I heard the middle of this interview last night, and read the transcript this morning. This is a serious conversation about impeachment, and contains some interesting insights. If you prefer to listen to it, the link takes you to the transcript, and in the upper left hand corner is the podcast.

Trump’s Fitness To Serve Is ‘Officially Part Of The Discussion In Congress’

http://www.npr.org/2017/05/04/526857048/trump-s-fitness-to-serve-is-officially-part-of-the-discussion-in-congress

May 4, 20171:22 PM ET

Heard on Fresh Air
Fresh Air
New Yorker writer Evan Osnos discusses the likelihood that impeachment or the 25th Amendment will be used to remove Donald Trump from office.

TERRY GROSS, HOST:

This is FRESH AIR. I’m Terry Gross. One of the many things that makes the Trump presidency unprecedented is that some members of Congress, as well as some ethicists, legal experts, psychiatrists and scholars, are already talking about possible paths to impeachment or how to remove the President from office through the 25th Amendment to the Constitution. My guest, Evan Osnos, has written an article in the current edition of The New Yorker titled “How Trump Could Get Fired.” It examines these efforts and considers the feasibility of ending Trump’s presidency.

During the past few months, Osnos interviewed several dozen people about the subject, including some of the president’s friends and advisers, lawmakers and attorneys who have conducted impeachments, physicians and historians and current members of the Senate, House and intelligence services. Osnos has been writing about Trump since Trump announced his candidacy in 2015.

Evan Osnos, welcome back to FRESH AIR. How seriously are President Trump’s opponents pursuing impeachment or removal from office through the 25th Amendment?

EVAN OSNOS: At the moment they’re not pursuing it. And I use that term advisedly because they would use that term carefully. And what I mean is that at this point, they are aware – both Democrats and others who are talking about the possibility of Donald Trump’s removal from office – they’re aware that there is a perilous element to talking about it publicly and actively because in some sense that can become a rallying cry for Donald Trump’s supporters.

So what they’re being is judicious. And what they’re saying is, we don’t believe right now that there are firm grounds for impeachment. If we did, then we’d be introducing that in Congress. What we believe is that there are the precursors or the indicators of types of behavior and standards in the White House that expose him to extraordinary risks legally and politically.

So there are members of Congress now who have begun to talk about in private the fact that they believe that some of Donald Trump’s actions, both in terms of how he talks about other branches of government, how he talks about the courts, the ways in which he has sought to de-legitimize the decisions of federal courts, that those could become the basis for a serious critique and ultimately a charge that he is undermining the norms of democracy or abusing the powers of his office.

But at this point, they are not prepared to go public in a formal sense. And – but it was pretty clear. You know, I work in Washington. I am talking to a lot of people who are involved in politics day-to-day, either as office holders or as, you know, the people around those office holders who in many ways hold a lot of power, deciding where the future of politics is headed.

And what became clear to me over the course of the last three months of the Trump administration was that this was not just water cooler conversation at the office or sort of late night monologue jokes about whether this president is fit for office, that there was, in fact, a much more formal conversation going on that doesn’t really make the newspapers on a day-to-day basis but is in fact very serious and scholarly. And people are beginning to try to understand what are the legal boundaries for a president who is in so many obvious ways unlike any president we’ve had before?

GROSS: Well, some people have been challenging President Trump’s mental fitness to serve in office. And that’s where the 25th Amendment comes in. Let’s start there. First of all, what does the 25th Amendment say?

OSNOS: The 25th Amendment was created after the assassination of John F. Kennedy, when people in government realized that the Constitution was pretty good at dealing with the possibility of the death of a president. That’s what vice presidents are for. But the Constitution was not well-equipped for another scenario, which was a president who, in Kennedy’s case, had he lived from a gunshot wound, was comatose perhaps. There was no legal way for the duties of the office to be discharged by anybody else, so the government would be paralyzed.

And so in 1967, they introduced this amendment which created under Section 4 a pretty remarkable set of legal capabilities. And what it says is that if a president is determined to be mentally or physically unfit, unable to discharge the duties of the office, then he or she can be removed. And the determination about whether or not the president is unfit, that can be made by the vice president and the Cabinet.

So if a majority of the Cabinet secretaries – and a majority eight people – if they decide that the president is showing the signs of instability, is really not able to do the job, all they do is write down on a piece of paper, and they give it to the leaders of the Senate and the House. And at that point, the president is no longer legally endowed with the same rights and legal authority, particularly over the nuclear arsenal, that he or she had before. But a president can object.

It’s a scenario – a sort of nightmare scenario that scholars describe as contested removal, in which a president would object to the idea that he’s been determined to be unwell. And at that point, then Congress has three weeks to decide the issue. And you can just sort of imagine. It’s kind of amazing to step back and think about what that would actually be like in practice, that you would have Congress actively, openly, publicly discussing the question of whether or not the president of the United States was mentally fit to return to the presidency.

During that three-week period, the vice president would be what’s known as acting president. And it would be up to the Senate and the House to decide by a two-thirds majority to remove the President. And if they don’t meet that two-thirds threshold – which is artificially high, it’s designed to make it very, very hard to do – well, then the president goes back to the job.

But I’ll mention one other piece of this which is important and has become, in some ways, the sort of leading official edge of this discussion about mental health. And that’s that under the 25th Amendment, the Congress is legally allowed to create another body beyond the vice president and the Cabinet to make the determination of the president’s mental health. That body could be, for instance, a set of medical professionals, doctors, or it could be former presidents or vice presidents. That’s never actually been created.

But since the beginning of the Trump administration, at least two members of Congress – Democrats from Maryland and from Oregon – have introduced bills explicitly, they say, in response to their concerns about Donald Trump’s mental health. And those bills would create this legal body which would have a greater say in assessing the president’s stability.

So in that sense, the question of whether or not Donald Trump is, you know, mentally stable is now a matter of public policy. It is now officially part of the discussion in Congress. And I think it’s there to stay.

GROSS: Do you know if anybody in Congress or in Trump’s inner circle has questioned his mental health?

OSNOS: In Congress, they certainly have. Look. I’ve talked to – I’ve talked to a lot of members of Congress over the course of the last few weeks. And most – let’s be clear, mostly it’s Democrats who, say, well, six months ago, this was a joke. This was a late night monologue matter, the question of whether or not Donald Trump’s – you know, is delusional when he says things like that there were 3 to 5 million illegal votes against him. Of course, there’s no basis to support that. Or when he says that he had the largest Electoral College victory in history, things like that which are quite easily and verifiably false.

You know, that is no longer – it’s no longer a joke. And what they say is that this is now a very serious matter. And, look. A number of Democrats who I spoke to, including Earl Blumenauer of Oregon, Jamie Raskin of Maryland who is a constitutional law professor, as well as a member of Congress, you know, what they told me is that they have had long conversations with Republican colleagues about their concern and some of their colleagues’ concern about the president’s behavior.

But their Republican colleagues, at this point, none of them have gone public or gone on record as saying anything more than, you know, what might be a kind of rhetorical critique, people like John McCain or Lindsey Graham who will say things like this president doesn’t seem normal to me. But they are not at the point of talking about the president’s mental health as a matter of public policy the way that some Democrats have begun to.

GROSS: If you’re just joining us, my guest is Evan Osnos, a staff writer for The New Yorker who has been writing a lot about President Trump dating back to the campaign. And his new article is called “How Trump Could Get Fired.” And it explores the different paths that his opponents are taking to use the process of impeachment or the 25th Amendment to remove the president from office. We’re going to take a short break here, and then we’ll talk some more. This is FRESH AIR.

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GROSS: This is FRESH AIR, and if you’re just joining us, my guest is New Yorker staff writer Evan Osnos, who has been following President Trump and, before that, candidate Trump. His new article is called “How Trump Could Get Fired.” And it looks at the path that his critics are taking to use the process of impeachment or the 25th Amendment to remove the president from office.

