Keeping Us Poor, Sick, Weak and Tired

In Conversation with Norm Ornstein

[Transcript edited for clarity, flow and length]

Mary Trump: I spoke with my friend and fellow nerd adventurer, the amazing Norm Ornstein, about the Medicaid cuts that were built into Donald’s big abominable bill and the impact they’ll have when they take effect after the midterms. We also talked about the stunning inhumanity of dismantling agencies like USAID and the knock on effects of losing our ability to wield soft power.

Norm, it is always so wonderful to see you, even under these circumstances, I have to say. One of the many reasons I wanted to talk to you is because you recently wrote a piece in The New Republic called “The Republicans Are Going to Kill People, But Not Until After They Vote.” I want to start with this piece because it so well articulates the diabolical agenda of the Republicans.

On the one hand, how open their cruelty is, how they so embody or exemplify a kakistocracy, which is not just rule by the most incompetent, but rule by the worst in every sense of the word, but also just how underhanded and diabolical it all is. This focuses on the provision in what I refer to as the big abominable bill that is going to cut Medicaid by over a trillion dollars over the course of 10 years. By the way, a trillion dollars is less than our defense budget right now, so clearly they have their priorities straight.

If you could talk us through a little bit what the implications of this are and why it’s so dangerous that all of these cuts are going to take place after the midterms, which the Democrats seem poised to win by large margins.

Norm Ornstein: And let’s hope so, because it’s our only hope of somehow beginning to counter, in even the smallest way, some of these depredations. Let me start, Mary, just by saying that most people, including most journalists who write about this, have a big misunderstanding of what Medicaid is.

The stories about this, and there have been a number, are that they built into their big, beautiful, horrible bill a trillion dollars in cuts in Medicaid. The major part of that is adding incredibly onerous work and reporting requirements that most people simply could not do. Some of this, by the way, is people who are not working, who are at some level able bodied. They’re not working because they’re taking care of other loved ones who are disabled or in trouble. The money from Medicaid doesn’t go directly to the people who are losing their health insurance, which is an awful part of this.

It goes to the providers. Much of it goes to hospitals because people on Medicaid end up in emergency rooms or going to the hospital, and they get paid through Medicaid. But the most important part of this that people don’t realize is how much of Medicaid is nursing homes. Almost two thirds of those people in nursing homes, they’re elderly, and there are also a lot of disabled people, are there because of Medicaid. Medicaid pays for them. What people have to do is draw down whatever assets they have until they’re at a point of almost destitution, and then they’re able to go into a nursing home.

So the Republicans knew that if they implemented, or began in any serious way to implement, these cuts before this midterm election, it would be yet another devastating blow to them that would cause them even more losses. So they kept the cuts from taking place until afterwards. I have to say, the bigger cuts come after the 2028 election, surprise, but they’re plenty big starting this next year.

Now, it’s not just what that means, but what it means to start with is that a lot of hospitals, and not just the rural ones, most are in trouble. We used to have a lot of independent hospitals. They’ve all been, or the largest share of them have been, bought up, many of them by investment firms, others by universities and others, and they’re doing a whole lot of vertical and horizontal integration so that they can survive. They have the hospital, they have doctors’ groups, they have insurers together. But once you start to cut out a sizable source of revenue for them, and they’re already doing all kinds of tricks to stay solvent, more of them are going to close.

Now, what happens when some close? We think of the rural hospitals. They’re the first on the firing line here. But we had an example a few years ago where a big hospital in Philadelphia, the one that took care of most poor people and working class people, had to close, and the other hospitals were overrun, their emergency rooms.

So let’s say that you or I fell down, broke a bone, and had to go to the emergency room. If you go to an emergency room that already has an overloaded operation, you’re going to have to wait longer, or you may not get treated at all. And they’re going to find, because the law says that anybody who has an emergency and goes to be treated has to be treated even if they can’t pay, it’s going to be an additional financial burden on those hospitals.

Now, the nursing homes, many of them are going to be forced to close. Others are going to have to cut way back because their revenue is going to be dramatically different. A lot of people are going to be basically told:

Sorry, we can’t cover you anymore. You aren’t getting paid for. You’re going to have to leave.

What do they do? They either go out on their own, which could be catastrophic, or they go to their children or grandchildren and say:

Sorry, we have to move in.

