Psychological Assessment of Donald Trump

On May 12, 2016, I published the post, “Will our next President be a psychopath?” It was a reference to Donald Trump and his mental instability, which was obvious (to me) even before he became President.

The post included these comments:

The June, 2016 issue of Discover Magazine contained a very interesting article titled, “Into the Mind of a Psychopath.” (“Fifty years ago, his chilling experiences as a prison psychologist led Robert Hare on a lifelong quest to understand one of humanity’s most fascinating — and dangerous — disorders.”).

The word (“psychopath”) has become a synonym for a certain type of evil, denoting a specific breed of cunning, bloodthirsty predator who lacks empathy, remorse and impulse control, readily violating social rules and exploiting others to get what he or she wants.

Psychopaths are capable of the most heinous crimes, yet they’re often so charming and manipulative that they can hide behind a well-cultivated mask of normalcy for years and perhaps their entire lives.

Only the ones who get caught become household names, such as Ted Bundy, “Killer Clown” John Wayne Gacy and “Ken and Barbie Killers” Paul Bernardo and Karla Homolka.

Research suggests 1 in 100 people are psychopaths who tend to blend in, like cold-blooded chameleons. We know psychopaths make up 15 to 20 percent of the prison population, at least 70 percent of repeat violent offenders and the significant majority of serial killers and sex offenders.

The post ended with this clear reference to Donald Trump:

I suppose most politicians have some measure of the psychopath in them. The lying and manipulation alone are qualifications. But, some are more psychopathic than others, and I suggest that this year, one is an extreme case — an extreme psychopath.

Subsequently, on July 28, 2019, I published “A psychopath slipped into the White House,” in which I listed:

. . . the Robert Hare Checklist of Psychopathy Symptoms. It consists of 20 symptoms which are rated 0 to 2. Zero means “does not apply,” one ‘applies somewhat’ and two ‘applies fully’. Subjects score between 0 and 40.

Normal individuals typically score less than five and many non-psychopathic criminals (who do actually have symptoms of antisocial personality disorder) may score 20 to 22.https://mythfighter.com/2019/07/28/a-psychopath-slipped-into-the-white-house/

I showed how Donald Trump stacked up on that test. He scored 39 out of 40 — the most extreme psychopathy score imaginable for a human being.

You can reference that scoring by clicking this link and seeing how you would score him.

Psychopathy is just one of what is known as the “dark triad,” which also includes narcissism and machiavellianism.

They are what psychologists use to evaluate dangerous or destructive personalities.

There is a test for Dark Triad measures (which include psychopathy and Machiavellianism) — those are what psychologists use to evaluate dangerous or destructive personalities.

Narcissistic Personality Inventory (NPI) is a real psychological instrument that’s widely used in research settings.

It was first developed by Raskin and Hall (1979). It appears in hundreds of peer-reviewed psychology papers and is considered the “gold-standard” self-report scale for grandiose narcissism (as opposed to “vulnerable” narcissism, which requires other instruments).

It covers: Entitlement / Grandiosity (Narcissism), Manipulation / Cynicism (Machiavellianism), and Callousness / Impulsivity / Lack of empathy (Psychopathy).

The subject is ranked on five levels: 1 = Strongly Disagree; 2 = Disagree; 3 = Neither Agree nor Disagree; 4 = Agree; 5 = Strongly Agree and there are 27 questions.

I asked ChatGPT to apply those rankings to Donald Trump. Here is its response:

#	Statement	My Rating
1	I like to use clever manipulation to get my way.	5
2	I have used deceit or lied to get my way.	5
3	I have used flattery to get my way.	4
4	I tend to exploit others toward my own end.	5
5	I have never been more charming than when I want something from someone.	4
6	I enjoy having control over other people.	5
7	I use whatever means necessary to get my way.	5
8	I sometimes humiliate others to keep them in line.	4
9	I sometimes take advantage of others’ weaknesses.	5
10	I generally am not bothered by the suffering of others.	4
11	I deserve special treatment.	5
12	Sometimes I get into trouble because I don’t think things through.	3
13	People see me as a natural leader.	5
14	I pay attention to recycling or other things like that.	1
15	I like to show off every now and then.	5
16	I know that I am special because people keep telling me so.	5
17	People often say I’m out of control.	4
18	I insist on getting the respect I deserve.	5
19	I avoid dangerous situations.	2
20	I have a strong will to power.	5
21	I enjoy watching people get into arguments.	4
22	I like to get revenge on people who have hurt me.	5
23	It’s not wise to tell your secrets to others.	4
24	I have been compared to famous people.	5
25	I have never felt sympathy for other people.	4
26	I am destined to greatness.	5
27	I feel embarrassed if someone compliments me.	1

Chat GPT’s assessment: A clinician seeing these traits might say: “This person shows extremely elevated narcissistic traits, with strong malevolent tendencies.

If corroborated in functional assessment, they could meet criteria for NPD — potentially among the most extreme seen.”

Narcissism is far more than merely self-love; else we all would be narcissists.

It is a serious, pathological condition as described in the September 27th issue of New Scientist Magazine, “The truth about narcissists: How to handle them, and can they change?”

Although narcissistic personality disorder is rarer than you might think, psychological research suggests it can come in two different types, one of which may be underdiagnosed.
By David Robson

Looking back, the signs were obvious: an extreme need for control, a pathological tendency to exaggerate and an almost comical sense of superiority.

My family member claimed to know more than everyone about everything, no matter the topic. He claimed to have the makings of a world-class teacher, doctor, writer or athlete, while also boasting about his modesty. Any disagreement would result in shouty rants or violent outbursts.

Family friends could barely believe it when I told them. “When he meets us, he acts like charm personified,” is how one put it. These were all classic traits of narcissistic personality disorder (NPD), a condition characterised by a disregard for the feelings of others combined with an extreme sense of self-importance, often manifesting in interpersonal abuse.

By the mid-1920s, the term “narcissist” came to describe a more general personality disorder, but it would take another 50 years for the Diagnostic and Statistical Manual of Mental Disorders (DSM) to include NPD.

Narcissism is considered one side of the “dark triad”, a trio of personality traits that can drive callous and cruel behaviour

NPD, according to its DSM definition, is characterised by grandiosity, a desperate need for admiration and a lack of empathy for others.

People with the condition frequently overestimate their abilities and inflate their accomplishments. The bloated ego comes with a sense of entitlement, a need for praise and constant attention, and a feeling of alienation – in the narcissist’s view, it would be impossible for other mortals to recognise the problems that come with being so extraordinary.

Narcissists are also often preoccupied with envy, either being very envious of other people or convinced that other people are envious of them.

Finally – and perhaps most damagingly – many of them manipulate and exploit others, with little regard for the hurt they cause. The consequences can be emotional and physical abuse.

People with narcissism might be aware of others’ feelings – they just might use that information for their own self-serving ends, or they don’t care.

