GOP may be working on health care plan B

President Donald Trump and Vice President Mike Pence spoke with several House members over the weekend to discuss a path forward, a senior administration official and Republican official with knowledge of the discussions told CNN. And House Speaker Paul Ryan — despite saying Friday that “Obamacare is the law of the land” — appears ready to keep going as well.

Trump himself isn’t giving up.

“I know we’re going to make a deal on health care, that’s such an easy one,” Trump told a bipartisan group of senators and spouses at a White House reception Tuesday night.

The fact remains, however, that House Republicans aren’t in a different position than they were on Friday. The math is the same. Republican leaders are still struggling to satisfy two diametrically opposed forces: moderates who want to see to government lend more support to middle and low-income people to buy health insurance and conservatives who want to see Obamacare repealed more fully so that even popular regulations like the one requiring insurers to cover people with pre-existing conditions disappear.

“At the end of the day, I don’t know that the weekend did much to change anything. I think it was a missed opportunity. I think it was an unforced error,” said Arkansas Republican Rep. Steve Womack.

“We’re mending our wounds right now,” Rep. Chris Collins, a Republican from New York told reporters Tuesday.

But Republicans can’t go back to their voters and say they’ve given up. Moving on from repealing Obamacare would mean Republicans may have to admit defeat and face a sobering new reality, in which, they were not able to deliver on the policy goal that united them and catapulted them to victory in the House in 2010, the Senate in 2014 and the White House in 2016.

“Opposition to government run health care has been a foundation of the Republican party for three or four generations now, so it is difficult to see House Republicans walk away from efforts to protect the American people from this awful law,” said Michael Steel, former spokesman for ex-House Speaker John Boehner. “At the same time, after last week, it’s difficult to see how the entire conference can find a unified position.”

“I think the divisions that have existed for some time look and feel particularly acute now that we have a Republican President,” Steel added.

White House downplaying role

Those divisions came out perhaps most dramatically when Trump got involved in the negotiations. Now, the White House is keeping its role much lower key than it did during the final push last week and insisting it is letting rank-and-file members of Congress drive discussions on health care, which are ongoing between a small group of House Freedom Caucus members and members of the moderate Tuesday Group.

The senior administration official told CNN that the White House believes its threats to move past health care have helped jolt House GOP members into action.

“All last week he was calling them. Now they’re calling him,” the official said.

White House press secretary Sean Spice publicly downplayed Tuesday any suggestion that there was a concerted effort to resurrect health care, only going as far as saying that there were continued conversations and exchanging of ideas.

“Have we had some discussions and listened to ideas? Yes,” Spicer told reporters in the briefing room. “Are we actively planning an Immediate strategy? Not at this time.”

On Tuesday, House GOP leaders also projected more optimism that something could still be done to dismantle the Affordable Care Act even as the political dynamics remained unchanged.

“I think we’re closer today to repealing Obamacare than we’ve ever been before, and are surely even closer than we were Friday,” House Majority Whip Steve Scalise said Tuesday morning.

Ryan vowed members would continue working although he didn’t offer any specific timeline.

In the Senate, Majority Leader Mitch McConnell was more frank that it was time to get to other issues.

“It’s pretty obvious we were not able, in the House, to pass a replacement. Our Democratic friends ought to be pretty happy about that because we have the existing law in place, and I think we are just going to have to see how that works out,” McConnell said. “We believe it will not work out well, but we’ll see. They have an opportunity now to have the status quo, regretfully.”

McConnell complemented Trump’s and Ryan’s efforts and then concluded his remarks on the debacle with four words: “Sorry that didn’t work.”

GOP base doesn’t want to give up

The concept of giving up is hard for many Republican rank-and-file members to swallow. Those who would have voted yes wish they could have gotten their colleagues there too. Members of the House Freedom Caucus, meanwhile, who were opposed to the bill, are grappling now with public admonishment from their new President.

