Insight, analysis & opinion from Joe Paduda

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That’s the only word that describes my reaction to the election.  Kudos to Bob Wilson, who bet me months ago this would happen – he was right, and I was very wrong.  I owe you a drink; make mine a triple.

I’ve heard from many of like and opposite political mind today, and will be the first to admit I cannot get my head around what happened.  It’s not so much that the professionals got everything completely wrong. No, it’s that we elected a person who, according to many members of his own party is totally unqualified to be president in so many ways.

After reading JD Vance’s Hillbilly Elegy, I’m beginning to understand the large swath of the population that is pissed off, feeling left behind and abandoned.  I also absolutely get that we Democrats are partially or perhaps largely to blame.  I don’t buy some of their complaints, but that’s irrelevant; they feel aggrieved.

So they voted to “drain the swamp”, to change Washington. Interesting thing about change; it can be good, or it can be bad.  In this instance, it may well be really, really bad. To get an idea, of what we can look forward to, take a look at the disastrous Kansas Experiment.

There will be huge repercussions for the healthcare industry.  Rand Paul has promised to put an ACA Repeal bill on Trump’s desk week one.  We’ll see if that gets thru the filibuster, but even if it doesn’t there’s much Trump can do administratively to alter ACA.  

Now’s not the time to get into this in detail; I’ll be hosting a special post-election Health Wonk Review Friday that will dig deep into the issue. For now, I’ll leave you, dear reader, with a message I sent to our three wonderful, smart, caring, adult kids.

Ok family. We have today to feel miserable and angry and disgusted. Tomorrow we get to work on fixing it. 74 years ago your 19-year-old grandfather flew through fighters and flak above Germany to save our country. It’s our job now. I had become complacent and lazy about preserving what we are so lucky to have. I see that very clearly, now that the consequences of that inaction are so apparent. It’s on us.


23 thoughts on “Shock”

  1. We cannot hide our heads in the sand when people lose their jobs to nations that barely can take care of their own people, or have too many other problems. We cannot listen to, or take orders from corporate leaders who can travel half way around the world in a day and a half, and don’t care that the country is literally falling apart, as long as their businesses improve their bottom lines. And we in the insurance industry cannot afford to poo-poo ideas that are out of the box, and are presented to make things better, not worse, just because of too many stakeholders or dinosaurs who rail against these ideas. And lastly, we have to accept that one day, our health care system will collapse and we will have to have single-payer, screw the health care insurers,

  2. All Healthcare professionals need to pay attention and be very vocal in call our senators and congressman. WE do have a voice and the expertise to drive policy. This will be important for all professional organization to have very strong, active public policy committees moving forward.

    I would recommend a consolidation of organization. We all should be on the same page. I know the Case Management Society of America is interested in partnerships/collaboration with organization focused on care coordination, transitions of care and healthcare advocacy. Let me know if any questions or an introduction to the leadership.

  3. Joe,

    Nice post.

    BUT, I don’t think any of use can comprehend the effects of a Trump presidency.

    I will be good to review in retrospect in mid-summer ’17.

    Crazy is as crazy does.

  4. This is a big shake-up. Democrats voting Republican. Republicans not towing the party line. Voting for one candidate simply because you despise the other one — quite frankly I think a lot of people flat out despise Hillary. There are plenty of good reasons in my opinion that Trump is better suited to lead our country than Hillary, but I won’t delve into that.

    Would Trump repealing the ACA be bad? No, not in my opinion. I am fortunate to have good insurance through my employer…and my insurance premiums/copays/coinsurance have skyrocketed and coverage has dwindled with all of the ACA mess. I’m lucky. Let me say it again…I’m lucky. I’ve helped my friends with their insurance nightmares while they try to figure out the marketplace and find a way to pay the bills. Personal responsibility for your healthcare is important like car insurance is important, but it has to be manageable.

    Now is the time to embrace the change and move forward as a country.

