is more common than many might think, and it threatens our ability to sustain a democratic society. The inability to honestly debate ideas cripples our capacity to effectively address serious problems.

Educators, and the public writ large, must also understand that challenging an opinion is not the same as silencing one. If a student voices opposition to childhood vaccinations or support for school vouchers, I am not silencing her by asking, "Why?" 

I want to know if her opinion is informed. I want her to think about the sources that inform that opinion. I want her to ask whether those sources are credible. I want her to ask what makes for a credible source. I want her to critically evaluate her own thought processes. I want to know if she's echoing someone else's thoughts, or if she is thinking for herself.

That is education. If Ms. DeVos has a differing opinion, I welcome her thoughts on the matter, but I'm going to ask her why she thinks as she does.

Tuesday, February 7, 2017

The Margin of Error

Trump, like all politicians, preys on certain ignorances among the population to advance his political agenda. And when I say "ignorances," I don't mean that in the nuanced sense, as if to refer to racism, sexism, xenophobia, or the like. I mean it in the literal, Webster's dictionary sense: "lack of knowledge, education, or awareness."

And, I suppose if I'm being super specific, it's the ignorances of our ignorances -- i.e., not knowing what we don't know -- that have been exploited most by the recent travel ban. If there's two things every politically engaged American claims to be, yet most certainly is not, it's Constitutional lawyer and an expert on opinion polls. We tend to cite both sources badly, and often only when the most tertiary readings support our position.

Apparently, our president is no different, at least according to his Feb. 6 tweet:
Any negative polls are fake news, just like the CNN, ABC, NBC polls in the election. Sorry, people want border security and extreme vetting.
First and foremost, to Mr. Trump: you're the goddamn president, and also a 70-year-old man. There's no fucking reason for Twitter to be your primary mode of communication.

But to my main argument, I assume that Trump is referring to the widely circulated CNN/ORC poll conducted last week, in which 47% of respondents approved of the ban, while 53% disapproved.

The CNN/ORC poll in question appears fairly sound (some might argue the travel ban question is a bit leading, though if that's the case I would say if anything it skews in favor of the ban). In either case, the margin of sampling error is plus or minus 3%, so a 50/50 split in public opinion is actually fairly likely. Unfortunately, many news outlets fail to report this all-important margin of error, and even when they do they fail to seriously consider it.

So let's talk about margin of error as it relates to opinion polling.

If you want want to know exactly what public sentiment is on any given issue, you'd have to ask every member of the population. This process is called a census. As the population increases in size, taking a census becomes more expensive and time consuming. Imagine how long it would take to poll all of the 200 million registered voters in the U.S.?

That's a huge reason why pollsters sample, or question a subset of the total population that reflects its general make-up. A representative sample of about 1,000 people can give you an immensely reliable estimation of how the total population feels.

But sampling, though efficient and reliable, is not exact. That's where the margin of error comes in. It basically operates as a cushion to indicate how good a pollster's estimate is. For most professional political polls, plus or minus 3-5% is the norm. Essentially, that means it's highly likely that the true opinion of the public lies within 3-5 percentage points of what the poll reports.

So, returning to our CNN/ORC poll, it doesn't actually state that 53% of American adults disapprove of the ban. It states that the pollster is highly confident that 50-56% of Americans disapprove of the ban.

What I'm saying is Trump should stop bitching. He may very well have the support he claims to have. And even if he didn't have that support, his grounds for complaining -- namely that the election polls were wrong -- has no standing in reality.

It's true that Trump's electoral win constituted an upset, but just barely. There were a variety of models that predicted a Clinton win, some narrower victories than others. Perhaps the most followed prognosticator was Nate Silver, who missed on five states. But if you take a look at the average polling numbers in those states, you'll see why the margin of error is so critical:

Florida: Trump, +0.2 (Trump won by 1.2)
North Carolina: Trump, +1 (Trump won by 3.7)
Pennsylvania: Clinton, +1.9 (Trump won by 0.7)
Michigan: Clinton, +3.4 (Trump won by 0.3)
Wisconsin: Clinton, +6.5 (Trump won by 0.7)

Real Clear Politics, which aggregates these polling averages, interprets them with a 5 point margin of error. That means the only state on this list pollsters "got wrong" was Wisconsin, which fell 2.2 points outside the margin. Every other result was well within the expected range.