Now we get to a part of what is a triple or quadruple whammy here, because it’s not just the cuts in Medicaid. This is where the diabolical and the ignorance come together. They’ve already cut out many of the subsidies that go to people for home healthcare. It’s people who have been at home taking care of loved ones or home healthcare outfits that come in and help those so that they can live on their own and don’t have to go into the nursing homes.

Now, that’s one part of the whammy. Let’s add another one. The outrageous, sadistic deportations and imprisonments in hellholes, concentration camps. Now the most recent, of course, being all the Haitians who have been here under Temporary Protected Status, most of whom have been extraordinarily important in their local communities.

Just ask Republican Governor Mike DeWine about those Haitians who were brought into Springfield, Ohio, that Trump and Vance have kept saying are eating the cats and eating the dogs. This is what DeWine said:

These are really important parts of our community.

Over a hundred thousand Haitians in this country have been working in the health world. They are orderlies in hospitals. They’re nurses’ aides. They’re a clearly important part of nursing homes. They’re going to be gone. They’re not going to be replaced in many cases. If they are, they’re going to be replaced by people who are less trained. We’re going to see shortages in these nursing homes.

That means that people who are there who need their medications at a particular time may not get them. People who need help going to the bathroom aren’t going to get that help. They’re going to go in their own beds. We’re going to see more bedsores. People in a medical emergency aren’t going to get treated. So we’ve got a horror story there.

Now let’s add one other component to this, which is the war on food safety and, actually, two components, and on serious diseases. A war led first by Robert F. Kennedy Jr. and the other lunatics who are running the Department of Health and Human Services. We’re seeing measles, soon diphtheria, tetanus, God knows what else. They’ve cut the pins out from under any help for any emerging pandemic.

Wait until the flu season begins because RFK Jr. has said:

Don’t take the flu vaccine.

Wait until we get a new strain of COVID and we don’t have people vaccinated for them. Look at the kids who are now being told by Donald Trump that the extraordinarily effective MMR vaccine that all kids have gotten to protect them, that has for decades been proven to be safe and effective. Now they’re going to take away coverage from some deadly diseases, but insist that people get three, four, or five separate visits, making them more costly, fewer people there.

What does that do to the healthcare system? They’re going to go to hospitals. They’re going to go to emergency rooms. They’re not going to get treated. And so we’ve got that. We have food safety. Another one today, we just heard, frozen pops that may have glass particles in them. We know about the dangers, about the explosive diarrhea from cyclospora, about the listeria outbreaks all over the place.

Now we can circle back for a second, Mary, to immigration. Two hundred thousand people who have been here undocumented, at least, have been working in meat and poultry processing plants. Why are they employed? Because nobody else wants these terrible jobs.

So they’re understaffed at meat and poultry processing plants, and the industry cut a deal where at least a significant share of the inspection of these plants is done by the companies themselves. So we can expect even more of those problems and even more of a burden on the healthcare system.

All of these insane policies, we can look at them separately and say, “This is outrageous,” but there is a synergy to them, an evil, disgraceful, horrible, dangerous, destructive, homicidal synergy to putting all of these together, and we’re all going to pay for it. All of us. So have a nice day, Mary.

Mary Trump: Thank you so much. This has been lovely. I almost don’t know what to say, but we must soldier on because, wow. Everybody reading knows that Norm and I subscribe to the principle that we have to look into the face of what we’re dealing with here. We can’t turn away. We can’t pretend that everything’s just fine. But this isn’t about making people so depressed that they feel hopeless.

However, by understanding what’s going on and how intertwined all of this is, I think it should make people more motivated to turn this around and hopefully spread the word that when these cuts happen, we cannot blame the Democrats who are in power at the time because this is a time bomb that the Republicans have set off in order to sow doubt and confusion in people’s minds.

Oh, the Democrats are in charge of everything now and this is happening. It must be their fault.

No, this is, as you say, all of the adjectives that you used to describe how vile and homicidal and diabolical all of this is.

So the more we understand it, the more we are prepared, and the more we need to position Democrats to have the power to undo it and not, after two years, say, “Well, it’s their fault. Let’s get Republicans back into office.” Republicans should never be elected ever again for anything.