This lack of concern for other people’s emotions is in stark contrast to their preoccupation with their own feelings. Narcissists are often easily offended.

Grandiose, or overt, narcissistsseem more outwardly confident and are more likely to boast and brag. Vulnerable, or covert, narcissists appear more introverted.

Christiane Büttner at the University of Basel, Switzerland, found that people scoring higher on a questionnaire measuring narcissism were significantly more likely to read situations as intentionally exclusionary, compared with participants with lower levels of the trait.

“Any perceived threat to their status or recognition is deeply aversive,” says Büttner.

You might think that being excluded would decrease someone’s delusions of grandeur, yet a further study suggested that the opposite is true. Büttner found that people’s sense of being ostracised could predict a rise in their narcissistic traits over the following 12 months.

She speculates that feeling socially excluded “triggers self-enhancing defences” to protect them from the pain.

“If exclusion is repeated or chronic, individuals might begin to compensate by inflating their self-image, becoming more self-focused, or engaging in more attention-seeking or antagonistic behaviours,” says Büttner.

SUMMARY

Donald Trump meets all the conditions. He is a psychopath and a narcissist. He has no concern for anyone but himself.

He requires constant reinforcement of his fragile ego, and he cannot be trusted ever to “do the right thing,” unless that coincides with his own egomaniacal needs.

He is the perfect cult leader, but he is the last human being on Earth who should be in charge of a powerful nation, because he always will use that nation’s power to further his own narcissistic ends.

In the next post, we will discuss the people who follow such a leader. You can decide who you know who fits the profile.

Rodger Malcolm Mitchell

Monetary Sovereignty

Twitter: @rodgermitchell

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Facebook: Rodger Malcolm Mitchell;

MUCK RACK: https://muckrack.com/rodger-malcolm-mitchell;

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A Government’s Sole Purpose is to Improve and Protect The People’s Lives.

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Chat GPT predicts the end of America. Do you really understand the danger?

This may be the single most important post I ever have published. It truly is shocking. It describes something far more dangerous than a simple “cult of the personality.”

I began by searching various sources for the characteristics of a cult leader and a cult follower. Then I sought answers to the question: “How does this apply to America?”

This post is longer than most, but you will want to read the entire thing.

Much of the following content originates from one AI, ChatGPT; however, as is often the case, additional information comes from many places.

CHARACTERISTICS OF A CULT LEADER

Cult leaders are rarely “mystical geniuses.” They tend to share the same psychological traits, regardless of ideology, religion, or era.

1. Charismatic Authority
They project:

Absolute certainty
Emotional intensity
A sense of special mission
This does not require intelligence — only confidence plus emotional fluency.

2. Narcissism
They believe:

They are uniquely important
Rules do not apply to them
Loyalty is owed to them
Not all narcissists build cults — but all cult leaders are narcissists.

3. Manipulative Empathy
They are highly skilled at reading others’ weaknesses. They use flattery when pulling someone in and shame and fear when controlling them

4. Simplification of Complexity
They offer simple explanations for complex frustrations:

“You are suffering because of ___”
“I alone can fix it.”
This is psychologically seductive — certainty relieves anxiety.

5. Isolation and Dependency Skills
They systematically:

Reduce outside influences
Redefine social identity
Punish dissent
The goal is to make the follower’s sense of self dependent on the leader.

CHARACTERISTICS OF A CULT FOLLOWER

Followers are not “weak-minded.”
They are humans under stress, which makes everyone vulnerable.

1. Need for Certainty
People join cults when they are:

Overwhelmed
Disoriented
Grieving
Economically insecure
Socially disconnected
Certainty acts like pain relief.

2. Search for Identity
A cult provides:

A sense of meaning
A role
A group that “understands”
This replaces confusion with belonging.

3. Outsourced Judgment
Once inside, the follower gradually stops making independent evaluations.

The reasoning shifts from:
“This makes sense” to “If I trust him, it must make sense.”

4. Fear of Social Loss
Leaving the group means:

Losing friends
Losing identity
Admitting past mistakes
That cost is psychologically enormous, so they stay.

5. Progressive Commitment
No one joins a cult suddenly. The steps are incremental:

Agreement
Loyalty
Sacrifice
Obedience
By the time obedience is required, the follower has redefined self around the group.

In Pure Psychological Terms:

Leader Trait . . . . . . . . . . Follower Trait . . . . . . . . . . . .Result

Certainty . . . . . . . . . . . . . .Need for certainty . . . . . . . . . . . Power transfer
Narcissism . . . . . . . .. . . . . Desire for identity . . . . . . . . . . . Emotional dependence
Manipulative empathy. . .Vulnerability . . . . . . . . . . . . . . . Attachment
Control structures . . . . . . Fear of loss . . . . . . . . . . . . . . . . .Entrapment
Grand mission . . . . . . . . . Search for meaning . . . . . . . . . . Shared purpose

A cult is not primarily about beliefs. It is about identity control and the formation of dependencies.

Descriptive Characteristics of Cult Followers: Not all followers share every trait, but the pattern is consistent:

1. Need for Certainty
Some people are deeply uncomfortable with complexity, ambiguity, or conflicting information. A cult leader offers absolute answers, which feels emotionally calming.

“Don’t think — I’ll think for you.”

2. Desire to Belong
People who feel ignored, disrespected, or invisible are especially vulnerable. The cult provides a new identity, and more importantly, a community.

“We are the only ones who truly understand.”

3. Externalization of Blame
Followers often come from backgrounds where life has felt unfair — poverty, failure, humiliation, or loss of status.
The leader gives them a villain to blame.

“Your problem isn’t you — it’s them.” (A convenient “them” is essential.)

4. Idealization of Authority
Some people are psychologically trained (often from childhood) to believe that strong authority = safety. They feel relief when someone takes control.

“Tell me what to do. I’ll feel safe.”

5. Identity Fusion
Eventually, followers merge personal identity with group identity.

“Disagreement with the leader” becomes “attack on me.”
They stop asking: “Is this true?”
They ask: “Does this support us?”
At this stage, facts become irrelevant.

6. Emotional Echo vs. Rational Thought
Cult followers respond primarily to emotion, not logic. Logic threatens group identity → emotion strengthens it.
Fear, anger, pride, grievance = fuel.

How This Maps Onto Political Movements
Not all political movements are cults. But some political movements use cult psychology deliberately. Here’s the overlap:

Cult Mechanism: How It Appears in Politics

–Absolute answers. Simple slogans: “Only I can fix it.” “Trust the plan.” “The enemy is everywhere.” “Make America Great Again.”
–In-group identity: Hats, chants, slogans, coded language, shared memes. (Uniforms without uniforms.)
–Clear external enemy: Immigrants, elites, the media, the deep state, the “globalists,” liberals, conservatives
–Leader as savior: The Leader is not just a politician, but a messiah, hero, victim, god, and father figure.
–Attacks on truth: Independent sources of reality (press, science, law, universities) are framed as “the enemy.”
–Emotion over evidence: Loyalty is proven by feeling, not by being right. Correctness is irrelevant. Loyalty is everything.