The president’s health records have ranged between totally opaque and incredibly vague and prone to generalizations (laughter) very positive generalizations. But a group of 35 psychiatrists sent a letter to The New York Times questioning President Trump’s mental fitness to serve. What did that letter say?

OSNOS: You know, that letter was extraordinary, partly because there are a lot of reasons why mental health professionals do not go public with their concerns about the mental health of politicians. You know, for a long time, this has been a taboo. They really do not talk about it.

GROSS: Well, actually violated a kind of ethical standard within the psychiatric profession…

OSNOS: Exactly.

GROSS: …That’s been the rule since 1973. Do you want to describe that?

OSNOS: Yeah. Yeah, well – so in 1964, when Barry Goldwater was running for president, a magazine called Fact asked psychiatrists, psychologists and others whether they believed that he was fit for the presidency. And more than a thousand of them came forward and said they did not. Goldwater, who lost the race, ended up suing for libel. He won, and as a result, the American Psychiatric Association created this ethical taboo against publicly diagnosing people who you have not directly examined and have not received their permission to talk about publicly. And that’s known as the Goldwater Rule.

And for years, it really was – it obtained without question. You just did not see psychiatrists opining in the press about whether or not a political persona was – suffered some sort of psychiatric problem. Donald Trump has changed that completely. There have been more than 50,000 mental health professionals who have come forward and signed a petition using their names, exposing themselves professionally to some sort of, you know, potential sanction, to say that they believe that he is – poses a risk to the public because, in their view, he demonstrates many of the characteristics of psychiatric disorders, including narcissistic personality disorder or what’s known as malignant narcissism, which is a combination of grandiosity, sort of hypersensitivity to criticism, an aggressive personality, sadism of one kind or another.

And so you have this really fierce debate going on right now in the psychiatric community, in the mental health community, about whether or not it’s appropriate to be talking about Donald Trump’s mental health. But what you hear from the people, like the 35 mental health professionals who wrote to The New York Times, is that they believe that above and beyond the Goldwater Rule that they have a more urgent ethical commitment. And that’s what’s known as the duty to warn. What that means is that if they in their practice come to believe that somebody, either a patient or somebody that they’ve encountered, poses an urgent risk to others, to the public, well, they have a responsibility to talk about that.

And that goes beyond their other commitments because they have to protect the public. And so what they say is that they believe that Donald Trump, because he is so impulsive and so sensitive to criticism and is now in possession of such extraordinary power, both in national security terms and in legal terms, they’re concerned that he could use that either in national security to start a war or in some ways to harm Americans. And that’s why thousands of them have come forward. And for that, we are really in an unusual territory because that doesn’t – we haven’t seen that before.

GROSS: So in response to this letter that was signed by 35 health professionals and published in The New York Times questioning the president’s mental fitness to serve, the psychiatrist who wrote the entry for narcissistic personality disorder in the DSM, the Diagnostic and Statistical Manual, which kind of defines all the psychiatric disorders, he challenged that. He said that President Trump does not have the kind of problems associated with a mental illness.

OSNOS: Yeah, yeah. Allen Frances, exactly as you say, he wrote in response and said that he did not believe that Donald Trump showed the level of impairment, meaning that basically how do you become president if you’re suffering from a psychiatric disorder? That you just – he does not seem incapacitated to the degree that you would typically expect from somebody who was diagnosable. The response to that has been forceful. They have said no, we see high-functioning people with psychiatric problems a lot. And so, you know, that debate is going to continue.

One of the interesting points that I think this brings up is if you look back over the course of the presidency historically, the fact that somebody is suffering terribly from something has never prevented them from becoming president. There was a study done by psychiatrists at Duke University that was published a few years ago which looked back at the medical records for presidents reaching back decades. And what they concluded was that 49 percent of United States presidents have suffered from an illness that would satisfy the standards of a psychiatric disorder. That includes depression, anxiety, substance abuse. Many of them abused alcohol at one point or another. And this was – you know, some of these are well-known. Abraham Lincoln, of course, as many people know, was depressed for much of his life. But there were others that it was not known at the time. It was largely hidden.

Lyndon Johnson, for instance – we don’t often talk about Lyndon Johnson’s mental health, but since his death, it’s emerged that two of his aides were so concerned about his own paranoia in the midst of the Vietnam War, as he felt growing political opposition around him, that they actually consulted psychiatrists to try to figure out what they could do to help him. And Lyndon Johnson had begun to carry statistics in his jacket pocket, which he knew were false. But these were statistics that he would use to recite to people to try to defend his policy choices, defend his positions. He was convinced that there were enemies, as he put it, around him who were trying to encircle and prevent his presidency from succeeding.

So what this says is that there are both reasons why presidents are able to get into office. They’re possessed with these extraordinary political gifts. But there is almost a unique level of stress associated with that job that means that they may not, in fact – that they may satisfy some of the characteristics of a psychiatric disorder while still at the same time succeeding in some obvious ways by simply being in the presidency.

GROSS: But the ways that President Trump is being challenged in terms of his mental health are different in the sense that some of the kind of grandiosity and narcissism that some people have attributed to him precede the campaign, let alone assuming office.

And, you know, for example, in terms of defining what some of his critics see as the problem, Laurence Tribe, who’s a professor of constitutional law at Harvard, said – and you quote this in your piece – he thinks that the inability to discharge the powers and duties of office should include an inability that can be manifested by gross and pathological inattention to or indifference to or failure to understand the limits of presidential powers or the mandatory nature of those duties.

OSNOS: Yeah, this is one of the things that’s really interesting about the 25th Amendment and Trump’s mental health. I think, you know, if you ask most people what they imagine about what would be required for a president to be relieved of duty for mental health, they think, well, you know, he has to be essentially incapacitated. We have to be talking about somebody who’s really just – who’s had a break with reality in all obvious ways.

And what Laurence Tribe – who is a constitutional scholar, as you say, at Harvard – what he points out is that actually no, the framers of the 25th Amendment were very clear about their intent. They said this is not a medical strict standard. This is a combination of medical and political characteristics, meaning that at any given moment, you have to be able to take in the full totality of whatever the challenges are the president is facing and decide whether or not that president is really capable of discharging their duties.

And if they show that they are simply so incapable of maintaining a reasonable command of the facts or understanding or reading the material that’s presented to them, well, then that can qualify as what professor Tribe calls pathological inattention. And he cites as an example the fact that just recently in the midst of this growing tension with North Korea over its nuclear arsenal, Donald Trump said publicly that the United States had, as he put it, an armada that was steaming towards North Korea.

At the time, that armada, as he put it, an aircraft carrier and the vessels around it were not. They were actually going the other direction. And what professor Tribe says is that that kind of casual disregard for the responsibility and capability the office, which, you know, that that constitutes in and of itself a level of concern that would – that qualifies consideration under the 25th Amendment. Because if the president is not able to understand the consequences of making a statement like that which could inflame North Korea, could lead it reasonably to assume that it is facing imminent attack, well, then that’s not discharging the offices of the presidency in the legal way.

GROSS: My guest is Evan Osnos, a staff writer for The New Yorker. His article, “How Trump Could Get Fired,” is in the current issue of The New Yorker. After we take a short break, we’ll talk about whether the president might be at risk of impeachment. I’m Terry Gross, and this is FRESH AIR.

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GROSS: This is FRESH AIR. I’m Terry Gross, back with Evan Osnos. We’re talking about his article in the current edition of The New Yorker titled “How Trump Could Get Fired.” It’s about the fears being expressed by some members of Congress, as well as some psychiatrists, legal experts and scholars that President Trump is unfit to serve. The article examines the two constitutional paths by which a president can be removed from office – impeachment and the 25th Amendment.