I want to read a paragraph from your piece that I think sets us up for broadening the conversation a little bit as just how this is all interconnected. There are so many moving pieces, but they are not separate. This is intentional and far reaching, and they’re not unrelated. You write:

The American healthcare system, unlike in most advanced countries, was jerry built, a combination of public and private entities and state and federal involvement, but the public and private are not separate. They are like organs in the human body. If one declines or fails, it has huge impact on the others.

And these cuts are going to reverberate in many catastrophic ways, and you elucidated those many catastrophic ways. On the one hand, it should remind us that the horrific immigration policies of this regime are not isolated to the terrible treatment of immigrants and undocumented workers. It has serious implications for our healthcare system, including and especially hospitals and nursing homes.

And to anybody saying Haitian immigrants are taking jobs real Americans want, no, they’re not. They’re taking jobs no Americans want, which is why the system has become so dependent on them.

So I want to talk about USAID and how similarly cuts to this one program have reverberated in ways other people may not understand. On the one hand, it should be enough for us to know that by eliminating USAID, which was an organization that literally helps children and adults in poorer countries not die from preventable diseases and starvation, that should have been enough.

And we already know that in excess of 700,000 people, including 400,000 children, died directly because of those cuts, but those cuts have a serious impact on American farmers. And why is that, Norm?

Norm Ornstein: So what we’ve seen, among other things, is that, and let’s also include in this horrible war in Iran, among the things cut off from the Strait of Hormuz was fertilizer. Fertilizer prices have gone way up. Fertilizer shortages, all at planting season, have meant that we’re going to have a catastrophe across the globe, including here at home, where we’re not going to have as much food and the food is not going to be as robust in other ways as well.

But one of the things I want to say about USAID, there’s so much that we can say about this. One thing that we can say about it is that if we want to look at kakistocracy, government by the worst among us, government by the most incompetent among us, by the most ignorant among us, by the most sadistic among us, look at DOGE.

They come in and look at an agency and they say, “Oh, foreign aid, blow it up.” It was illegal, by the way. It is an agency that exists because Congress created it, and they had no right to do this, but they did it for stupid reasons. Then Trump puts Marco Rubio, Little Marco, in as the acting administrator of the shreds of the agency that are left. Rubio sends an order out to the DOGE people saying:

Okay, that’s fine, but be sure you don’t cut lifesaving programs.

So what do these idiots do? They basically Google lifesaving programs, as if the PEPFAR program is listed as lifesaving. They don’t find any, so they eliminate them all. Rubio then lies and says:

Look, I went through all 30,000 programs.

As if he could do that while also being Secretary of State and acting head of the National Archives. Talk about stupid. And everything’s fine.

And we know that all of these people were killed. But let’s take this to another level as well, Mary, which is I have long been on the board of an organization, a nonprofit called the U.S. Global Leadership Coalition, which supports development and diplomacy. One of the core components of this has been a coalition of former military leaders, three, four, and five star generals, admirals, and the like, who have been enthusiastic here because they’ve said the best way for us to avoid a war is not to spend $1.5 trillion, including hundreds of billions on Trump class destroyers and big ships that are obsolete in this day and age.

It is to make sure that countries don’t fall into total disarray, people dying, lack of food, and enabling terrorists to move in and take over, which in turn makes them more impoverished, leads to more immigration, that leads to more of a strain on the countries in Europe and here that are bringing in people who have to leave because they’re threatened, could be killed, or simply can’t survive.

And that has led in part to this backlash that has given us neo Nazis in positions of power. So all of this, creating food disasters, children unnecessarily dying, a Secretary of State who is an accessory to mass murders out there, it has much larger implications for us and for the world. It’s not just that blithely allowing nearly a million people to die is unspeakable. It is that there will be far more second and third order effects from all of this, done by a bunch of idiots who had no clue what they were doing. And instead of saying, “Oops, boy, did we make a mistake here,” they double down.

Mary Trump: They’re taking their direction from Dear Leader, who is the biggest idiot of all of them, and that, of course, would be Donald. So it seems like, to the extent that they have any overarching plan beyond enriching themselves, domestically the goal is to make as many of us as possible poor, sick, weak, and tired, or at least feeling disenfranchised and demoralized, and globally to squander any soft power we used to wield, which was one of the ancillary benefits of having a program like USAID, and cede ground to our erstwhile enemies who seem to be Donald’s allies, North Korea, China, Russia in particular.