Why Followers Stay Even After Clear Failure
Once the follower’s identity is fused with the group:

–Leaving feels like self-annihilation
-Admitting the leader was corrupt means admitting you were fooled
-That is psychologically unbearable. So instead of leaving, the follower doubles down.
-The more evidence they were wrong, the more fiercely they defend the leader.
This is why logic does not work. You cannot argue them out of it, because they did not join through logic.

The Key: Followers aren’t stupid. They are not mentally deficient. They are emotionally positioned to need:

certainty
identity
belonging
meaning
direction
someone to blame

The leader effectively meets those needs.

Summary
A political movement becomes cult-like when:

The leader is positioned as infallible
The group identity becomes a substitute for personal identity
Opposition is framed as evil, not merely wrong
Emotional loyalty replaces evidence-based reasoning
At that point, the movement no longer operates in the domain of politics.
It operates in the domain of faith.

HOW A POLITICAL CULT COLLAPSES
(This is always predictable — they collapse the same way.)
We are talking specifically about the Trump movement because it is the dominant political cult structure in the U.S. right now. The same pattern has occurred with many historical leaders (Father Coughlin, McCarthy, Wallace, Perón, and others).

1. The Grand Promise

The Trump cult began with a clear, identity-binding promise: “I alone can fix it.” “We will win so much you’ll get tired of winning.”

The implied guarantees: Permanent political victory, restored status for the followers, cultural dominance, personal validation

Supporters are emotionally invested in the promise of reclaimed power, especially those who felt culturally displaced (white grievance politics).

2. Reality Fails

Trump loses the popular vote twice.
Republicans lose the House, Senate, and Presidency under him.
The “deep state purge,” “mass arrests,” “100-year conservative rule” — none materialized.
His administration becomes chaotic and internally adversarial.
His legal, business, and financial dealings collapse into indictments.
The prophecy fails in observable reality.

3. The Blame Shift
To prevent mass shame-driven defection, the narrative pivots: “We actually won — it was stolen.”

This is psychologically necessary. If the loss was legitimate, the followers picked a loser. Unacceptable. So reality had to be rewritten.

The enemy list expands: Deep State, CIA. FBI, Courts, Military leadership, “RINOs,” Media, Universities, Voting systems, and anyone who acknowledged the loss

This preserves the emotional bond.

4. Inner Circle Fractured
Once it became clear that Trump could not deliver victory, legal consequences were real, and continued loyalty meant personal ruin.
His insiders began defecting, testifying, flipping, or distancing. Examples: Mattis, Barr, Kelly, Bolton, Pence, Mulvaney, Raffensperger, State-level Republican officials, Major donors
Fox News pivoted to alternatives, Media influencers moved to more profitable conspiracy lanes
Every cult collapse involves inner-circle erosion before base erosion.

5. Social Cost Begins to Outweigh Identity Reward
For mainstream followers, being openly pro-Trump becomes: Awkward in professional settings, detrimental to career mobility, embarrassing in educated circles, corrosive to family and community relationships

The signal flips: Trump support no longer elevates status — it damages it.

6. The Remaining Base Radicalizes
The people still fully committed are: grievance-driven, conspiracy-dependent, emotionally entangled, identity-fused

Their rhetoric becomes: more violent, more persecuted, more apocalyptic. This is precisely what happens to all cults once the mainstream layer exits. They intensify and shrink.

Trump then cannot moderate — because the remaining base would abandon him if he did. So he must keep escalating. This accelerates the collapse further.

7. The End State
The collapse will not look like dramatic defeat. It will look like withering irrelevance.
The mainstream stops talking about him. The base fades into fragmented conspiracy streams.
The mythology survives ONLY in nostalgia and fringe media. The followers quietly rewrite their personal histories:

“I like his policies, not the man.” “It went too far near the end.” “He changed.”

No one admits they were in a cult. They just stop talking about it.

But Trump survived and made a comeback, because post-cult followers psychologically rehabilitated themselves. What replaced the identity they lost?

Amazingly, Trump replaced himself.

After a political cult collapses, the emotional problem is not the propaganda or the ideology — it is the loss of identity. The followers didn’t just believe a set of ideas. They believed a story about themselves.

The collapse destroys that story. So the psychological vacuum must be filled. And history shows that authoritarian movements fill that vacuum in a consistent, mechanical way.

1. They (Trump) Offers a New Identity
The message is, “You are not a fool who was misled. You are a heroic survivor of a great betrayal.” This reframes:

Shame → into martyrdom
Embarrassment → into special insight
Humiliation → into righteous anger

The follower is given a new identity that prevents them from processing the failure honestly.

2. Trump Provided a Replacement Myth
After collapse, people need a story that explains:

Why things went wrong
Who to blame
What comes next
Why they should keep believing

So the narrative shifts from victory prophecy to revenge prophecy.
Before collapse: “We will win and restore greatness.”
After collapse: “We were betrayed by hidden enemies, and we will rise again.”

This is exactly what also happened in:

post-Confederate South → Lost Cause myth
post-WWI Germany → stab-in-the-back legend
post-Soviet Russia → humiliated nation revival story
The content varies; the psychological function does not

3. They Transfer Loyalty from the Leader to the Movement and back to the Leader
Once the leader becomes untenable (too old, too indicted, too incoherent), the authoritarian structure shifts loyalty from: The Leader, to: The Cause

This lets followers retain their identity after the leader fades or convinces them that He is the cause.

It sounds like:

“He was flawed, but he awakened something in us.”
“The movement is bigger than any one person’s flaws.”
“We must carry on his fight.”
This preserves the cult without the cult leader or with a new, more awakened leader.

4. They Channel Grief into Organized Resentment
People who lose a belief are grieving.

Authoritarian movements convert grief into anger because anger: Feels stronger than sadness; Has direction; Can be mobilized

So the messaging becomes: “They stole your future.” “They laughed at you.” “They want you silent.”

That resentment is then pointed at: Minorities, intellectuals, institutions, immigrants, journalists, academics, Jews (always, for 2,000 years), anyone who benefits from a pluralistic society. This is scapegoat replacement, and it is always the same.

5. They Create Parallel Social Structures
After the collapse, many followers have lost: their old community, their sense of special purpose, their shared language

So the authoritarian movement builds a replacement society: private media echo system, alternative “education” pipelines, social clubs, rallies, forums, chat communities, new symbols and rituals

This allows them to live inside an artificial culture, shielded from mainstream norms. It prevents reintegration into reality.

6. They Introduce the Next Savior
Once the emotional ground is stabilized, the movement introduces a new leader, always framed as: “The One Who Will Finish What the Previous One Began.”

This leader is: -Younger, -More polished or more brutal (depending on the era), -Less encumbered by the old leader’s baggage-Presented as the natural continuation. This is already beginning with JD Vance.

