Trump's America

by Newt Gingrich

  And this was just one example.

  USA Today reported that Sharron Helman, the Phoenix VA Health Care System director during the wait times scandal, was on paid leave for six months.13

  Also, Lance Robinson, associate director at the Phoenix VA hospital, was put on paid leave for 19 months after the scandal broke, then got put back to work14 for two months before being given a termination notice in 2016.15

  According to the Daily Caller, David Houlihan, a doctor and chief of staff at the Tomah VA known as the “Candy Man,” was on paid leave for 10 months during an investigation into drugging veterans with massive amounts and dangerous combinations of opioid painkillers.16 He eventually surrendered his medical license to avoid further investigation into his activities.

  Finally, the Clarion Ledger wrote that Jose Bejar, a neurologist at the Topeka, Kansas, VA, received more than $330,000 while on paid leave for two years after five women accused him of sexual misconduct. He finally pleaded no contest to the charges.17

  It is surprisingly difficult to discipline, or even to terminate, these members of the bureaucracy. The bureaucracy is currently entitled to lengthy and expensive appeals processes, during which employees receive their salaries. President Trump has been working to empower his cabinet members with more authority to discipline bad employees, and he has already seen some success.

  This utter public failure of the VA was horrible, but it served an important purpose in exposing the corrupt bureaucracy. The 2016 Forrester Research Customer Experience Index found the federal government was ranked last by survey respondents out of 21 major industries. In fact, of the 319 brands tested, 5 out of the 8 of the worst performing brands were run by the federal government.18 And according to Pew, just 20 percent of Americans believe that government programs are “well run.”19

  This failure of the bureaucracy proved to be a big motivator for Americans in the 2016 election, and Donald Trump seemed to be the only candidate truly willing to take on the swamp.

  TRUMPING THE BUREAUCRATS AND DRAINING THE SWAMP

  Indeed, President Trump has been working to strike at the heart of the bureaucracy and counteract the wrongdoing and corruption that has been allowed to fester throughout the Washington swamp.

  First, the president has appointed judges who will uphold the rule of law and provide a much-needed check on the bureaucracy’s rogue attempts to sidestep the Constitution.

  He has also put in place serious reformers like VA Secretary David Shulkin, who has already overseen tremendous improvements in care at VA hospitals and clinics.

  In June 2017, President Trump signed the Department of Veterans Affairs Accountability and Whistleblower Protection Act20 as a positive step toward helping Secretary Shulkin in reforming the VA. According to the Government Executive, this “law will give VA Secretary David Shulkin the authority to fire any employee, lower the threshold to prove the action was justified and expedite the appeal process. Trump said it would help [the] VA remove employees involved in recent scandals involving waitlists and patient data manipulation.”21

  More specifically:

  The bill would allow the department’s secretary to fire, suspend or demote an employee with only 15 days’ notice. Employees would be able to appeal to the Merit Systems Protection Board in an expedited timeframe. MSPB would have 180 days to issue a decision, with the law designed to make it easier for VA to prove a negative personnel action was warranted. Employees would maintain the right to appeal an MSPB decision to federal court.

  Unionized and Senior Executive Service employees would each have distinct, internal grievance processes that would have to be completed within 21 days. VA could revoke bonuses from employees found to have engaged in misconduct or poor performance prior to the award and dock retirement benefits from workers found guilty of a felony that could have affected their work.22

  The appointment of Office of Management and Budget Director Mick Mulvaney, who is committed to bringing bureaucracies under control, was also a critical step in reigning in the bureaucracy. Importantly, Mulvaney is also serving as acting director of the previously out-of-control Consumer Finance Protection Bureau, which I discussed previously.

  At his first State of the Union Address on January 30, 2018, President Trump called on Congress to change the laws that protect federal employees who do not do their jobs, saying:

  I call on Congress to empower every cabinet secretary with the authority to reward good workings and to remove federal employees who undermine the public trust or fail the American people.

  This is important because there is only so much the president can do on his own. Congress must enact serious civil service reform by getting rid of the protective language the bureaucracy has been able to weave into our laws.

  President Trump and the Republican Congress have made historic strides toward giving American citizens the open, honest, fair, accountable, and lawful government that they deserve. However, there is still much more to be done.

  As Inez Feltscher Stepman with the Federalist pointed out on January 31, 2018, “in November 2016, Washington was abuzz with talk of ‘landing teams,’ as though transitioning from a Democratic administration to a Republican one was akin to landing at Omaha Beach. After Trump’s election, bureaucratic employees in the executive branch openly declared their intention to ‘resist’ by undermining his policies.”23

  This is what President Trump is facing—a bureaucracy that is prepared to fight a war. We have to make sure the bureaucrats lose.

  CHAPTER THIRTEEN

  LET’S TRUMP ADDICTION

  On October 15, 2016, then candidate Donald Trump stepped onto a stage in Portsmouth, New Hampshire, to address a state ravaged by opioid addiction. It proved to be one of the defining moments of his campaign.