Osnos is a staff writer at The New Yorker and has been writing about Trump since the start of his presidential campaign in 2015. When we left off, we were talking about Osnos’s interviews with people who are questioning the president’s fitness to serve.

Of course, one of the president’s most powerful powers is to order a nuclear a attack. And somebody’s always accompanying the president with the nuclear football that has, like, a nuclear plan attached to it and the ability to start a nuclear war. You spoke with Bruce Blair, a research scholar at the Program on Science and Global Security at Princeton. And he told you that if Trump were an officer in the Air Force with any connection to nuclear weapons, he’d need to pass the Personnel Reliability Program. What is that?

OSNOS: The Personnel Reliability Program is administered to anybody in the chain of command up to a certain level, which is to ensure that if they have their hands anywhere in the process of firing a nuclear weapon – so meaning if they’re a launch officer at a silo in the – you know, deep underground in the Midwest, or if they’re somebody in the Pentagon who’s involved in the process of considering and relaying nuclear orders – that they have to be assessed for their emotional stability, their financial profile so that the Pentagon knows that they are not in debt to anybody, so that the Pentagon knows that they do not have serious financial risks that might shade or guide their judgment.

So they answer a set of questions. And on that list of questions are things like have you ever been close to bankruptcy? How well do you sleep at night? Are you prone at all to losing your temper? And what Bruce Blair – who is a scholar at Princeton now and was for many years an ICBM launch officer in the Air Force, he’s a scholar who looks at the intersection of national security and science – what he says is that everything that he knows from his own Air Force career makes it quite clear that Donald Trump would not pass that Personnel Reliability Program test because he has not released his tax returns.

We don’t know what his financial commitments are and also because he has not released the health information that most presidential candidates have released. We don’t know, for instance, whether or not he has had emotional instability in the past. We don’t know a lot of details about his overall health. So for that reason, the irony here, of course, is that in order to be president, you don’t have to pass that test. But if Donald Trump was lower in the chain of command, he – as Bruce Blair puts it – would have almost certainly not been allowed to be involved in the nuclear chain of command.

GROSS: So let’s talk about what you’re hearing about impeachment. Let’s first define what impeachment means, what the standard for impeachment is.

OSNOS: Yeah. Impeachment is one of the very first things that was written into the Constitution. And it is the legal right of the public through Congress to remove a federal officer. Of course, the president is who we’re talking about. And in order to do that, the president would have to be found to have committed treason, bribery or what’s known as other high crimes and misdemeanors. That’s a term that came out of English law.

And what’s important about that is that it’s not the same as an ordinary legal standard. It’s not as if you have to violate the U.S. criminal code. It is a very specific thing. High crimes and misdemeanors was defined by the framers of the Constitution as being a violation of the public trust. So it’s not, you know, it’s not that it has to be that you, you know, did some very specific crime that would land you in an ordinary court. It’s that you have essentially committed a crime against the country – a crime against your own office.

And, you know, we sometimes think of an impeachment as a prosecution. It has in some ways the aroma of a court about it. You know, it uses terms like charges and verdict, but that’s not what it is. It does not put somebody in jail, obviously. What it does is it removes them from office. So it is a – it’s a tool of political accountability. It’s a way of holding the office of the president to account when there is no other way of holding the office of the president to account.

GROSS: OK, so it’s not a criminal trial. It’s not about violating the criminal code.

OSNOS: Exactly.

GROSS: But on the other hand, President Trump faces dozens of civil proceedings. And if he’s found guilty in civil court, does that affect the possibility of impeachment? Does that come into play? Is that taken into consideration?

OSNOS: It is. And actually, even before you reach the question of a ruling in civil court, you know, that Donald Trump is right now, as you say, facing a vast range of different kinds of civil proceedings. He’s been sued by somebody who was thrown out of a rally in Louisville, Ky., who accuses him of inciting violence. He’s been accused of sexual harassment, is facing a proceeding in state court in New York and a whole range of other cases.

The reason why these are enormously risky for Donald Trump is that when a president is deposed, meaning that when they give a deposition or when they ever appear under oath, then they are at risk of perjury. And we know from the experience of Bill Clinton, who was ultimately impeached for two charges – perjury and obstruction of justice – that any time a president is under oath, that is a very, very risky moment.

This is one of the reasons why just before the Trump administration came into office, he and his lawyers settled cases, including the Trump University case in New York which was a fraud investigation, in which he agreed to pay tens of millions of dollars to his accusers. This is designed, in part, because they’re trying to make sure that Donald Trump does not need to go under oath.

GROSS: You write that many scholars believe that the most plausible path for a Trump impeachment is based on corruption and abuse of power. For example?

OSNOS: Traditionally when we think of abuse of power, we think of, for instance, Richard Nixon, who used the IRS or the CIA to target his opponents. But abuse of power is actually much broader than that. And Donald Trump has exposed himself to that accusation in a couple of very specific ways. Number one, when Donald Trump issued an executive order that banned immigration from Muslim majority countries, that order was stalled by a judge in Seattle, a federal judge.

And Donald Trump went public, as you remember, and he said that a, quote, “so-called judge,” unquote, has now put the country at risk because he said if there is an attack on Americans, you should blame that judge. I’m paraphrasing there. But this is what he said publicly. And, you know, some of us, I think we just sort of chalk it up to Donald Trump’s speech, that that’s the sort of things that he says.

But actually, if you’re somebody who is involved in the federal government and in the basic architecture of a democracy, that’s deeply concerning because what he’s doing is fundamentally seeking to discredit a co-equal branch of government. The judiciary, after all, is no less or more powerful than the presidency. But what he’s doing is using the exclusive power of the president, this bully pulpit, this power to be able to speak to 310 million Americans, and he is seeking to say that that judge is illegitimate and in furthermore, that if Americans are harmed, that that judge is responsible. That kind of statement in and of itself could be used as the basis for an abuse of office accusation.

GROSS: Is there another example that’s been cited of President Trump denigrating or defying an equal branch of government?

OSNOS: There is, and I think this is the one that is probably the most acutely vulnerable to him. Senator Richard Blumenthal, who is a member of the Judiciary Committee, former attorney general of the state of Connecticut – so somebody who is deeply fluent in the law of the land – said to me that he sees on the horizon a constitutional crisis. That’s his term, and he means it very specifically. He’s referring to the possibility that the Trump administration will resist the efforts of other parts of the government to obtain information.

So if they issue a subpoena in the Russia investigation, if the FBI or if the intelligence committees in the Senate and the House ask the White House for information and if the White House refuses to provide that information, that right there is exactly what a constitutional crisis is. And it’s worth remembering that that’s the moment in Richard Nixon’s presidency when things began to unravel. In October of 1973, the appellate court ordered Richard Nixon to provide secret tapes that he had made of his own conversations to the special prosecutor. And he resisted. And as a result of resisting the court’s order and of trying to fire the special prosecutor, he began the process of his own undoing.

And Richard Blumenthal, who is, after all, a very measured, careful communicator on the subject of the law – doesn’t talk about this stuff casually – said to us on the record in this story that he believes that we’re heading towards a similar scenario because the White House has already started to resist the disclosure of documents. You saw just recently that Republicans and Democrats overseeing the House Oversight Committee have said that the White House has rejected their requests for documents related to the hiring and firing of National Security Adviser Michael Flynn. It’s one of those moments that sounds incredibly bureaucratic and esoteric but is in fact a very significant landmark because it represents the White House stonewalling efforts of an equal branch of government to do its job.

GROSS: Let’s take a short break here, and then we’ll talk more about paths some people in Washington are pursuing toward trying to impeach President Trump. If you’re just joining us, my guest is Evan Osnos, a staff writer for The New Yorker, and his new article is called “How Trump Could Get Fired.” We’ll be right back. This is FRESH AIR.