The followers transfer their emotional dependency smoothly.
This is how: Lenin → Stalin, Mussolini → Salò hardliners, Hitler → postwar Neo-Nazi cells → later white grievance politics, Chávez → Maduro

And yes — in the U.S. context — it’s how MAGA will transition to: DeSantis-like technocratic authoritarianism or a younger, media-optimized demagogue, or a charismatic theocratic populist (a growing possibility).

The names are irrelevant; the function is invariant.

Summary
After the collapse, authoritarian movements:

Replace shame with martyrdom
Replace defeat prophecy with revenge prophecy
Shift loyalty from Leader to Cause
Convert grief into resentment
Build a parallel social world
Present a successor to carry the identity forward

The followers never have to confront the idea: “I was wrong.” They slide from one identity enclosure to another. The walls stay invisible.

WHAT NEXT?
The Former Cult Splits Into Four Predictable Groups

1. The True Believer Core (~10–15%)
These are the ones who never leave, no matter what.
Characteristics:

Identity fused with the movement
Consumes only propaganda media
Experiences personal ego injury if the leader is criticized
Often older, isolated, or socially dislocated
They become the nucleus of the successor movement.

This group radicalizes rather than detaches: miitia formations, parallel churches, apocalyptic language
“civil war” rhetoric
They are loud, but too small to win elections on their own.
This group is not persuadable. Ignore them.

2. The Opportunists & Grifters (~5–10%)
These are: media personalities, political strategists, fundraisers. influencers
professional rage merchants
They never believed the ideology.They believed in the money.

When the cult weakens, they: rebrand, reposition, adopt new buzzwords, look for the next profitable outrage vein
They will move quickly to support the new authoritarian leader, whatever name or style emerges.

This is how Bannon → Trump → “traditionalism” networks evolved. They are the transmission belt between old cult and new.

3. The Embarrassed Majority (~50–60%)
These are the bulk of the movement. They believed in the promise, not the theology. They supported the leader not because of ideology but because:

it made them feel dominant
it gave them identity
it promised the return of cultural prestige

When the cult collapses, this group: does not apologize. does not reflect, does not renounce, They simply go quiet. They say: “I liked his policies, not the drama.”

Then they wait.

This group is where the successor authoritarian leader will recruit support. They are the political prize. They are persuadable only through status, not argument.

4. The Disillusioned (~15–25%)
These are the ones who actually leave the movement permanently.
Characteristics: Higher education, younger or socially networked, better real-world feedback loops (jobs, cities, professional communities)

They eventually confront the shame, Their exit comes with grief and sometimes depression. They are the only group that can be reintegrated into democratic culture, but only if offered a non-humiliating identity replacement.

If democracy offers: “You idiots were wrong” → they go back to the authoritarian orbit.

If democracy offers: “You were misled, now help repair things” → they return.

This requires grace without indulgence. Difficult, but not impossible.

What Replaces the Identity?
This is the core of the question. After collapse, people don’t need new facts. They need: belonging, meaning, a story in which they are still the hero

The next leader will be less chaotic, speak in moral, historical, or religious tones, promise restoration, not a successor authoritarian movement offers exactly that: “You were warriors in the first fight. Now the real fight begins.”

Revolution. This is how authoritarianism matures after the initial charismatic collapse. In the U.S. specifically, the emotional replacement will likely be: Christian-nationalist identity fused with victimhood mythology and revenge-based patriotism.

In other words, the next phase will be less Trump and more Franco / Orbán / Salazar / DeSantis-style cold authoritarianism, or Vance-style educated sophistry.

The Key Forecast
The collapse of the charismatic cult does not end the movement. It hardens it into a more disciplined, bureaucratic, and strategic authoritarian structure. Trump was the spark. The successor will be the system.

The Successor Authoritarian Will Be the Opposite of Trump in Form, But the Same in Purpose

Trump has been emotional, chaotic, undisciplined, improvisational, narcissistic, rather than strategic. That worked only for the first, mobilization phase.

As his own successor he is transitioning to the institutionalization phase. Following Trump, the next authoritarian leader will have the following traits:

1. Calm, Efficient, and Coldly and Even More Cruel and Controlled
Not a shouter. Not emotional. Not showy. Someone who projects competence and stability, even if that image is manufactured. Tone: measured, “adult,” “serious,” “reasonable”

This person’s appeal is: “I will do what Trump couldn’t — effectively.” Or, “I will finish what Trump started.”
They will not rant. They will speak in moral certainty, not emotional chaos.

2. Speaks the Language of “Order,” “Tradition,” and “Normalcy”
They will not emphasize revolution. They will emphasize restoration: “We need to bring back decency, faith, values, stability.”

This is how Franco replaced Falangist chaos. It is how Orbán replaced Hungarian nationalism gone disorganized. It is how Putin replaced the post-Soviet disorder.

The message is: The chaos of the charismatic era was necessary, but now we must build something lasting.

3. Presents Themselves as a Moral or Religious Figure

Expect: Christian nationalist framing
Language of spiritual struggle
Claims of divine purpose

Framing political opponents as evil, not wrong. This moves the movement from: Personality cult → Moral crusade, which is far more durable.

4. Uses Polite Language to Justify Brutal Policy
They will not say: “We should crush the opposition.” They will say: “We must protect our children from dangerous ideologies.” “Not everyone shares our values; they shouldn’t control our institutions.” “We will restore safety and harmony.”

The cruelty is disguised as caretaking.

In professional political science terms: This is Soft-Fascist Pastoral Rhetoric.

5. Knows How to Work Bureaucracy
Trump did not understand government, which limited him. Now, as his own successor, he has been advised to know procedure, place loyalists into civil service pipelines, reshape school boards, neutralize oversight departments from inside, reward compliant media, and erode judiciary independence.

This is how authoritarian systems consolidate sustainably.

(Now that Trump is his own successor and has learned from the bitter experiences of his previous failures, he has begun to consolidate dictatorial power. Dictatorships are much more difficult to overthrow than are cults. Cults die with the leader. Dictatorships can live for centuries, as new tyrants step up to even greater brutality.)

America’s next tyrant will be boring on purpose. Boring is harder to rally against.

6. Presents Authoritarianism as Common Sense
Instead of: “We will crush them!” Expect: “Everyone can see the system is broken. We simply need to take reasonable steps to restore trust and fairness.”
“Reasonable steps” will include:

voter suppression packaged as “election integrity”
censorship packaged as “parental rights”
minority exclusion packaged as “security”
opposition disqualification packaged as “anti-corruption enforcement”
Everything will sound reasonable to people who aren’t paying attention. This is the danger.

What They Will Look Like (Trump’s true successors)
-Late 30s to mid-50s
-Clean-cut, disciplined appearance
-Fit or at least controlled physical presentation
-Military, legal, or executive background (governor, prosecutor, admiral, CIA officer)
-Married with children (presented as “model family”)
-Photographed often in church, military bases, small-town diners

This is iconography, not biography.