  New Hampshire has been one of the states hardest hit by the nationwide opioid epidemic. When Trump visited, the state had lost nearly 500 people in 2016 alone to opioid overdose. Families were being torn apart, and the suffering was enormous. The state’s leadership, public health officials, and first responders were grappling with how to deal with this growing crisis.

  In front of more than 2,000 granite staters, Trump noted, “Recovery medications have the potential to save thousands and thousands of lives. We prescribe opioids like OxyContin freely, but when patients become addicted to those drugs, we stop doctors from giving patients the treatments they medically need.”

  This direct acknowledgment of a clear problem was textbook Trump.

  In 2016, most of the country was affected by the opioid crisis, and the response from the Obama administration—as well as virtually every candidate for office, save for Trump—was lacking in fundamental ways. The Obama White House knew the scope of the crisis at hand but lacked the will and energy to address it head on.

  The Obama administration passed the problem to the Surgeon General. The outcome—one more government report was issued in October of an election year. This was not exactly meeting urgency with urgency.

  By contrast, Trump’s intentional effort to face the opioid epidemic directly led to his wide support in counties with the highest rates of opioid overdose deaths. This was a remarkable aspect of the 2016 race because these counties had previously been carried by Democrats or carried with a much lower percent by Romney in the 2012 election. Some have dubbed these election deciders the oxy-electorate.

  The opioid crisis in their communities was just another reason they felt forgotten by the Obama administration and Democrats for the previous eight years. It compounded frustrations caused when high-paying manufacturing and mining jobs were replaced by lower-wage service jobs. These are the communities where “Make America Great Again” was not just a mantra but a daily prayer.

  President Trump did not forget them.

  One year after Trump’s New Hampshire speech, he and First Lady Melania Trump brought the weight of the White House to the crisis. The First Family jointly addressed the country from the East Room with advocates, membe
rs of Congress, and families of those suffering through this crisis in attendance. The First Lady clearly expressed the wide reach this crisis has had, saying:

  Drug addiction can take your friends, neighbors, or your family. No state has been spared, and no demographic has been untouched, which is why my husband and this administration has dedicated itself to combating this health crisis by using every resource available.

  It was here that President Trump then outlined his bold agenda to expand treatment to evidence-based medicine, break down outdated barriers to treatment, and initiate a massive public awareness campaign. He declared the epidemic a nationwide public health emergency.

  Unlike his predecessor, Trump didn’t stop with words.

  In Trump’s first 100 days as president, the Department of Health and Human Services (HHS) initiated a new plan for fighting the opioid crisis. Shortly after that, President Trump handpicked New Jersey Governor Chris Christie to lead the Commission on Combating Drug Addiction and the Opioid Crisis.

  The Commission was instructed to outline what the federal response to the opioid crisis should involve—from parity enforcement to expanded use of medication-assisted treatments.

  To be sure, this problem is far from solved. However, President Trump has undeniably done more in his first year to address this crisis than President Obama did in eight—as the epidemic exploded under his watch.

  However, the president cannot do this on his own. Trumping the opioid crisis is going to take a truly bipartisan American spirit to work at the speed this crisis—and the loss of American lives—requires. This is why I’ve joined with former congressman and addiction survivor Patrick Kennedy and criminal justice reformer Van Jones to form Advocates for Opioid Recovery (opioidrecovery.org).

  THE GATHERING STORM IN AMERICA

  Before the 1990s, the use of prescription opioids was sparse, episodic, and mostly limited to clinical settings. But when new, highly addictive, easy-to-use drugs like oxycodone came to the market, America was a prime target.

  “Physicians and medical professionals were bombarded with advertisements and educational materials that touted opioid-based treatments.” Doctors, under pressure to treat pain more seriously, bought into the messaging and prescribed opioids in massive amounts.

  Peaking in 2012, U.S. physicians wrote 255 million prescriptions for opioid painkillers—enough to give a bottle of pills to every adult in the country.1 The United States now leads the world in opioid consumption. As a point of comparison, Americans are prescribed about six times as many opioids per capita as the French or Portuguese.

  As a result, the overdose and opioid addiction epidemic is disproportionately American. A recent United Nations report indicated America makes up roughly 4 percent of the world’s population but accounts for 27 percent of the world’s drug overdose deaths.2 Opioids are driving this statistic.

  Here are some other grim facts being driven by opioid abuse:

  • On average, 175 Americans die every day from overdoses;

  • A person dies every eight minutes from an opioid addiction;

  • Overdoses kill more people than gun violence or car crashes;

  • In 2017, more people died of an unintentional drug overdose than in the entire 20-year Vietnam War conflict.3

  This is an absolute crisis. And it is in danger of becoming worse.

  From the Center for Disease Control and Prevention Prescribing Rates4

  SOURCE: CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2016. https://wonder.cdc.gov/.

  New types of opioid drugs are finding their way onto our streets. Fentanyl, a synthetic version of heroin, is among the worst offenders. At 100 times the potency of morphine or heroin, a dose of fentanyl the size of a grain of salt can kill a person.5,6 As a result, the death rate from synthetic opioids (including fentanyl) increased dramatically in 2015.