“We’re gonna get a ‘yes,’ we’re gonna get to ‘yes.’ It will be a better bill and I think everybody is going to be very happy in the end,” said Rep. David Brat, a Republican from Virginia and a member of the Freedom Caucus.

“I think we have plenty of time. We can fix this,” said Idaho Republican Rep. Raul Labrador, another House Freedom Caucus member.

Texas Republican Rep. Randy Weber, a member of the House Freedom Caucus who opposed the GOP health care bill said Tuesday he thought that the GOP conference could find a way to get a revised Obamacare bill through the House if they all got in a room and put their heads together.

“We need to stay here on the weekend and have an all-day conference,” Weber said, noting that the one-hour weekly meetings weren’t enough time to work through the sticking points.

Weber, who didn’t vote for Ryan for speaker in January, even complimented Ryan and said that he texted the speaker over the weekend when some conservative media figures pushed for him to step down and told him “don’t even think about it. You’re doing a good job. My prayers and my support are with you.”

Still hard to govern

Womack said Republicans need to keep moving and show they can govern with their majorities in the House and Senate and Trump in the White House.

“The people who were ‘yes’ on the health care bill were reminding Paul this is something we promised and we got to push in that direction,” Womack said. “It’s more a reflection of the need to show that we can do something with our governing majority, but again it comes back to numbers. If you don’t have the votes, you don’t have the votes.”

But Trump and Ryan say they want to go to tax reform next, but that’s not going to be any easier.

“How do you move forward?” said Rep. Mario Diaz-Balart, a Republican from Florida. “If you can’t do this, can you then do tax reform? If you think this is complicated and controversial, wait ’til we get into tax reform.”

Transgender child’s mom: love your kids, period

I recognized the dress immediately. It had been his older sister’s — cast away, no doubt, in a donation bag that was never donated.

I didn’t race outside, tear the dress off and proffer admonishments. I watched, instead, as his makeshift wand of willow danced through the air — a little princess going from flower bed to flower bed casting enchantments over the marigolds.

I let our child continue playing undisturbed, but before I returned to my soup, I did what we all do when we see something adorable: I grabbed my phone and snapped a photo.

Later that night, my husband and I went to dinner with another couple we didn’t know well. As a fellow mom will do, the wife asked to see photos of our children, so I took out my phone and began swiping through recent family shots.

“Aren’t their children adorable?” she exclaimed, grabbing the phone out of my hands and showing photos to her husband.

Before I could get my phone back, they had discovered the photo from that afternoon.

I saw them exchange puzzled looks, then the wife said: “This is your son?”

‘Indulgence and permission are two different things’

Sensing their disapproval, I smiled and responded as calmly as I could, “Yes, he likes to play princess sometimes.”

“You really shouldn’t encourage that behavior,” the wife said with the grave compassion usually reserved for a potentially terminal illness. “When our son was little, he liked to play dress-up, too, but we didn’t indulge it. Not one bit. I even hired a male nanny! And now our son is completely normal! A strapping teenage boy — very popular with the girls — nothing odd about him at all!”

“You can’t indulge it,” the husband concurred. “That’s the key. It’s no different than enforcing bedtime. Children are very malleable. You can shape them, but not if you indulge their every whim.”

I politely thanked them for their (unsolicited) advice and my husband deftly changed the topic, but as I lay in bed later that night I couldn’t stop thinking about the the word “indulgent.”

My child at play.

Was it really indulgence to allow our child the freedom to express himself? It’s not as if he was shooting a BB gun at the neighbor’s pet cat, or throwing sand in another kid’s face.

Since that incident, I’ve had the word “indulgent” leveled at me many times by various detractors who disagree with the unconditional love and support my husband and I have offered our now-eight-year-old transgender daughter, as if that choice was the same as offering her an extra slice of chocolate cake even though we knew she already had seconds.

And here’s what I would say to those people: when it comes to parenting, indulgence and permission are two different things.

When we indulge a child, we let them get away with something — usually a behavior considered reprehensible by others. When we offer a child permission, we give them the reassurance that what they are doing is okay.