What They Will Sound Like
-Calm
-Fatherly or school-principal tone
-Rarely jokes
-Uses words like heritage, duty, responsibility, courage, honor, renewal
-Speaks as “we,” not “I”
Most common phrase: “We all know something has gone wrong in this country.”
Followed by: “Good people are afraid to speak the truth.”

This sets up: persecution narrative, moral urgency, permission to act extralegally

In Summary
The successor authoritarian will be: colder, smarter, more efficient, less dramatic, more legitimate-seeming, less obviously insane

Trump was the arsonist. The successor will be the architect of the new structure built on the ashes.

At this point, Chat GPT makes its predictions. My prediction is that Vance follows the tradition.

1. Ron DeSantis (Governor of Florida)
Why he fits the profile:

-He has a military/legal background (Navy JAG + deployment).
-Young (born 1978) and therefore helps project generational renewal.
-Has governed with a focus on culture-war issues, “order,” and “tradition,” rather than chaotic theatrics.
-He is already positioning himself as the “competent” alternative to the chaos phase of the movement.
Weaknesses/obstacles:
-He remains closely associated with the earlier charismatic phase (the cult leader) and may carry baggage from that connection.
-He has already sought higher office (2024) and failed to secure it, which might damage the perception of momentum.
-His style is still somewhat combative and media-facing; the successor might need to appear more restrained.
-Likelihood estimate: High (70–80 %) of being one of the structural successors — perhaps not the only one, but a major contender.

2. Vivek Ramaswamy (Entrepreneur & Politician)
Why he fits the profile:

-Born 1985 (age ~40) — very young relative to most national leaders.
-A businessman/outsider, which fits the “new-system” flavor rather than a career politician.
-Has the charisma and media-savvy, able to appeal to younger audiences and present renewal.
Weaknesses/obstacles:
-Lack of government executive experience (governor or national office) compared to others — the successor might need a strong operational resume to implement changes.
-He may be perceived as too flashy or “startup” rather than “steady statesman,” which could undermine the “order/tradition” reframe.
–If he remains too closely tied to the cult leader (via loyalty or endorsement), he may inherit the baggage rather than escape it.
-Likelihood estimate: Medium-High (50–60 %) — he is a wildcard who could emerge especially if the movement decides on a youth/outsider identity.

3. Kristi Noem (Recent Governor of South Dakota & now Secretary of Homeland Security)
Why she fits the profile:

-Executive experience as governor, which provides the institutional credibility the successor will need.
-Presents an image of rural, traditional America (farm-ranch background) that aligns with restoration/tradition messaging.
-Female leader: This can provide a fresh face for the movement and help expand demographic appeal.
Weaknesses/obstacles:
-Age (born 1971) makes her somewhat older than the “young successor” archetype.
-Her national profile is less developed than the top two; she may have to overcome perception as a regional figure.
-There are controversies about her record and image that adversaries could exploit.
Likelihood estimate: Medium (40–50 %) — a strong contender but with more barriers than the top candidates.
Synthesis & Forecast
The next authoritarian successor is most likely to come from the pool of “governor-level” executives who can credibly claim to implement the movement’s agenda—not just mobilize it.

The movement will favour someone who can say: “We tried the chaos phase, it didn’t work — now we bring order.” That argues for someone like DeSantis.

The successor will also try to broaden the base, so a “new face” (either younger or from a different demographic) like Ramaswamy or Noem could be chosen as the “face,” while operational control remains with the older structure.

Timing is critical: The successor will emerge when the cult-leader’s brand becomes too toxic for broad adoption, but the movement has enough momentum to organize elections, media, and bureaucracy behind a new figure.
What the successor authoritarian leader will look and sound like (continued)

Once the first charismatic leader fails—whether through scandal, defeat, senility, death, legal collapse, or simply loss of narrative control—the successor is almost never a flamboyant repeat.

The next one is colder, smoother, less improvisational, and more managerial. The charisma becomes institutional rather than personal. This successor leader tends to have three defining psychological and rhetorical traits:

1. He presents himself as the “Adult Version” of the movement

He does not shout, rant, or perform.
He uses controlled diction, shorter sentences, and speaks in calm authority.
His message to the traumatized followers is:
“You were not wrong. You were betrayed.”
The betrayal may be blamed on: the Media, the Elites, the Generals, the Judges, the “Moderates,” The original leader’s staff, family, or advisors, and inevitably, the Jews.

But not on the followers themselves. He soothes the humiliation of collapse by reframing it as noble suffering.

2. He promises Order, not Glory
The first leader promised Rebirth.
The second promises Stability. This matters. Collapsed followers no longer are seeking victory. They are seeking:

Psychological quiet
A sense of being safely led
Restoration of identity

So the successor leader speaks in the language of: Law, tradition, heritage, hierarchy, discipline, “Return to normal,” “Protect what we have left”
He is careful to sound responsible, even when his program is authoritarian.

3. He normalizes the ideology
He does not call it “revolution.”
He calls it: “Balance,” “Return to values,” “National restoration,” “Moral defense,” “Security,” “Continuity of our heritage.”

He avoids the original leader’s outrageous statements, not because he disagrees, but because he understands something the first leader did not: To make authoritarianism dominant, it must sound like common sense.

The successor recasts extremism as moderation. He will say things like: “We simply want fairness.” “Everyone should be treated with respect, but we must defend our culture.” “We’re not extremists; we’re preserving order.”
This is the professionalizer of the movement.

The pattern is invariant. The successor is less interesting but more effective. The public face becomes technocratic, predictable, serious, moralizing, and bureaucratic. The movement becomes routine. Once it is routine, it no longer feels like a cult—even though, structurally, it still is.

And here’s the key point: The successor authoritarian is the one who locks the door behind the movement. The first leader awakens the emotions. The second leader codifies them into law. This is why the successor is far more dangerous.

It also is why Trump is more dangerous today than he was in his first term. Today, he has learned from failure, and he is being guided by people who understand cults and dictatorships better than he did.

How democratic institutions unknowingly facilitate the successor.

1. Democracies Reward Competence, Not Chaos
The first leader (Trump) thrives on chaos: rallies, conspiracies, media spectacle. The democratic system, by contrast, is designed to handle orderly, repeatable, procedural behavior.

Once the first leader falters, the system favors someone calm, disciplined, and operationally competent.
Ironically, the successor’s obedience to institutional norms is what makes them appear legitimate. They exploit trust in the process to consolidate authoritarian power.

2. Procedural Weaknesses Enable Legal Entrenchment
Voting laws, court structures, regulatory bodies, and bureaucracies often have ambiguities. The successor uses these ambiguities to:

Appoint loyalists to key positions
Redefine rules quietly
Reinterpret existing laws to entrench control

These moves are “legal,” so democracy cannot stop them without extraordinary measures. The system assumes compliance and precedent; the successor assumes compliance and manipulates precedent.