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GROSS: This is FRESH AIR, and if you’re just joining us, my guest is New Yorker staff writer Evan Osnos. He’s been writing about Donald Trump since Donald Trump was a presidential candidate. His latest article about the president is called “How Trump Could Get Fired,” and it’s about Washington insiders, including people in Congress, who are considering pursuing the path of impeachment or using the 25th Amendment to the Constitution to remove President Trump from office.

Well, Sally Yates is going to testify before a Senate panel on Monday, and she was the acting attorney general who was removed from office by President Trump after she refused to enforce his travel ban. She apparently warned White House Counsel Don McGahn that Michael Flynn, who was the brief national security adviser to President Trump, that Flynn lied when he said he hadn’t discussed U.S. sanctions on Russia in conversations with the Russian ambassador to the U.S. during the campaign. And Yates apparently told McGahn that Flynn spoke with Russians and could be compromised and that this was a very serious issue. And she apparently implied that as a result Flynn should be fired. It took three weeks for Flynn to be fired from that position, and the reason that was officially given was that he lied to Vice President Pence about the nature of his conversations.

So if Michael Flynn is found to have colluded with the Russians, does that reflect on President Trump in a way that might be impeachable?

OSNOS: Yeah. This is a classic demonstration of the principle you hear very often when it comes to presidential scandal or investigation, and that is what did the president know and when did he know it? So the question that the – that will be under consideration when Sally speaks to Congress is, how high did her information reach into the White House? Were others aware of the fact that Michael Flynn was potentially exposed to compromise, was potentially exposed to blackmail by the Russians? And were actions taken either to cover that up or to defer action to remove him?

What this gets to is, I think, one of the most powerful lessons of the history of impeachment, and that is that investigations lead to investigations. And what I mean is that Donald Trump came into office in the already very unusual position of having an FBI – active FBI – investigation around his associates into the – whether or not they colluded with Russia to interfere in the election. But that may ultimately not be his biggest problem. His biggest problem may be that that investigation produces other probes of other things. And we’ve really already begun to see that process.

So Devin Nunes, who was the ranking Republican on the House Intelligence Committee, was forced to remove himself from the investigation of the Russia case because it had become clear that he had acted inappropriately to look at classified information with the White House and then went public with that information in a way that was certainly not appropriate. And he’s now under an ethics investigation by the House.

So, you know, one of the things that’s so interesting here is that all of this may have begun with an investigation into how and why Russia interfered in the U.S. election. But by the time this is over, you are going to see that there have been all of these additional side processes, additional investigations, that spin off of that main process. And it’s impossible to know at the outset which one of those is the one that is most potentially damaging to a president.

GROSS: Well, you know, continuing with the kinds of investigations that are going on, there’s an investigation into Paul Manafort, the former campaign chair for Trump who received millions of dollars in cash from pro-Russian groups in Ukraine, Carter Page, former foreign policy adviser to the Trump campaign. Investigations into his connection to Russian agents are ongoing now. So there’s – as you said, there’s all these investigations that could lead to more investigations of things we don’t even know about.

OSNOS: Yeah. That’s the lesson of really the Clinton impeachment, which is if you remember, that began with an investigation into a failed real estate deal in Arkansas called Whitewater. And nobody would have guessed in 1994 when that investigation began, that it would have ultimately led more than four years later to the impeachment of a president for covering up an affair with a White House intern.

That’s the dynamic that is worth paying attention to now because it’s really difficult to know which one of these different strands is going to be the most relevant. But he is already just within his first three months in office facing a scale of ethical skepticism and formal investigation that he’s really unlike any president that we’ve seen before.

GROSS: Because impeachment has to be passed through the House and the Senate, you need to be politically unpopular with people in Congress. Republicans control the House and the Senate. And so it seems unlikely that they would impeach a member of their own party. Republicans are also in the majority of the Supreme Court. So does that lower the odds that the impeachment process would ever succeed because what are the odds that Republicans would impeach one of their own?

OSNOS: You’re absolutely right that a Republican president is unlikely to be subject to an impeachment proceeding initiated by Republican leadership in the House and the Senate. But a president needs his own party to survive impeachment in a couple of very specific ways. Number one, if the Republican House goes into Democratic hands in 2018, then it is really – this becomes not a theoretical question, but becomes an immediate political question.

So Democrats have already indicated in one form or another that they would be prepared to move ahead with a serious consideration of impeachment of this president, if not yet prepared to say formal resolutions to that effect. So what that means then is that for Donald Trump to defend himself against a Democratic-led process pursuing impeachment, he would need Republicans because the Republicans in the House would have to stay on-side and support him in a vote. It’s a simple majority meaning that if 51 percent of the House votes for impeachment, then the president is impeached. And so he needs every Republican he can get to stay with him in that case. Then it would go to the Senate.

And in order for a president to be removed from office, two-thirds of the members of the Senate would have to side against him. And in order to meet that two-thirds threshold, that means that a number of Republicans would have to vote against Trump. So for that reason, he needs Republicans on his team.

And in some ways, that’s one of the things that is – that’s one of the indicators that suggests that he is at risk in ways that the public doesn’t fully appreciate yet because Republicans in Congress are at this moment less privately satisfied with Donald Trump than they publicly admit.

GROSS: My guest is Evan Osnos, a staff writer for The New Yorker. His article in the current issue is titled “How Trump Could Get Fired.” We’ll talk more after a break. This is FRESH AIR.

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GROSS: This is FRESH AIR. Let’s get back to my interview with Evan Osnos about his article in the current issue of The New Yorker titled “How Trump Could Get Fired.” So looking historically, two presidents have been impeached – Andrew Johnson who took over as president after Lincoln was assassinated and Bill Clinton who was impeached in the House, but the Senate did not convict. So, you know, he remained in office. So if we look historically at those two examples, are there lessons to extract from the past that might be relevant to the impeachment process?

OSNOS: Yeah. There are lessons, actually very important ones in some ways. The number one most important lesson is that, you know, the single greatest most important ingredient in figuring out who gets impeached and who doesn’t is popularity. The simple fact is that Congress tends to not impeach popular presidents, and that’s because this is – you know, it goes back to the very, very most important point about impeachment, which is it is not a prosecution. It is a political process. It’s designed to try to remove somebody from office who has been determined to be both, you know, through this kind of an ineffable process of divining the public’s support. It’s about trying to decide whether that person is no longer capable of doing the job.

So if you lose political popularity, then you are acutely vulnerable. That’s point number one. Point number two is that Congress itself is very powerful in curtailing the powers of a president, either by, you know, by hobbling them through impeachment, even if they don’t remove them from office by subjecting them to that level of investigation, humiliation. It is a way of holding them to account. And in both of those cases – in Andrew Johnson’s case, in Bill Clinton’s case and also in Richard Nixon’s case – though he was not ultimately impeached because he resigned, he is very much a sort of object lesson in the process of impeachment. All three of them lost the support of their own party in Congress to some degree. And as a result, that made them vulnerable.

And, you know, strangely enough when we talk about impeachment, we often think, well, the most important thing is the, quote, unquote, “smoking gun.” You know, it’s this piece of evidence that you have to have that shows that they did something that breaks the law. And, you know, it certainly is helpful. It may in fact be necessary. But everybody who has studied this process closely agrees it’s not the most important thing.

You know, the most important thing is who controls the House of Representatives? If the opposing party controls the House of Representatives, then a president can be investigated. And through that process, they begin to chip away at a president’s public approval. They begin to expose potential acts of wrongdoing that have been concealed. Therefore, you know, the single most important thing in Donald Trump’s political survival right now is the 2018 midterm elections.

GROSS: So because impeachment is a political process that requires passage in the House and then conviction in the Senate – Republicans control both the House and the Senate now, but in the midterm elections in 2018, there is the possibility that Democrats will win a majority in the House. That might be a remote possibility, but it is a possibility. So if Democrats won a majority in the House, how would that affect the likelihood of impeaching the president?