So is that it, do you think? Is that the be all and end all for these fascists and murderers who have so much blood on their hands? It’s incalculable. Is it literally just about their own power and their own wealth, and there’s really no strategy beyond that?

Norm Ornstein: Well, I will say that there isn’t a day that goes by when I don’t tweet out, “It’s about the grift. It’s always about the grift.” So the fact that they are using this to enrich themselves and their buddies, and that includes, of course, one of the most horrific parts of this, which is selling pardons to horrible people in return for money.

And that means that some of the worst grifters who have bilked hundreds of thousands or more of Americans out of their money not only get pardoned, but they don’t have to repay any of it. So we’ve got all of that too. We always have to look at the grift.

And look, let’s face it, we’ve got Steve Witkoff and Jared Kushner, who are not part of government, waltzing around the world, cutting deals to make more money for themselves and their families while they sell out American foreign policy in the process.

We’ve got that going on. But I think another part of this is that Donald doesn’t like small d democrats, doesn’t like democracy. His role models are the worst dictators on Earth. And let’s look at one of the outrages of this week. Even as we have seen North Korea, the worst government out there, a total totalitarian society, sending 50,000 troops to help Russia in Ukraine, Donald Trump stabs in the back one of our closest allies, one of the most vibrant democracies, a democracy, by the way, that actually did remove and send to prison a corrupt leader, South Korea, and undercuts them while giving a nice pat on the back and more to Kim Jong Un and North Korea.

So this is a combination of corruption, grifting, and helping the worst among the world’s leaders while sticking it to the best of our leaders. And the consequences, and this is, of course, where I used to say that Donald Trump was a lifelong malignant narcissistic sociopath. I’ve changed that to psychopath because all of this is hurting Americans, and it’s hurting, probably as much as any of them, his own supporters and his own voters, while also treating people, human beings who have come to this country, many of whom have committed no crimes, who are doing what they were supposed to do to be legal migrants, and not just sending them to concentration camps or hellholes in this country, not just deporting them to their own countries, but sending them to countries they’ve never heard of where they’re stuck in prison even though they’ve done no crimes.

And a lot of the people who voted for him take it and they don’t care. And what have we seen in totalitarian regimes going all the way back? What did we see in Germany in the 1930s? It’s when you start to treat human beings as less than human, any class of human beings.

With the Nazis, it started with those who were disabled and those who had mental and physical challenges, and then they began to get rid of them. This was eugenics in action. And then they moved on to Gypsies and to Jews and did it for others as well. Once you start down a path of saying, “These are not human like us,” there is no end to it. The end is a really bad one. No one, of course, is more important in this than Stephen Miller, who has, other than Natalie, probably the ear of the president more than anybody else.

Mary Trump: But Norm, he got left on the plane, so I’m not so sure that he has as much influence as he’d like to. Or no, he definitely has influence. I’m not so sure that he’s as indispensable as he probably likes to think because clearly Natalie Harp, former valet and co conspirator Walt Nauta, former caddy Dan Scavino, and drunk guy Pete Hegseth are worth more than everybody else in this horrific kakistocracy.

Norm, this is dark stuff, obviously, and there has been no time in my lifetime that’s been worse. I think this blows the late 1960s out of the water. It’s important, I think, to see a way through. So what do you think we can do or tell people to make them stay engaged enough and recognize that, as bad as things are, yeah, sure, they can get worse if we tap out, but they can get a lot better too?

Because I think the way I’m trying to look at it is it is often in our darkest moments where we have the most possibility to affect real positive change. Do you think that’s fair? And if so, what are some steps we can take between now and the midterms to make sure we turn this around?

Norm Ornstein: It is really important, first of all, that we start with a frame that any vote for any Republican in this coming election is a vote to support all of the stuff we’re talking about. And if you’re in Michigan and you’re thinking that Abdul El Sayed is really not somebody you want to support, just remember that Mike Rogers, who, by the way, has been seen in photos with the vile racist Jake Lang, who just did a terrible demonstration in Dearborn, an anti Muslim demonstration, Mike Rogers will be a loyalist. He will do everything Trump wants, and that means supporting all of these things.