3. Public Deference Creates Space for Moral Authority
Ordinary citizens, media, and even political opponents tend to defer to anyone who looks like they “know what they are doing.” The successor uses this deference to normalize controversial policies:

Censoring or manipulating information → framed as “public protection”
Excluding rivals → framed as “ethics enforcement”
Expanding state control → framed as “security”
Democratic norms—courtesy, legalism, bureaucratic restraint—become shields for authoritarian consolidation.

4. Institutional Fragmentation Delays Pushback
The U.S. (and most liberal democracies) has distributed power: courts, legislatures, states, agencies.
Fragmentation slows reaction. The successor can exploit this delay to entrench policies, often incrementally.
By the time opposition organizes, many decisions are irreversible or appear irreversible.

Example: Strategic court appointments, bureaucratic appointments, or subtle election law changes.

5. The Successor Exploits Crisis Fatigue
The public is tired of chaos, scandals, and failed promises. They are willing to trade civil liberties for “stability”, especially when the threat is framed as protecting children, culture, or the nation itself.

The first leader created the crisis emotionally; the successor consolidates it institutionally.
People accept policies they would have rejected under the first chaotic leader.

6. Successor Uses the Original Leader as Both Shield and Sword
Even after collapse, the first leader is a brand: Media attention keeps the movement relevant, Followers remain loyal out of identity and nostalgia

The successor does not need to confront the first leader directly. They can frame themselves as: “Continuing the mission,” “Correcting past mistakes,” “Building the long-term structure the first leader inspired”

This legitimizes authority without needing chaos or charisma.

Summary: Why Democracies Inadvertently Enable the Successor

Stage 1: Emotional Vacuum & Identity Transfee The cult leader collapses (legal trouble, scandal, electoral loss). Followers are traumatized: shame, humiliation, anger. The successor leader presents themselves as:
“I am here to protect you and finish what was started.” Key tactic: Reframe shame as noble struggle.
Outcome: Emotional loyalty transfers from the first leader → the cause → the successor.

Stage 2: Institutional Positioning Successor places loyalists in bureaucracy, courts, local election offices, media, and think tanks. Actions are “legal” or “routine,” but designed to consolidate control.

Stage 3: Narrative Domination Control of messaging and social legitimacy. Media outlets loyal to the movement amplify “stability and protection” framing. Opponents framed as threats to children, culture, or public safety.Majority sees successor’s authority as common sense, not extreme.

Stage 4: Incremental Power Expansion Instead of dramatic coups, the successor consolidates authority incrementally. Each step seems minor individually; cumulatively, they shift the system toward authoritarianism.
Outcome: Structural control is achieved without mass unrest.

Stage 5: Cultural & Social Reinforcement The successor normalizes control via rituals, symbols, and language: Flag displays, public ceremonies, historical reinterpretation. Education policy enforcing a “patriotic” or “traditional” curriculum Followers internalize loyalty, making reversal politically difficult.

Stage 6: Legitimizing the Successor The first leader may still exist publicly but is used strategically:
As a shield: “We are continuing the mission he started.” As a sword: followers’ nostalgia motivates compliance with the new leader. The successor achieves near-total control while appearing legitimate.

Stage 7: Durability & Systemic Entrenchment Once in place, the successor uses the bureaucratic, judicial, and cultural infrastructure to defend their authority. They no longer need rallies, conspiracies, or personal drama. The movement becomes a machine. Hard to dislodge, even after the first leader’s cult fades.

Key Takeaways
The successor doesn’t need to be flashy or charismatic — they exploit the systems left behind. The public perceives order and normalcy; the consolidation of power is largely invisible at first.

The emotional and social needs of followers are met through ritual, identity, and narrative, not through direct violence.

Democracy’s procedural and decentralized structures actually enable the slow, almost surgical entrenchment of authoritarian power. Trump is already behaving like a proto-successor consolidator, even while he is technically still the cult leader.

He is effectively serving as both shield and sword for the eventual institutional consolidation.

The Strategic Observation
This is why Trump is dangerous beyond personal charisma. Many think he only mobilizes rallies or emotions. In reality, he is laying the foundations of a movement that can survive and consolidate even without him.

This is the pattern every historical cult-successor sequence follows — first chaos, then controlled, bureaucratic authority.

Even without winning office, the first leader can prepare all levers for the successor. Emotional loyalty, institutional control, and cultural reinforcement all combine to create a movement that survives collapse.

The successor can then step in and operate with legitimacy, calm authority, and procedural “cover”. The movement becomes a self-sustaining authoritarian machine.

America is in its greatest danger since the Revolutionary War, and very few people understand that.

Rodger Malcolm Mitchell

Monetary Sovereignty

Twitter: @rodgermitchell

Search #monetarysovereignty

Facebook: Rodger Malcolm Mitchell;

MUCK RACK: https://muckrack.com/rodger-malcolm-mitchell;

https://www.academia.edu/

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A Government’s Sole Purpose is to Improve and Protect The People’s Lives.

MONETARY SOVEREIGNTY

Paul Krugman speaks truth to power

I generally agree with Paul Krugman. Aside from some quibbles I may have regarding his MMT version of economics (I mostly agree with him there, too), he is a terrific writer and very smart — which is why I have devoted this entire post to something he wrote about “No Kings Day.”

Here it is, it its entirety:

While MAGA’s spin was both insane and revealing, the No Kings Day 2 Marches were a major step towards taking our country back.

Last Saturday’s No Kings Day 2 was awesome to behold. The very best of America shone through. From coast to coast, in big cities and small, in red states as well as blue states, Americans peacefully marched to uphold our humanity as a country and to show our solidarity against autocracy and lawlessness.

And also awesome were the right-wing attacks on Kings Day 2 participants in the days before the rallies. They were so extreme and so unhinged, so utterly disconnected from reality, that they defeated their ostensible purpose of intimidating the marchers into silence.

While the rest of us saw families, old people, young people, folks in funny costumes, many of them waving the Stars and Stripes, MAGA saw criminals and America-haters.

But I have a theory about the deeper purpose of the MAGA attacks on No Kings Day 2. America, I’d argue, is currently operating in a strange condition — what I would call a “bubble autocracy.” Donald Trump has not yet consolidated anything like absolute political power.

But parts of our society — the Republican Party and a number of supposedly independent institutions like, say, CBS — are in effect living inside a bubble in which they operate as if he has. Within that bubble, a cult of personality around Trump has been built, a cult of personality worthy of Kim Jong Un.

And to show their fealty to Dear Leader, Republicans must engage in bizarre rhetoric.

Before I explain my theory of how the right lost its mind, some personal observations.

I attended Saturday’s No Kings Day march in Manhattan, for several reasons. As a citizen, I felt it was my duty. As a journalist, I wanted to see with my own eyes the mood, and whether there was violence either by or, far more likely, against the protestors.

And I was, to be honest, feeling some anxiety about crowd size: a disappointing turnout would have been a significant blow to our chances of saving American democracy.