OSNOS: I think there’s no question if Democrats control the House of Representatives as a result of the 2018 midterms, that significantly raises the likelihood of an impeachment process because all of a sudden they would have subpoena power. They would have the ability to convene hearings and subcommittees and special committees dedicated to investigating ethical conflicts or abuses of office or civil complaints against the president. All of those would suddenly become active, live political issues.

And then on top of that, there is the problem of whether or not the White House would cooperate. And if the White House did not cooperate, then that’s an additional risk. So really there is just a tremendous amount riding on the 2018 midterm elections when it comes to this president’s political future.

GROSS: So Democrats are only 23 members away from having the majority. Like, what do you think the odds are that they would take over the House?

OSNOS: Well, I assumed at the outset of this project that Republicans are in very firm territory and control the House. Because of gerrymandering, they’ve basically created a lot of very safe seats for themselves. And there’s some truth to that. But actually Republicans told me – these are people who look at long-term trends in electoral results – they said actually that the party needs to be much more concerned than it is because historically if one party controls the White House and both houses of Congress, they tend to lose 35 seats in the next midterm election.

Right now, that would be a big enough loss to give control of the House to Democrats. Republicans control it by 23 seats. And so, you know, from a member of Congress Republican named Tom Davis who ran the Republican congressional election operation on multiple elections told me of his former colleagues very bluntly. He said they are living in la-la land right now. They don’t fully appreciate the risks that they’re facing. If Democrats take the House – and he thinks that they stand a good chance of doing so – this president is exposed immediately to investigation.

GROSS: Well, Evan Osnos, thank you so much for talking with us.

OSNOS: My pleasure. Thanks for having me, Terry.

GROSS: Evan Osnos is a staff writer for The New Yorker. His article “How Trump Could Get Fired” is in the current issue. If you’d like to catch up on FRESH AIR interviews you missed, like this week’s interviews with comic W. Kamau Bell, writer Richard Ford and Richard Rothstein who wrote a new book about policies that mandated housing segregation, even in the north, check out our podcast.

ORGANIZATIONAL CULTURE
To Build a Winning Team: An Interview with Head Coach Bill Walsh

Richard Rapaport

https://hbr.org/1993/01/to-build-a-winning-team-an-interview-with-head-coach-bill-walsh

Joining the august company of Knute Rockne, Paul Brown, and Vince Lombardi, former San Francisco 49ers and current Stanford University football coach Bill Walsh is recognized as one of the most important figures in football history. Walsh, like other coaching legends, has done far more than produce consistently winning teams: in his case, three Super Bowl championships for the 49ers in eight years and an organization enshrined in the press as “The Team of the ’80s.” During his ten-year career with the 49ers and as a coach at the high school, college, and professional levels, Walsh developed a uniquely thoughtful style of play and a successful system of team management that has become one of the most respected in the modern game.

Less of a psychologist than Rockne, and never a disciplinarian like Lombardi, Walsh nevertheless produces winners through a businesslike approach to maximizing the potential of players and coaches. His ability to coolly analyze opponents, matching their weaknesses with his teams’ strengths, has made come-from-behind wins a Walsh football hallmark.

Believed to be too cerebral for a top position for which extreme macho was long considered an ineluctable quality, for years Walsh was forced to content himself with assistant coaching positions. Prized nonetheless for his skills on offense, Walsh was honored for honing All-Pro quarterbacks Dan Fouts, Kenny Anderson, and Greg Cook.

In 1977, at age 47, Walsh became Stanford’s head football coach. That year, he took a moderately talented Stanford team to a national ranking and a win in the Bluebonnet Bowl. In 1979, Walsh was named head coach and general manager of a dreadful 49ers team that had been virtually dismembered in the late 1970s by mismanagement and horrendous personnel decisions.

Walsh immediately began to develop long-range strategic and personnel plans for the 49ers. He also focused on what other coaches had considered the minutiae of the game: minute-by-minute choreographing of practices, breaking down individual and group tactics into parts, and defining responsibilities and setting objectives for both players and coaches.

This season, Walsh has been paid the ultimate accolade for a coach: former Walsh assistants are NFL head coaches in Tampa Bay, Minnesota, Green Bay, New York (Jets), and San Francisco.

Retiring after his third Super Bowl victory in January 1989, Walsh signed on as a football analyst for NBC Sports, eschewing numerous bids to coach professionally before stunning the football world in 1992 by returning as head coach at Stanford.

This interview was conducted by Richard Rapaport, who is a San Francisco-based writer and a contributing editor to San Francisco Focus and Forbes/ASAP. His political commentary appears frequently in Knight-Ridder and other newspaper chains around the United States.

HBR: Do you see a link between managing and coaching?

Bill Walsh: I see coaches and executives who have more similar skills today than ever before. When I was with the 49ers, I was both head coach and general manager, so my duties were more business oriented than those of a lot of NFL head coaches. Today’s NFL is a very complex world, and great football knowledge alone won’t get your team to the Super Bowl.

Historically in sports, there has been one central figure in the organization whose presence dominates everything and whose judgments people identify with. That one person is the dictator, and everyone else simply does whatever he says. In a lot of ways, the old system was much easier for all involved. The dictator gave orders and everyone else just followed them.

Now working successfully with the people in the organization demands more from the coach or the executive. In coaching, I think of it as the coach’s ability to condition the athletes’ minds and to train them to think as a unit, while at the same time, making sure each athlete approaches his own game with total concentration, intensity, and skill. There should never be a moment on the football field when a player doesn’t feel challenged both physically and intellectually. That is why the old bludgeon approach is leaving football the same way it is leaving business.

What is replacing the old approach?

Management today recognizes that to have a winning organization, it has to be more knowledgeable and competent in dealing with and developing people. That is the most fundamental change. The real task in sports is to bring together groups of people to accomplish something. In the old days, the approach was rather crude. The organization would simply discard a player who did not fit a specific, predefined mold. If a player did not conform to the way management wanted him to behave, or if he made the organization uncomfortable, it got rid of him. That was the typical response.

Today, in sports as elsewhere, individualism is the general rule. Some of the most talented people are the ones who are the most independent. That has required from management a fundamental change in the art and skill of communication and in organizational development. Most important, there has been much more recognition and acknowledgment of the uniqueness of each individual and the need that people have for some degree of security.

How does that translate into winning teams?

Those teams that have been most successful are the ones that have demonstrated the greatest commitment to their people. They are the ones that have created the greatest sense of belonging. And they are the ones that have done the most in-house to develop their people. That commitment has come through in the personality of the organizations. It is true of the Redskins, the Raiders, and, of course, the 49ers.

What is the biggest obstacle to creating this kind of organization?

The coach must account for his ego. He has to drop or sidestep the ego barrier so that people can communicate without fear. They have to be comfortable that they will not be ridiculed if they turn out to be mistaken or if their ideas are not directly in line with their superior’s. That is where the breakthrough comes. That is what it takes to build a successful, winning organization.

That approach was certainly critical to the success of the 49ers. It contributed to an environment where our team could be more flexible and adaptable in responding to the unexpected moves of our opponents.

I tried to remove the fear factor from people’s minds so they could feel comfortable opening their mouths. They knew they could be wrong one time and then, when they got a little more information, change their opinion and not be demeaned for it. In fact, I made a point of reminding our coaching staff that I expected them to change their opinions and impressions over time. It’s quite natural: the more information you develop, the faster things can change.

But having enormous self-confidence seems essential for a leader—especially in pro sports. What is the role of healthy versus unhealthy ego in a competitive organization like a football team?

English is a marvelous language until it comes to the word “ego.” We Americans throw that around, using that one word to cover a broad spectrum of meanings: self-confidence, self-assurance, and assertiveness—attributes that most people think of as positive.