Susan Collins is the chair of the Appropriations Committee in the Senate. She voted not just to fully fund ICE, but to make sure there were no constraints put on that legislation. She voted to make sure that they were left unfettered, including not demanding body cameras, including basically letting them run rampant. And we know that when we had an innocent person murdered by them in Maine, she was upset and troubled and clutched her pearls, but just keep in mind that votes for any of these people will be a vote otherwise.

Second, if you have money or any ability to contribute to campaigns, first give some money to Mary’s PAC, which is going to distribute it appropriately to the right kinds of candidates. We had a very interesting primary election. It’s actually an open primary in Alaska yesterday where Mary Peltola, the Democrat, got more votes. It’s the top four who go in November against the incumbent, Dan Sullivan, who has voted down the line for all of these horrible things.

Give some money to Mary Peltola. Give some money to Peggy Flanagan, another Native American in Minnesota who I know and think very highly of. She is very progressive. Whether that’s your cup of tea or not, her opponent is Michele Tafoya, well known to people because she was a sports reporter, but she’s a Trumpist through and through. Give some money to Dan Osborn, the independent candidate for the Senate in Nebraska.

Look around and see races, and that includes state legislative races and other local races. It certainly includes important positions like Secretary of State in many of these states to make sure that we have people who are not going to support horror stories and horrible policies in place.

And then not only vote, but make sure that if you can be a poll watcher, if you can get out there and protect the polling places. If you are going to vote, if you have an opportunity to vote early, vote early because they’re going to do whatever they can on Election Day to have long lines and disrupt them, including sending ICE in to pull a citizen out of line, beat them, haul them away for three days before releasing them so that they can intimidate people away from going to the polls.

If you’re going to vote by mail, hold off for now until we see what the Supreme Court does to make sure that that’s going to be okay. But if you’re going to do it, don’t do it days in advance. Do it as far in advance as you can. And if you have an opportunity, if you have a mail in ballot, take it directly to the voting authority instead of relying on the mails.

The Postal Board of Governors has been dominated by Trumpists, and the head of the Postal Service is all in on this and is trying to destroy our voting process. Those are things that we can do now. And beyond that, always, if you see terrible things happening in your community, from ICE or from anybody else, film them if you can, get a record, see what we can do to hold these people accountable.

If you’re a lawyer and you’re a member of a bar association, when you see lawyers in your state or who are members of the bar in your state who are lying or doing bad things to support Todd Blanche, Harmeet Dhillon, and the other parade of horrors in the Justice Department, file a complaint with the Bar Association. Try and make sure that all of these lawyers understand that they can be held accountable even if they can’t be sued.

So those are some things we can all do now in the interim. It is really important. They’re going to do everything they can to disrupt this election or steal this election. We have to fight back with every avenue that we can.

And also, finally, on this front, if you know the governors or the secretaries of state or the attorney general in your own state, and you talk to them, tell them to make sure they’re prepared to keep ballots from being seized by the FBI or others, or thugs intimidating voters. Make sure that they’re mobilizing their own state National Guards, their state police, their local police, your mayors as well, to guard these polling places and that they have orders to block, even if they are federal authorities, from committing atrocities and breaking the law in the service of this narcissistic psychopath.

Mary Trump: Yeah, the last point is a really good one because remember, states control their own elections. The federal government has no involvement, or should have no involvement, in elections, and governors have an enormous amount of power.

And what should make people feel better is that Democratic attorneys general meet monthly because they know what’s coming. So they are preparing, and that is a really good thing to know because it made me feel like, okay, they are paying attention. Even though some establishment Democrats live in their little bubble, people at the state level really do know that the threats are real, and they’re preparing to protect against them.

So Norm, I kept you much longer than I said I was going to, but I could listen to you talk all day long. Everybody should read everything Norm writes. His Twitter, he has one of my favorite Twitter accounts. Check out his Twitter account. He has a wonderful podcast, Words Matter, with our friend David Rothkopf.

Norm, anything else you want to promote or to say, anything to help people find you?

Norm Ornstein: Twitter and Bluesky are @NormOrnstein. And just to say how much I love Mary and Ronda.

Mary Trump: We love you and Judy so much, and hopefully we’ll see you soon. And thank you again for your time. And everybody, Norm Ornstein, my goodness. What a treat. Norm, hopefully we’ll talk soon.

Norm Ornstein: You bet, Mary.

Mary Trump: Thanks, everybody. The conversation continues in the comments, so let us know what you think.