    1. Repealing of ACA be bad? It’s only added insurance coverage for tens of millions of people (both through Medicaid expansion and Exchange coverage) who will now lose coverage. This loss of coverage will create more uncompensated demand to providers, raising employer group premiums even further. Back to the days of 40m uninsured. You could change some things about ACA but repealing it will create significantly bigger issues.

      1. My premiums jumped $450 a month in just over a year. Chopping up Obamacare is one of the main reasons I voted for Trump. I don’t think American’s voted for Trump or Hillary because they liked them. They voted off their platforms. Trumps just happened to be more popular. People were pissed off in what’s happened to our country over the last 8 years…including myself. Trump has surprised many people. Maybe he will surprise many people and be a decent president. Don’t we all hope that?

  5. Great post Joe. No matter how disheartening the results were for me, my husband, and our 6 children- we talked about Moving on, being strong, and uniting for what we believe.. .. or moving to Canada.

    1. Thanks Peggy. Remember Hillary won more votes. We can’t leave. This is our country. We have no other. We begin tomorrow.

      1. You have to admit it is amazing foresight by our founding fathers that the country will not be run by hyper-populated inner cities of NYC, LA, Philly, Chicago, etc… which massively inflated the popular vote (the by-county US map is breathtaking how red it is). The ‘real’ work and the heartbeat of America gets done in the heartland and those are the new ‘silent majority’ that the dems abandoned. It’s a new world out there and time for Trump to ‘shut up and show us’. Can we pull together and make this country great again? We shall see…….#allthreechambersnoexcuses

        1. John – thanks for the comment.

          I take exception to your claim that the “real work” gets done in the “heartland”. Look at the economic data – most economic output is from teh coasts. As to the forefathers somehow forecasting the rural vs city vote, that is just not true. The issue they tried to balance was state vs population-based voting authority which resulted in the Senate and House, and the electoral college. Cities v rural wasn’t the driver

          1. Joe, with regards to your statement…” Look at the economic data – most economic output is from teh coasts” I think you are missing the point. Economy is about input and output, simplistically. Compare that with the human body. Most of the input and output comes from the coasts( the mouth and the anus), but if you don’t take care of the heart, the others aren’t going to matter.

          2. thanks for the comment. We Dems clearly missed the boat with the non-college educated white population. However your analogy makes no sense in the context of the commenter’s post or in the context of economic output.

  6. Our founder fathers were wise enough to create a system with “checks and balance” in place to ensure that opposing voices and ideas are recognized. President Elect Donald Trump, will face the same challenges all presidents face when attempting to make substantial change. But “immigrants” really are they the reason that manufacturing left America, are the “immigrants” the reason we are more concerned about a minimum wage over a professional wage, are “immigrants” the reason the OIL & GAS industry continues to cripple our economy and control our foreign agenda? It’s impressive that the President Elect managed to convince the ELECTORATE that “immigration” is an issue that the nation should be concerned about.

  7. Well, first off, Joe, thank you for graciously admitting I was right. That was the second big thing many people did not expect to see this week. I can successfully check another box off my bucket list.

    As we have discussed before, Trump was not my first choice, but he was my final option. The fact that the Dems posted a seriously flawed candidate of their own did not help their cause.

    I would agree with your assessment that there is a “large swath of the population that is pissed off, feeling left behind and abandoned”. You may be surprised that I don’t fully agree with your statement that “Democrats are partially or perhaps largely to blame”. They are, but the Republican establishment is no less to blame in the Trump phenomenon. This election was very much about an entire mass of FORGOTTEN citizens weary of a bloated, slothful government only concerned with pleasing special interests – often at the expense of that same ignored citizenry.

    I would also encourage you not to go too far down the path labeling Trump supporters as toothless, ignorant hayseeds. He got 49% of the white college educated vote. I know many, many educated, successful PRODUCERS who ended up supporting him over Hillary. He did get a disproportionate share of the blue collar vote (who normally vote Democratic) – which if you recall is what I predicted he would do.