  China has played a significant role in causing fentanyl and other synthetic opioids to become commonplace. Chinese exporters are finding ways to mail them into the United States directly and through Canada and Mexico. Some efforts have been made to cooperate with U.S. authorities7 to shut down the imports, but President Trump should apply serious trade pressure on Chinese President Xi Jinping to cut this industry off at its knees. It’s time we communicate with President Xi in the economic terms he understands.

  THE MEDICAID PROBLEM

  Another contributing factor to the epidemic are the loopholes in our own health care systems.

  A recent report by U.S. Senator Ron Johnson (R-WI), chairman of the Senate Homeland Security and Governmental Affairs Committee, showed that low patient cost sharing from Medicaid have played an unintentional role in driving the opioid crisis.8 For some opioids, such as oxycodone, the Medicaid beneficiary co-pay is $1 for 240 pills. Meanwhile, the street value for those pills could be $4,000 or more.

  For some cash-strapped Medicaid beneficiaries, the temptation to defraud the system by presenting phantom pain to multiple doctors, gathering the pills, and selling them on the street is just too much to resist. Enterprising criminals also quickly organize beneficiaries to do their bidding.

  We know Medicaid is a factor because this problem has been spreading more rapidly in states that extended their Medicaid programs. The committee report sites internal HHS data, which indicates that between 2013 and 2015, death rates due to drug overdoses rose nearly twice as fast in Medicaid expansion states than in states that did not expand Medicaid. This is supported by Centers for Disease Control and Prevention (CDC) data, which shows in 2015 the five states with the highest rates of overdose deaths were all Medicaid expansion states: West Virginia, New Hampshire, Kentucky, Ohio, and Rhode Island.

  Government agencies must crack down on health care fraud. The Trump administration must find and deal with all who are trying to profit from this system at the cost of American lives.

  And fraud is not Medicaid’s only problem.

  Outdated laws make it nearly impossible for residential treatment facilities with more than 16 beds to treat Medicaid patients for opioid addiction. This law, the Medicaid Institutions for Mental Diseases exclusion, has been part of the Medicaid program since its creation in 1965. This exclusion was meant to favor community-based care and protect mental health patients from overcrowded and under-resourced facilities, but it has become an artificial barrier keeping Medicaid patients from getting treatment at these facilities.

  President Trump boldly announced his administration’s intent to overcome this troubling exclusion and is using executive authority through a waiver program to do just that. However, Congress must provide a permanent legislative solution.

  OPIOID ADDICTION IS UNIQUE

  The American health care system has always given mental health a lower priority than physical health. Some progress has been made, but mental health remains undertreated and brain science is still underfunded and underappreciated.

  This poses serious challenges for dealing with opioid addiction since it is a mental illness.

  Most people living with addiction are not receiving any medical treatment. Even many of those who are getting treated are not receiving the most effective care. Only about one in ten people with a substance use disorder receive any type of treatment.9

  Worse, our current system for opioid addiction treatment is antiquated. It uses old information and perceptions about addiction and treatments. Furthermore, it doesn’t take into account that opioid addiction is unique.

  Behavioral approaches like traditional therapy and abstinence-based rehabilitation are indeed successful options for many types of addiction and can be part of the solution for this crisis.

  For people living with opioid addiction, however, abstinence-only and talk therapy often fails and can be deadly. Opioid misuse, even for a short time, changes the brain’s chemistry. When a patient tries to stop using opioids, the body starts the withdrawal process.

  If the individu
al later relapses and attempts to take the same dose of opioids he or she is used to, the brain often can’t handle it, the body shuts down from the overdose, and the person dies. In fact, a person is more likely to overdose and die after going to an abstinence-only, in-patient rehabilitation center than if they never sought treatment at all.

  Even if they do not overdose, 80 percent or more of those in traditional treatment for addiction relapse.10

  Despite these crushing facts, the United States still pours resources into abstinence-only rehabilitation and expects a different result. This not only fits the definition of insanity—it is deadly.

  MEDICATION-ASSISTED TREATMENT, FIGHTING BIAS

  There is a better way. The research is unequivocal that behavioral therapy combined with recovery medications, such as methadone, buprenorphine, and Suboxone, is the most effective way to treat opioid addiction.

  Evidence shows this combination of treatment can cut the mortality rate among addiction patients by half or more.11 It also leads to improved health and functioning. Behavioral therapy helps people develop support systems and coping mechanisms to stay on their road to recovery. At the same time, opioid recovery medications help patients better weather the withdrawal process and curb cravings.

  The effectiveness of medication-assisted treatment is supported by the World Health Organization, the United Nations Office on Drug Policy, the CDC, the National Institute on Drug Abuse, and the American Society of Addiction Medicine. However, only 41 percent of treatment programs offer any kind of medication-assisted treatments. Even if such treatments are offered, many patients don’t receive the medications.