So long as the poll is conducted with representative samples, well constructed questionnaires, and otherwise sound methodology -- common for organizations like Gallup, Reuters and Pew (among others) -- you can and should trust the results. But equally important is learning to interpret those results, both as individual questions and on the whole.

It's incredibly dangerous to dismiss good information out of hand, especially if the major reason for your dismissal is that you simply don't like the results. That's largely how Trump appears to operate, not just with polls, but with everything, though that's a longer conversation best left for another day.

Tuesday, January 31, 2017

Trump and his Media Magicians

In the days since President Trump’s inauguration, news consumers have watched members of the press all but implode over the recent barrage of “alternative facts.”

In the administration’s first full day, White House Press Secretary Sean Spicer, presumably under direction from Mr. Trump, used his first press briefing to claim the president’s inauguration crowd was the largest in history. Not long thereafter, Mr. Trump reiterated his belief that he lost the popular vote because 3 to 5 million illegal residents voted fraudulently, and has since indicated he plans to investigate this alleged voter fraud.

From all the available evidence, these claims are demonstrably false. And not false in the maybe-sort-of-kind-of way that has dominated our politics in recent years. Flat out false. Easily observable false. Unbelievable that anyone in a position of power would suggest them false.

That’s what journalists have found so utterly baffling. It’s not what Mr. Trump and Mr. Spicer said that so confounds them, but rather why they would say it. Writers, reporters and pundits’ heads are spinning frantically as they attempt to wrap their minds around these lies. In general, the narrative that has dominated the news cycle during this first week is that Mr. Trump would only make such assertions if he were incompetent, insecure or some combination of the two.

And therein lies the answer to the ultimate, “Why?” No, not that the president is incompetent or insecure – though he perhaps may be. The answer is that Mr. Trump has been able to dominate the news cycle. Or, to be more precise, he has dictated it.

Since taking office, Mr. Trump has taken a variety of actions, many through executive orders, that have potentially far reaching effects on numerous fronts: access to health care, abortion rights, trade policy, climate change. These are all crucial issues that may significantly impact the lives of American and global citizens alike.

To be fair, these actions by Mr. Trump have garnered some media attention, though that attention seemingly pales in comparison to time spent debunking and debating alternative facts – or falsehoods, in the old tongue.

But that’s the media magic of the Trump administration. Magic is the practice of slight-of-hand. We’re only mesmerized by the magic act if we focus so much attention on the magician’s left hand that we overlook what he does with his right. That’s essentially been the playbook for Mr. Trump’s first week. In the left hand are outlandish lies concerning voter fraud and crowd size, so ridiculous in nature that both the public and the press have paid too little attention to the orders Mr. Trump has signed with his right.

Whether Mr. Trump’s administration is putting on this magic show purposefully or by accident is hard to say. After all, much of the press response to these false claims has been understandably negative. However, if the primary and general election contests are any indication, this stunning behavior will be rationalized (The tax returns can’t be released because of an audit) replaced by something as, if not more, shocking (He grabs women where?!), and ultimately forgotten, buried amidst the seemingly endless array of past blunders.

I’m not arguing that media outlets should ignore these falsehoods. In fact, I think most journalists have done right by the public to hold the administration accountable. But there must be some perspective, some proportionality of response. Do we really need five days of around-the-clock coverage of the administration’s inauguration crowd claims when even cursory comparisons of photographs, Nielsen ratings data and DC Metro records can quickly and clearly demonstrate to any reasonable person that these statements are false?

Perhaps the limited resources of our press might be better spent in helping the public understand how sometimes complex bills and obscure executive orders might affect their lives and the lives of their fellow citizens. Adding context to Mr. Trump’s actions of public import is more greatly needed than adding conversation to Mr. Trump’s actions of self-delusion.