    Finally, I would caution all that Trumps election is only a beginning. He still has to navigate a large part of his agenda through those pesky slothful pols of both parties in Congress. This isn’t 1930’s Germany, and our Reichstag will not burn in the middle of the night. It is going to be a fascinating new variable in the ongoing experiment called the United States of America.

    1. Bob – If “people” didn’t think I’d acknowledge you were right and I was wrong, those people don’t know me well.

      I did NOT label nor characterize Trump supporters as “toothless, ignorant hayseeds”; those are your words, not mine. I too know a number of colleagues like yourself who supported Trump. I believe their – and your – decision was catastrophically wrong – and I sincerely hope it wasn’t.

      1. No, I think you misunderstood. The surprise was not your admission; its that I was in the first place.

        Did not mean to put words in your mouth. I know you did not call Trump supporters that. Just using it as an example of broader descriptions that seem prevalent in social media at the moment. Merely making the point that not all Trump supporters are uneducated.

    2. Well said Bob! I am with you. I voted Trump because of his platform and nothing more. I was one of the pissed off American’s that was sick of the direction our country was heading and tired of both parties. I want Trump to do well and I would hope all American’s feel that way.

        1. For me personally it was the chopping of Obamacare. It has been a big financial blow to my young family of a wife and 5 kids. $450/month raise in premiums over the last year. I wasn’t happy about that. I am a big supporter of the 2nd amendment. I also don’t like the many social changes our country has embraced (Socialism, attacks on religion, college “safe places”, etc.)Also I feel the Iran nuke deal was pretty bad and how Obama has catered to Iran. There are many other things I could go into but this would be a pretty long post. So for me I looked at it as if I were going to have back surgery. I would take a good surgeon with horrible bedside manors over a bad surgeon with good bedside manors. I wasn’t looking for a friend to vote for, I voted for someone to clean up America. I don’t know if Trump will be a good president or not but I knew what we would have gotten had Hillary won. So I voted with a little hope that Trump may be a good president. If he isn’t then me and many others will be wrong just as many people who voted for Obama admitted they were wrong thinking he would be good. It’s hard to know for sure. I do know we need to come together and do what we can to help this country. Unfortunately it takes a natural disaster or tragedy to unite the country. I sure hope that doesn’t happen.

  8. In the long run, the ACA issue only affects 6% of the market. There are bigger issues at hand, runaway spending, enormous deficits. The return to economic sanity where folks like me that have reduced our debts to zero and save money are actually rewarded with being able to make our money work without going into the figment that are stocks, funds etc. There is much that has been upside down starting with the Bush Presidency, Trump is merely a symptom and a response to being trampled, ignored and insulted for many years. People came from all walks of life and political leanings to put him into office. The Clintons never had a chance, they were a bad investment for George Soros and global investors that put their bet into their campaign and their Foundation. Both parties are really the same and are in the pockets of the same people. Remember that the less the Federal Government does the better off I am. I know this paradigm has shrunk as more and more are beholden to the Federal Leviathan, but its not what the founders envisioned for us.

    1. Tony – thanks for the comment. I’d suggest there are any number of Federal entities that provide deep value; I’m reminded of the pictures of the protestor in an electric scooter wearing the “keep your government hands off my Medicare” sign.

      Many of those protestors voted for Trump.

  9. Realize that when Obama came in in 2008 the economy was a veritable wreck. To make something out of that took some work and it could have easily tanked. And Cruz filibustered with green eggs and ham to keep the government on hold.

    And so we lost over 33% of our retirement kitty, hard work went into that, lots of hours, missed family time, and thrifty living.
    So yes I think Obama has done a good job with what he inherited.
    And as for Trump he is the ultimate marketeer. We will see if there is any substance to him.
    He certainly is a misogynist. I would not let my teenage daughter near him. What he says about women is directed to your mother, your grandmother, and your daughter. PCT, his names for women!

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Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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