I like to think that the permission we gave Samuel to play as he saw fit in his early years paved the path for later emotional security.

On the eve of his sixth birthday, after a four-year battle with self-hatred and depression, he felt safe enough to transition from living as a boy to living as a girl. It was like witnessing a second birth.

And now we have a daughter who greets each day with excitement. Her name is Sadie, and she’s just as precious to us as her male counterpart was, only much, much happier.

What if we had punished Samuel instead of embracing Sadie?

I sometimes ask myself what would have happened if we had taken our dinner companion’s advice. What if we had shamed our son, or punished him? What if we had refused to let him out of his room unless he agreed to behave like a traditional boy?

In those early years of our child’s life, when my husband and I searched the Internet for information about children who claim to be the opposite gender than their anatomy indicates, we found these two statistics: Forty percent of transgender people attempt suicide each year, whereas a child who is accepted by his or her family is eight times less likely to attempt suicide later in life.

Better to be labeled as over-indulgent parents for letting our son play princess, we told ourselves, than to have a dead child.

If you worry that you, or someone you know, is indulging a young child by allowing him or her to cross-dress or do otherwise non-stereotypical activities, think again. Child development experts claim that children understand their gender identity as young as age 2.

But most children lack the vocabulary to articulate how they feel when they are so young. Their only recourse at gaining understanding may be to don a tutu as a boy, or to wear a Superman costume as a girl.

If your young child or student is a boy who likes traditional girl things, or a girl who likes traditional boy things, it doesn’t mean that he or she is transgender. It might mean nothing at all, or it might indicate that the child is what experts call “gender fluid.” It could be a phase, or it could be something more permanent.

No matter the reason, a child’s gender exploration isn’t something to punish.

Of course the nonconforming child’s behavior may be something you fear, and possibly for good reasons. You might live in a community that lacks understanding and compassion. You might be part of a religious group that doesn’t accept transgender identity as a possibility.

It doesn’t matter. Support that child anyway.

‘We’re living our lives, just like you’

Some may decry this decision, as if you are aiding and abetting a criminal. Nothing could be further from the truth. You are aiding and abetting the crucial work we all do in trying to figuring out who we are and why we’re here.

Like me, like my husband, like hundreds of other parents who have faced their young children’s gender dysphoria, you must push past fear and replace it with curiosity. And then you need to start learning, and connecting with other families who are going through similar experiences.

And if you don’t know any gender nonconforming children, or if you think the parents who support nonconforming children are mentally ill, child-abusing monsters — all things we have been called — I would wager a bet that if you came over to visit some afternoon, you might be surprised at how similar we are to you.

You might notice my teenage daughter’s school books and SAT prep manual scattered around. You might hear the sound of my younger daughter’s squeals as our dogs chase her around the house. You might notice we have the same favorite show playing on our TV, and if you look closely enough, you might see the imprint in the sofa where my husband naps as he pretends to watch.

What you wouldn’t notice is that one of my two daughters is transgender. You wouldn’t notice because there is nothing to notice.

We’re living our lives, just like you: struggling to keep things balanced, trying to look on the bright side, trying to get enough sleep, to drink enough water, to remember to brush our hair before we leave the house, to floss before bed, to say please and thank you, to apologize when wrong.

Those of us who are raising transgender children know it is time for us to be brave; to step forward; to introduce ourselves to you and welcome you into our lives; to prove that we haven’t indulged our children but merely chosen to love them.

Don’t use cotton swabs to clean your ears

Updated clinical guidelines published Tuesday in the journal Otolaryngology-Head and Neck Surgery say they’re not appropriate for earwax removal. In fact, information for patients in the guidelines say no to putting anything “smaller than your elbow in your ear.”

Regardless, most of us hoard a stash of the soft-tipped paper sticks; they seem so perfectly suited to that dirty job.