But there is another side that can wreck a team or an organization. That is being distracted by your own importance. It can come from your insecurity in working with others. It can be the need to draw attention to yourself in the public arena. It can be a feeling that others are a threat to your own territory. These are all negative manifestations of ego, and if you are not alert to them, you get diverted and your work becomes diffused. Ego in these cases makes people insensitive to how they work with others and ends up interfering with the real goal of any group efforts.

The Turnaround CEO

What do you think are the essential management skills of a successful head coach?

The role of the head coach begins with setting a standard of competence. You have to exhibit a strong working knowledge of the game. The head coach must be able to function effectively and decisively in the most stressful situations. And the head coach must demonstrate resourcefulness—in particular, he is responsible for designing a system of football that is not simplistic. The head coach’s system should never reduce the game to the point where he can blame his players for success or failure simply because they did not physically overwhelm the opponents.

Successful coaches realize that winning teams are not run by single individuals who dominate the scene and reduce the rest of the group to marionettes. Winning teams are more like open forums in which everyone participates in the decision-making process, coaches and players alike, until the decision is made. Others must know who is in command, but a head coach must behave democratically. Then, once a decision is made, the team must be motivated to go ahead and execute it.

What does it take to create a decision-making process in which people feel they can participate?

It starts with the expectations the head coach sets. It is part of the job to expect everyone in the organization to be an expert in his or her particular area of responsibility, to refine their skills continually, and to be physically and intellectually committed to the team. The head coach has to make it clear that he expects everyone to participate and volunteer his or her thoughts, impressions, and ideas. The goal is to create a communication channel that allows important information to get from the bottom to the top.

On Organized Labor

During 49ers games, my coaches and I always tried to respond to what the players said. We knew that we needed their input. And it often made a difference. For example, in a game against New Orleans in 1987, I told the team at halftime that we would call one particular pass play when we got inside the Saints 30-yard line. In the stress of the moment, when we got there, I simply didn’t think of sending in the play. But on the sideline, Steve Young, our backup quarterback, immediately reminded me of it. He wasn’t a bit hesitant. I called it, and we scored.

I couldn’t worry about being embarrassed because I had forgotten what I said in the locker room. We were after results. We all wanted to win.

If that is what it takes to be a successful coach, what are the qualities that define the modern football player?

The key to being a modern football player is the ability to respond quicker, both mentally and physically, than the other player. Some people are naturally quicker physically. But to win, you need to be quicker as a team. You must beat your opposition to the punch every time.

Physical strength and speed are important advantages, but even more advantageous is having the training that permits you to respond intelligently to whatever confronts you. That means more precision, better execution, and quicker response than your opponents. Under the extreme stress of game conditions, a player must condense his intellect and focus it on thinking more quickly and clearly than the opposition.

How do you achieve that quickness and responsiveness in your teams?

It is all in the way you prepare. Preparation allows us to overcome the fact that we might not be the most physically talented team. During the 1980s, the 49ers may not have been as talented as the New York Giants or Chicago Bears, who had measurable advantages in speed or strength. But we were able to compensate in the way we prepared for a game.

Some coaches rely on relatively simplistic plans. When their plans don’t work, they say that it was the players who did not block hard enough, did not run hard enough, or just were not tough enough. We have gone beyond that pattern of failure and finger-pointing. The responsibility for the success of the team starts with the coach, who develops the plan that is then executed by the players—who are extremely well-prepared.

Being prepared starts with identifying the essential skills our team needs to compete effectively. The next step is to create a format to teach those skills. Here at Stanford, our practices and game plans are far more detailed than those used by most of our opponents. There is more to learn with our schemes, so we demand more mental commitment and concentration from the players.

How do you approach the job of structuring practices so your players will be prepared?

I believe in extremely precise, minute-by-minute, tightly structured practices. We focus far more intellect and put far more thought into what we do in practice than other teams do. We have five or six skills or techniques that we want each of our players to be able to use in carrying out his assignment, where our opponents usually will have only one or two.

Take an offensive lineman, for example. Before the ball is snapped, that guard or tackle might have only three or four seconds to decide what kind of blocking technique to use on the man in front of him. Say there are four blocking techniques he can use. By the way his man is positioned, by the situation in the game, by what he has learned to expect from his opponent, he will be able to select one of those techniques.

Many other teams take a more simplistic approach. They teach their players one approach, one technique. Our approach gives our players more dimension. When we are playing powerhouses like Notre Dame, Texas A&M, or Washington, we have to use our extra dimensions to compensate for being physically outmanned. That is the intellectual part of the game. That is the area in which we ask more of our players than our opponents are asking of theirs.

How do you teach those skills?

The most important tool for getting things done is the drill. For example, we work on drills to teach running backs about pass protection against blitzing linebackers. You have to identify the 6 different situations that can occur. Then you have to allocate the time to work on those 6 situations and also the 20 techniques that you want your running backs to be able to apply. In teaching those skills, sometimes you want to have your guards and tight ends participate, or even the entire offensive unit. All of that requires preparation, discipline, and focus from both coaches and players.

The way I coach, I know ahead of time how I am going to run the whole season’s worth of practices. I have established the priorities for what we need to accomplish and allocated the time in which to teach the necessary skills.

I establish the program long before we take the field so I can use most efficiently the time available for learning and so the players do not get bored or distracted. The players must know clearly and at all times exactly what it is that they have to get out of any given drill. After 35 years of coaching, I have found that you can’t do anything in less than 10 minutes or in more than 20 minutes.

Another distinction in drills is between those skills and techniques that can be taught individually and those that require groups. It is also critical to allocate time for team play and to build in practice segments that focus on the execution of particular plays and particular game situations that you want to be ready for.

Why is it important to prepare so many skills for so many contingencies?

Making judgments under severe stress is the most difficult thing there is. The more preparation you have prior to the conflict, the more you can do in a clinical situation, the better off you will be. For that reason, in practice I want to make certain that we have accounted for every critical situation, including the desperate ones at the end of a game when we may have only one chance to pull out a victory. Even in that circumstance, I want us to have a play prepared and rehearsed. Say it is the last 20 seconds of a game and we’re losing. We have already practiced 6 plays that we can apply in that situation. That way, we know what to do, and we can calmly execute the plays. We’ll have no doubt in our minds, we will have more poise, and we can concentrate without falling prey to desperation.

Can you recall a specific instance where this actually paid off for one of your teams?

In 1987, we were down 26–20 against Cincinnati. We got the ball back on their 25-yard line with two seconds left in the game. It could have been a hopeless situation. We put three receivers to the left and Jerry Rice to the right. Joe Montana got the ball, looked left, pump faked, and then threw right, where Rice was covered man-to-man in the end zone. It was a touchdown, and it won an important game for us. But it would not have happened if we had not been prepared.

You need to have a plan even for the worst scenario. It doesn’t mean that it will always work; it doesn’t mean that you will always be successful. But you will always be prepared and at your best.

“You need to have a plan even for the worst scenario. It doesn’t mean that it will always work.”

But the same applies to virtually every situation at every point in the game. Say you are on the defense and inside your own 25-yard line. The situation can vary, so there are a number of particulars you need to prepare for. You have third down and inches. Third down and feet. Third down and yards. Inside the 15-yard line, all that changes, and inside the 5 it changes again. Each situation is different, and for each you might have 15 different game situations to practice. You have to allocate time for all of them, you have to practice plays, and you have to work with individuals. And then all of the separate situations have to be pulled together to give a continuity to the team’s play.

One of the most impressive attributes of your 49ers teams was their ability to take what some people might consider a disadvantage and use it to their advantage. Did you work on developing this skill?

I can think of several cases where we consciously tried to work on the players to reverse what in football are usually crippling disadvantages. One was playing on the road. In football, the home-field advantage is often decisive. But we were able to bond together, play in enemy territory, and feed on the emotions of the situation, without being intimidated by the other teams or their fans.