No surprise that Trump attempted to discourage participation by declaring in advance that “I hear that very few people are going to be there,” while his lackeys spouted insane conspiracy theories.

I needn’t have worried. The march I joined was immense. G. Elliott Morris and the independent science newsroom Xylon estimate that 320,000 people protested in New York, and their median estimate is that more than 5 million protested nationwide.

As Morris says, Saturday’s events were very likely “the biggest single-day protest since 1970.” Furthermore, the event was completely nonviolent: The New York Police Department reported zero arrests:

Screenshot of tweet from NYPD reading as follows:

The majority of the No Kings protests have dispersed at this time and all traffic closures have been lifted.

We had more than 100,000 people across all five boroughs peacefully exercising their first amendment rights and the NYPD made zero protest-related arrests.

And reports from across the country indicate that there were only a handful of arrests nationwide. If I had to describe the mood in one word, it would be “joyous.”

But these observations raise two questions. First, what are we to make of the completely unhinged things Republicans were saying in advance of the protests? And second, do people marching and carrying signs matter, even if they number in the millions?

On the first question, let’s review what Republicans said. CNN has a good rundown of the craziness coming from leading Republicans in advance of No Kings Day 2.

Mike Johnson, the speaker of the house, called them “hate America rallies” consisting entirely of the “pro-Hamas wing” and antifa.

Scott Bessent, the treasury secretary — remember when people thought he was the adult in the room? — said that the demonstrations would involve “the most unhinged in the Democratic Party.”

And Karoline Leavitt, the White House press secretary, attacked the whole Democratic base:

The Democrat Party’s main constituency are made up of Hamas terrorists, illegal aliens, and violent criminals.

These claims were all self-evidently absurd. So why make them? CNN says that it was a “weird strategy”: Calling grandmothers Hamas terrorists won’t convince anyone who isn’t already deep in the MAGA tank and will backfire as those not in the tank see the disconnect between this rhetoric and the reality of the protests.

But it all makes sense once you realize that what we have been seeing in operation isn’t the Trump administration’s strategy for dealing with its critics. It is, instead, the strategies of individual MAGA apparatchiks for dealing with He Who Must Be Obeyed.

A couple of months ago Henry Farrell had a useful post explaining why people around Trump shower him with ludicrous compliments.

Farrell cited work by the political scientist Xavier Marquez, who pointed out that autocracies that build a cult of personality around their leader are subject to “flattery inflation.”

Marquez’s examples go all the way back to the Emperor Caligula, but the logic has remained the same over the centuries. (Trump hasn’t yet appointed his favorite horse as consul, but he did make Pete Hegseth secretary of [defense] war.)

Here’s how it works. The ruler’s lackeys and courtiers believe that they must praise him to the skies, proving their loyalty by offering paeans to his wisdom, character, and golf game. And they must continually up the ante:

How do you show your loyalty? By paying the costs of humiliation. The more grotesquely over the top your praise, the more credible it is as a signal of support for Dear Leader.

Apparatchiks’ willingness to degrade themselves will hurt their reputation with other people.

But for exactly that reason, it serves as proof of loyalty to the one man who counts, Donald Trump.

The more appalling the self-abasement, the more effectively it will serve this purpose.

What I would argue is that a similar process of self-reinforcement applies to telling lies that serve the autocrat’s ego.

Call it “mendacity inflation.” Trump insists that he’s overwhelmingly popular and that only a lunatic fringe disapproves of his presidency.

Well, to show loyalty his hangers-on must go further, declaring that grandmothers and parents pushing prams down 7th Avenue are illegal aliens and violent criminals.

The humiliating absurdity is a feature, not a bug. Simply lying about demonstrators isn’t enough; to prove their MAGA mettle people in Trump’s orbit must tell lies that are grotesque and ridiculous.

Again, what’s historically odd about this is that while Trump’s personal depravity may match that of historical autocrats, his power doesn’t. Call him Caligula, if you like, but he can’t order Senators — even Republican Senators — to commit suicide.

(Dear historians: yes, I know that many of the stories told about Caligula were probably exaggerated.) He’s only able to act as if he has absolute power within a limited enclave, a bubble created by greed and fear.

And on that point, my second question arises: does it matter whether people are out there marching and carrying signs, even if they number in the millions?

Well, there is a solid body of research by political scientists like Erica Chenoweth about the effects of civil resistance — nonviolent shows of opposition to those controlling or attempting to control the government.

The clear answer from this research is that demonstrations like No Kings Day can make a big difference. They are a show of the depth and popularity of a movement, reassuring those who are opposed to a nation’s direction that many, many others share that opposition.

Moreover, if a broad cross-section of society is represented in the demonstrations — and the crowds I saw consisted of a mix of seniors, middle-aged liberals, families with children, students and other unthreatening types — they can induce defections from the ruling regime, because the protestors can’t easily be “othered,” portrayed as strange and alien.

So protests with a wide base of support can ultimately pierce the regime’s bubble. In fact, in the aftermath of the massive scale and breadth of the demonstrations, the MAGA propaganda machine has gone remarkably quiet, although Mike Johnson has claimed that the demonstrators were all Marxists.

And Trump himself is in denial. From CNN:

The president shows no sign of changing course. He called Saturday’s mass protests a “joke” and described them as “very small, very ineffective.” The people who took part were “whacked out,” Trump said.

“When you look at those people, those are not representative of the people of our country,” he told reporters aboard Air Force One on Sunday.

Maybe Trump even believes that. But it was the opposite of the truth.

What the No Kings Day 2 demonstrations showed me is that we continue to be a great nation, despite how Trump and his minions try to separate, divide, gaslight and intimidate us.

Saturday’s marches were a giant step towards taking our country back.

If Paul Krugman isn’t on your “must read” list, put him there.

Rodger Malcolm Mitchell

Monetary Sovereignty

Twitter: @rodgermitchell

Search #monetarysovereignty

Facebook: Rodger Malcolm Mitchell;

MUCK RACK: https://muckrack.com/rodger-malcolm-mitchell;

https://www.academia.edu/

……………………………………………………………………..

A Government’s Sole Purpose is to Improve and Protect The People’s Lives.

MONETARY SOVEREIGNTY

The biggest scam in medicine begins Jan 1

We might have hoped that eventually, Congress would understand its mission: To defend and improve the lives of the people.

And we might have hoped that eventually, Congress would understand it has the unlimited ability to create the dollars to defend and improve the lives of the people.

And we might have hoped that we, the public, would learn that our federal taxes do not fund federal spending, so even “wasteful” federal spending costs us nothing, and in fact, benefits us by adding growth dollars to the economy.

Sadly, those hopes, once again, are dashed, as an intentionally ignorant and uncaring Congress and President have found a new way to make our lives worse.

In a six-year experiment that begins Jan. 1, millions of original Medicare beneficiaries in six states could be required to get advance approval, called prior authorization (PA), before certain medical services, procedures or devices are covered.