So the authors of the guidelines — an advisory panel of the American Academy of Otolaryngology-Head and Neck Surgery — have injected a little bit of freshness into the usual advice, giving more explanation as to “Why not?” They even included a consumer representative on the panel.

“We really have come to appreciate that clinicians are not the only users of (the guidelines), that patients are really interested in their own care and people are really taking ownership of their own care,” said Dr. Seth Schwartz, chairman of the guideline update group for the academy.

Here’s why not: Cotton swabs, hair pins, house keys and toothpicks — the many smaller-than-our-elbow-objects we love to put in our ears — can cause cuts in our ear canals, perforate our eardrums and dislocate our hearing bones. And any of these things could lead to hearing loss, dizziness, ringing or other symptoms of ear injury.

Instead, most people can just let nature do its job. Our bodies produce earwax to keep our ears lubricated, clean and protected: Dirt, dust and anything else that might enter our ears gets stuck to the wax, which keeps any such particles from moving farther into the ear canal. Our usual jaw motions from talking and chewing, along with skin growth within the canal, typically helps move old earwax from inside to the outside the ear, where it is washed off during bathing.

The guidelines published in 2008 were overdue for an update. While new randomized trials have been included, “nothing very dramatic” has changed, other than an improvement in the methodology itself, said Schwartz: “The process has become a little more transparent in the way we actually write the guidelines now. We are more clear about why the decisions we made are made and what data there is to support it.”

Patient are apparently interested in the nitty-gritty of ear care: More than 50,000 people downloaded the old guideline, Schwartz said.

“It’s kind of amazing how many people were interested in reading that,” he said.

The do’s and don’ts

To be “a little bit more patient-friendly,” the guidelines now include lists of “Do’s and Don’t’s” for everyone and a list for people who have had problems with cerumen impaction, the official term for earwax buildup, a condition that is more common among the elderly, according to Dr. James Battey, director of the National Institute on Deafness and Other Communication Disorders.

Impaction can occur when the ear’s self-cleaning process doesn’t work very well. The resulting waxy buildup blocks the ear canal, causing difficulty hearing.

“For those with impacted ear wax, the use of cotton-tipped swabs may push the earwax deeper into the ear canal and harm the eardrum,” Battey said. He added that “about 2% of adults with impacted earwax may go the doctor with hearing loss as their symptom.”

“Impacted earwax is best addressed by a health care professional,” he said.

In the all-important “Don’t” section, you’ll find warnings against “overcleaning” your ears. Excessive cleaning may increase earwax impaction, according to the authors.

“It’s cultural” to want clear ears, Schwartz said, but “wiping away any excess wax when it comes to the outside of the ear is enough to keep it clean.”

Another warning in the new guidelines: Do not use ear candles. Not only can they cause “serious damage” to your eardrum, “there is no evidence that they remove impacted cerumen,” wrote the authors.

“Home therapies are fairly effective,” Schwartz said, adding that the “whole host” of over-the-counter wax-softening drops as well as home-use irrigators are effective and safe. “Even drops of water in the ear can be effective to soften the wax,” he added.

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Still, among the items on the “Do” list is to ask your health care provider about how to treat earwax impaction at home, since “you may have certain medical or ear conditions that may make some options unsafe.”

“It’s not a bad thing to have wax in your ears. Everybody does and should. It’s more of an issue when it becomes too much,” Schwartz said. The guideline definition of “too much” is an operational one: If you have symptoms — such as pain, drainage, bleeding or hearing loss — then you have a problem.

“If it’s causing symptoms, absolutely go to your doctor,” Schwartz said, repeating what is likely the most important “Do” list recommendation. Still, some people attribute their symptoms to wax buildup when it’s just not the case.
Among older people, “hearing loss becomes very, very common,” said Schwartz.

In fact, aging, along with infections and exposure to loud noise, is one of the most common causes of acquired hearing loss, according to Battey.

Yet many people cannot imagine that they’ve begun to lose their hearing, and as a result of this disbelief, Schwartz said, “a patient has wax cleared, and then their doctor needs to look deeper.”