To accomplish that, I would condition the 49ers to adversity. We would talk about how it feels to fly into enemy territory. We would discuss what crosses your mind when you take the field. It allowed us to turn our status as outsiders into our advantage. When I talked with the team, I would use examples from the early days of World War II as illustrations of the desperate and heroic fights we could emulate. By talking about what could be a disadvantage, we turned our people on. We made it an advantage.

The other example is the injury factor. Some teams come unraveled when a star player gets injured. With the 49ers, an injury often served to arouse the team to play harder. Again, my approach was to talk about it openly. I would make the point that reserve players always had to be prepared, and that when they got the chance, they should actually improve on the performance of the injured player. Again, I used historical examples from warfare. For instance, in the Civil War, the best trained people, the front line and even generals, were often the first to fall. Often it was the reserves who would achieve victory. So when our reserves took the field, they were conditioned to feel this way and they knew what was expected. They would feel much more positive about going into the game.

In teaching skills to your players, how do you organize your own thinking about the players you are trying to reach?

Take a group of ten players. The top two will be supermotivated. Superstars will usually take care of themselves. Anybody can coach them. The next four, with the right motivation and direction, will learn to perform up to their potential. The next two will be marginal. With constant attention, they will be able to accomplish something of value to the team. The last two will waste your time. They won’t be with you for long. Our goal is to focus our organizational detail and coaching on the middle six. They are the ones who most need and benefit from your direction, monitoring, and counsel.

How do you achieve a balance between group skills and discipline on the one hand and player individuality on the other?

They go together in defining the two directions you need to pursue at the same time. First, you develop within the organization and the players an appreciation for the role each athlete plays on the team. You talk to each player and let each one know that, at some point, he will be in a position to win or lose a game. It may be one play in an entire career for a certain player or many plays each game for a Joe Montana. But the point is that everyone’s job is essential. Everyone has a specific role and specific responsibilities. And each player has to be prepared both mentally and physically to the utmost to play that role.

“At some point, each player will be in a position to win or lose a game.”

Second, you talk to each player and indicate the importance of everyone’s participation in the process—that it is important for everyone to express himself, to offer ideas, explanations, solutions, formulas. You want everyone to enter into the flow of ideas, even ideas that may seem extreme in their creativity.

You are actually striving for two things at the same time: an organization where people understand the importance of their jobs and are committed to living within the confines of those jobs and to taking direction; and an organization where people feel creative and adaptive and are willing to change their minds without feeling threatened. It is a tough combination to achieve. But it’s also the ultimate in management.

Is there a situation with a player that exemplifies this balance between giving explicit direction and permitting individual creativity?

Take Joe Montana, for example. He is a perfect combination of the two vital aspects that are necessary for developing greatness as a quarterback.

The formula for the success of the 49ers offense was a highly disciplined, very structured form of utilizing the forward pass. To make our system work, Joe had to master the disciplines to know which receiver to throw to, when, and why. The success of the team depended on Joe’s ability to work within that framework. Consequently, the job of the coach was to use drills and repetition so that Joe developed almost automatic moves and decision-making ability.

But there is an extra quality that it takes for a quarterback to become a world champion—or, in Joe’s case, the best ever. And that is an instinctive, spontaneous, natural response to situations that arise in games. Part of Montana’s greatness was that 10% to 15% of the time his spontaneous instincts would break loose and make a phenomenal difference in the outcome of a game.

It is the job of the coach to find the best of both sides. We had to have a very structured system of football, and we also wanted instinctive and spontaneous play.

How do you go about the job of coaching a player like Montana to develop that kind of balance?

Early on, we had to encourage Joe to trust his spontaneous instincts. We were careful not to criticize him when he used his creative abilities and things did not work out. In practice, we worked with Joe repeatedly on specific plays. When he was placed in a game, we called only those plays because we knew that he should be confident that he could execute them. But we didn’t jump him the minute he would break the pattern. Instead, we nurtured him to use his instincts. We had to allow him to be wrong on occasion and to live with it.

Of course, with different players the problem takes on a different look. In the case of quarterback Steve Young, it was almost the opposite. We had to work with him to be disciplined enough to live within the strict framework of what we were doing. Steve is a great spontaneous athlete and a terrific runner. But we found that we had to reduce the number of times he would use his instincts and increase his willingness to stay within the confines of the team concept.

For example, we would be at a point in a game where we had designed a special play to break the defense wide open and score a touchdown. In his early days, Steve might not have had the discipline to wait for that play to develop. Instead, he would see an opening and run with the ball for a five-yard gain. He would let his instincts and emotions affect his patience with the play and his confidence that the entire team could execute.

As a coach, how do you know what it takes to bring out the best in a young player’s abilities?

Unfortunately, there is nothing exact about it. Experience is really the only teacher. I was 47 years old when I became an NFL head coach. Typically, that job comes to people when they are between the ages of 35 and 40. I was in a subordinate role as an assistant coach for a longer period of time than most, so I was forced to analyze, evaluate, and learn to appreciate the roles that other people play more than I might have. In retrospect, I was lucky.

College Football: The Professional Approach

But if developing your players is an inexact art, there are bound to be mistakes. How do you deal with them?

Again and again in the development and selection of personnel, you have to account for miscalculation. In professional sports, the person who is best at dealing with personnel is the person who recognizes his or her errors and deals with them the quickest and most effectively. That could mean adopting a long-term approach, or it could mean the release of a player.

Take our drafting of John Taylor in 1986. John came to the 49ers as a wide receiver from Delaware State. He had great physical talent, but not a lot of background in playing sophisticated football. We simply miscalculated how long it would take John to be ready to play in the NFL. Consequently, we were disappointed in him. John was not adapting well to the competition, he appeared confused and frustrated, and he had lost his enthusiasm.

But instead of giving up on him, we took a longer term, more patient approach. We waited an extra year to allow him to mature and grow into this level of competition and into the role we wanted him to play. Now he is an All-Pro and one of the great receivers in the game.

The other side to that would be the decision I made with Thomas “Hollywood” Henderson. He was a very bright, articulate, charming person, but he also had an uncontrollable drug habit. I made a calculated choice that involved a high risk when we acquired him from Dallas—that I could personally nurture and rehab and influence Thomas into once again becoming a great linebacker. It was a miscalculation on my part. I gave it every chance to work, but finally I had to decide that it simply was not going to.

When you reach that point, you have to make a controlled and well-planned retreat. You regret the decision that you made, but you have to live with it, and you have to work yourself out of it. That is one important facet of good management: deciding how to acknowledge your mistakes.

Do you simply gloss over them? Do you blame someone else? Are you so insecure that your ego will not let you do anything but maintain that your original decision was correct? I could have kept Thomas Henderson on the team, but then the 49ers would not have become world champs. Or I could have had the public blaming Thomas or blaming an assistant coach. But none of those approaches would have helped the team.

In this case, I did not want to publicly embarrass Thomas, but I did want to show the team that I was still in control and that drug abuse would not be tolerated. We simply had to move as smoothly as possible to release Thomas for any number of reasons, remove him from the picture. I made a mistake, acknowledged it, and decided what to do about it.

If the personnel issue is so overriding, do you have a methodology for the way you evaluate players?

We use a five-bracket ranking system to categorize people we are looking at. The first is the star player who cannot miss. The second is a player who will someday be a starter and play for a number of years. The third will make the team, and the fourth has an isolated specialty—covering kickoffs or fielding punts. The fifth is someone who will make the squad and help you by playing solidly in a backup role.

You want as many superstars as you can get. The more stars, the better. But the difference between winning and losing is the bottom 25% of your people. Most coaches can deliver the top 75%. But the last 25% only blossoms in the details, in the orchestration of skills, in the way you prepare.

When you go into a draft, what are the particulars you are looking for in a player?