If successful, the pilot project could lead to wider use of prior authorization in original Medicare, possibly using artificial intelligence (AI). The practice is already widely used in Medicare Advantage, with some plans using AI and algorithmic software to help make coverage decisions.

It’s designed to speed up coverage decisions and cut wasteful spending on at least 16 devices, procedures and services that are “particularly vulnerable to fraud, waste and abuse or inappropriate use,” according to CMS.

A sick old woman is carried on a stretcher from an ambulance. The woman is talking on ONE telephone. — **My doctor says I need surgery immediately. I’ve been on the phone for over an hour to get prior authorization. What do I do?**

There is no way that waiting for prior authorization can “speed up” anything.

Technology companies that participate will be paid based on savings from denied medical claims, which has drawn the ire of the American Medical Association and consumer organizations.

If your pay depends on your denying health care claims, what will you do?

Right. Deny claims. And that is exactly the experience people have had with PA.

The pilot project comes amid concerns from lawmakers, government watchdogs and others that Medicare Advantage plans’ prior authorization procedures can create burdens for caregivers, who have to figure out how to appeal, and risk the health of patients by delaying or denying care that would otherwise be covered under original Medicare.

Prior authorization helps save the federal government money by screwing sick people.

There is no simpler, more accurate way to say it. Under the false banner of cutting “waste,” the government plans to cut services. Remember, because the government is Monetarily Sovereign, “cutting waste” is meaningless.

The federal government cannot run short of its sovereign currency, the U.S. dollar. Even if the government collected zero taxes, it could not run short of dollars.

Even if the federal government collected zero taxes and tripled spending, it still could not run short of dollars.

Unlike state and local governments, the federal government creates unlimited dollars by pressing computer keys. In reality, so-called “wasteful” federal spending benefits the economy. It adds to Gross Domestic Product.

GDP = Federal Spending + Nonfederal Spending + Net Exports

The sole purpose and effect of prior authorization is to reduce, delay, and eliminate medical services and to transfer much of the remaining cost to the ill.

It is a program only a right-wing Republican could love — and even that right-winger won’t love it when he/she has payment or procedure denied because some bureaucrat in Washington won’t pay for the procedure your doctor prescribed.

The terrible irony is that while the Republicans, under Trump, tell you that Washington is filled with “useless” people who must be fired randomly, the Republicans want those remaining “useless” people to make your healthcare decisions.

Here are some examples of what the current administration wants to subject you to:

94% of physicians report care delays due to prior authorization, AMA says

The survey underscores the urgent need for reform and regulation of prior authorization, the AMA said.

In December 2022, the Centers for Medicare and Medicaid Services released a proposed rule to speed up prior authorization approval.

Physicians spend almost two business days each week on prior authorization requests and 35% have had to hire additional staff to exclusively handle the administrative burden, the AMA said.

The AMA said other survey results show that 80% of physicians report that prior authorization can lead to treatment abandonment; 33% of physicians report prior authorization leading to a serious adverse event for a patient in their care – with 9% reporting it’s led to permanent bodily damage, disability or death.

Prior authorization complexity does not eliminate unnecessary treatments, the AMA said. Eighty-six percent of physicians report that prior authorization leads to higher overall utilization of healthcare resources.

Many ophthalmologists have faced – and continue to face – broad prior authorization policies on cataract surgeries from certain insurance giants, the AMA said.

Rheumatologists have long decried prior authorization policies for worsening outcomes for their patients. Many rheumatology patients rely on expensive biologic medication to treat their disease, meaning they are commonly a target of insurers, the AMA said.

And then there’s this evaluation of the “Save the government money by costing people money, their health and their lives program.”

Imagine you have a cancer growing in you, and your doctor tells you that you need treatment right away. Good luck with that:

The Patient Experience of Prior Authorization for Cancer Care

Question What is the patient experience with prior authorization (PA) for cancer-related care?

Findings This cross-sectional study of 178 patients with cancer with experience with PA showed delays to care (with most delays ≥2 weeks), increased anxiety, and patient administrative burden. The PA process was rated bad or horrible by most respondents and was associated with decreased trust in the health care system.

This study suggests that PA for cancer care can have discrete negative associations with outcomes for patients; streamlining the process is key to optimizing the quality of care delivered and improving the patient experience with cancer care.

Prior authorization (PA) requires clinicians and patients to navigate a complex approval pathway. Resultant delays and denials can be particularly problematic for patients with cancer, who often need urgent treatment or symptom management.

Results:
22% did not receive recommended care due to delays or denials.
69% reported a PA-related delay in care; of those with delayed care,
73% reported a delay of 2 or more weeks.
67% had to personally become involved in the PA process;
20% spent 11 or more hours dealing with PA issues.
The PA experience was rated as bad 40% or horrible 32%
PA-related anxiety was higher than usual anxietyand was correlated with delay length, and time spent
After PA, 89% of patients trusted their insurance company less, and83% trusted the health care system less.
22% of patients did not receive the care recommended by their treatment team because of PA.

PA processes may require clinicians and patients to navigate a complex approval pathway and can lead to delays in receipt of care or denials of recommended
Delays and denials can be particularly problematic for patients with cancer, who often need urgent treatment or symptom management.

Oncologists have reported suboptimal care and delays in cancer treatment owing to PA’s bureaucratic interference in clinician-patient decision-making; an oncology survey found that payer pressures, including handling PA, ranked as the most pressing practice concern.

An American Medical Association survey found that 90% of respondents reported treatment delays due to PA.
73% of surveyed oncologists reported that patients “routinely” expressed concerns to them about PA-related delays.

About 33% of physicians in the AMA survey said PA criteria are rarely or never evidence based.
62% of physicians reported difficulty in determining whether a service required PA.
Patients described the process as arbitrary, with lack of communication, lack of transparency

Does this really sound like an improvement to Medicare? Does it sound like you will receive better care at less cost?

IN SUMMARY

Your federal taxes do not fund government spending. The sole purposes of federal taxes are to regulate the economy and stabilize the dollar, not to provide funding for government spending.
The federal government cannot run short of money. It creates dollars simply by voting to fund projects.
FICA does not fund Medicare. The federal government has the power to fund a comprehensive, no-deductible Medicare plan for everyone of every age in America, without collecting a penny in taxes.
The current administration is in the process of firing hundreds of thousands of federal workers; yet, those remaining workers are expected to administer PA, a complex process that requires medical expertise and handling hundreds of thousands of individual cases.
No one knows your medical needs better than your doctor, yet the government wants a Washington bureaucrat to make your medical decisions and overrule your doctor.
Delays or refusals to provide services have cost people’s health and lives.
PA does not save you or your doctor time or money. PA does not improve service. On the contrary, PA costs you and your doctor time and money, and worsens medical services.
Private insurance companies are dollar-constrained. They use PA so they can deny services. Their people are paid to deny services. The federal government is not dollar-constrained. Its purpose is to protect you and provide service.