It is always a combination of factors that add up to the right person. It’s his level of natural ability. It’s his competitive instincts. It’s also the history of that athlete; his ability to learn, retain, and apply what he has learned; and his ability to work under stress with other people.

Then you have to be able to project those qualities into the slot or role that athlete would play for your team. And you have to do that over time, thinking about the short, middle, and long term. For example, a player could come in and play a certain role in his first year, and then in his second year that role could develop or be enhanced. After a number of years, that player might end up in a feature role, and then revert back to the role in which he started as the wear and tear of the game begins to take its toll.

You have said that one of the most important attributes of any organization is the way it treats its people. In pro football, with frequent trading and the yearly competition from rookies for veterans’ jobs, cutting a veteran player or convincing him to retire is a big part of your job. How do you handle that part of the personnel issue?

Any good coach or manager has got to be responsible for phasing his people through the organization. It may be the most emotionally difficult part of the job. When you do it, you often end up as the most unpopular person in the organization. Yet it is part of the role that the leader must play. It has to be done and done continually. You have to be prepared to use your own professional judgment as to when and why it is time for one of your players to call it quits.

As the head coach, I forced myself to deal with this process rather than turn my back on it or hand it off to the assistant coaches. In fact, in this area you can only listen to the assistant coaches so much because, typically, they would rather have veteran players on the team. It makes their coaching job easier. Subconsciously, I think assistant coaches feel much more comfortable with ten-year players than with the rookies. The coaches have become friends with the veterans, they have great faith in them, they understand each other. And the veterans already know what the coaches want done out on the field.

In sports, there is an arc of utilization that describes most athletes’ careers. By that I mean a curve that a coach can use to project what a player can do now, next year, and ten years from now. A player may be a superstar this year, but with minor injuries nicking at him and starting to add up, he won’t be a superstar three years from now. And then in the next phase you have to begin thinking about replacing him.

Most people don’t realize it, but the players who get all the attention are usually the ones on the downside of their careers. Ironically, the organization is often paying the most money to the team members who are on the descending curve as players. When players are starting to wind down their careers but are still playing effectively, you have to remind yourself how to use them. You have to gauge how they practice, what you ask them to do on the field, what kinds of situations you use them in, how much playing time they get. These are all factors that ultimately lead to the point where you judge that a younger player could do the job as well. That younger player is on an ascending curve on the arc. That is when you have to make your move.

How do you go about making that move without dealing the veteran player a crushing blow?

There will be some suffering, and there is no way to avoid it. It’s simply part of the process. There will be agonizing, frustration, and anger. But the coach has to make the decision to improve the team. The real danger is if the decision aimed at improving the team leads to so much bitterness that the fallout causes other players to take sides. When the team becomes divided, the decision has done more harm than good.

That is why managing people’s emotions is such an important part of the coach’s job. You begin by acknowledging that your decision will cause some suffering. Then you do whatever you can to soften the edges, to reduce the anguish and frustration, to communicate your own sensitivity, and, in a sense, even to manipulate the player.

You recommend manipulating people rather than being honest?

The easiest thing is to be truly honest and direct. In fact, it sounds just great to say that you are going to be honest and direct. But insensitive, hammer-like shots that are delivered in the name of honesty and openness usually do the greatest damage to people. The damage ends up reverberating throughout the entire organization. Over time, people will lose the bonding factor they need for success. And over time, that directness will isolate you from the people with whom you work.

The real task is to lead people through the troubled times, when they are demoted or find themselves at the end of their playing days, and to help them maintain as much of their self-esteem as possible. These are the tasks that really define the job of the manager. A manager’s job is not simply having a desk filled with family pictures and a wall covered by plaques for good behavior. It’s developing the skills to understand and deal with people.

You have described a variety of tasks that the coach has to be sensitive to, including the ability to make tough decisions and the need to soften the edges when it comes to dealing with people. What has made your system so successful?

The bottom line in professional sports is winning. Everything has to focus on that product: winning football games. Other offshoots—the public relations, the merchandising, the high-sounding philosophical approach—mean little compared with being successful on the playing field.

But winning does not necessarily mean being a victor in every game. It’s not winning every game at any cost. We have to remind ourselves that it’s not just a single game that we are trying to win. It is a season and a series of seasons in which the team wins more games than it loses and each team member plays up to his potential. If you are continually developing your skills and refining your approach, then winning will be the final result.

But I have seen coaches who are simply too sentimental, who allow themselves to be too maudlin about “breaking up the old family.” They are going to lose sight of the bottom line. And there is another kind who are severe, tough, and hard-hitting. But they sacrifice the loyalty of the people around them. In that situation, people are always afraid that they are going to be the next to go. These coaches rarely have sustained success.

Somewhere in the middle are the coaches who know that the job is to win, who know that they must be decisive, that they must phase people through their organizations, and at the same time they are sensitive to the feelings, loyalties, and emotions that people have toward one another. If you don’t have these feelings, I do not know how you can lead anyone.

I have spent many sleepless nights trying to figure out how I was going to phase out certain players for whom I had a strong feelings, but that was my job. I wasn’t hired to do anything but win.

Ranking every NFL head coach, from Bill Belichick to the Class of 2017
You know Bill Belichick sits at the top of the coaching profession, but who slots in at No. 2?

Pete Prisco

http://www.cbssports.com/nfl/news/ranking-every-nfl-head-coach-from-bill-belichick-to-the-class-of-2017/

Call it the great coaching divide. That ís what we have in the NFL today. There ís New England Patriots coach Bill Belichick, and the rest — no matter how you stack them — are way, way, way behind.
Belichick is arguably the greatest coach of all time, a sentiment bolstered by continued success in the era of free agency and roster turnover. Of course, Tom Brady cures almost any ills and allows Belichick to be bold with his roster, but even so he is a detail freak who gets the most out of his players and is unreal when it comes to game planning.
Add all that to his five Super Bowl rings and Belichick is the obvious No. 1 on my list ranking current coaches from 1-32. Nobody else is in the conversation and it’s not because there aren’t plenty of good coaches in this league.
Belichick drives fantasy players nuts because they never can tell what the Patriots will do on offense from week to week. And on defense, Belichick’s hybrid unit is as unpredictable as they come. It’s all testament to his greatness: You never know what ís coming.
He ís not afraid to take chances. Those Super Bowl rings — including the latest, the epic comeback vs. Atlanta after trailing 28-3 in the second half — are his skins on the wall. They allow him freedom to gamble, though any risk is always calculated.
I can’t read enough about Belichick and his philosophy. Books or stories about him are textbooks on coaching and team building. This might sound like I am slobbering about the guy, but he has made some bonehead decisions late in games — which I am quick to point out, much to the chagrin of Patriots nation — though none of them diminish his football genius; it just shows that even the best can screw up situational coaching.
Even though he got lucky getting Brady in the sixth round — that’s the only way to describe drafting the greatest of all time that late — Belichick also has helped mold Brady into the player we see today.
It’s always a treat to log onto Patriots.com and watch Belichick break down tape of players and plays. I recommend it to anybody who wants to take a look behind the curtain at this football savant.
For this list, I’m ranking 27 coaches who have experience, with the five first-time coaches tied at No. 28. It wouldn’t be fair to rank them since they have yet to coach a game. They have a long way to go to sniff Belichick territory. Then again, so does everybody else.
1. Bill Belichick, Patriots
Five Super Bowl victories solidifies this spot. It’s hard to consider any conversation about the best ever without his name coming up. How much longer will he do it is the question. He has a winning percentage of .673, which is 11th all time, one spot behind Don Shula. He has 237 regular-season victories, which is fourth all time, and he can tie Tom Landry for third if he wins 13 next season. Shula appears to be out of reach with 328, but he did it in 33 seasons. Belichick has done it in 22, although 14 of Shulaís seasons came with a 14-game schedule and one shortened to nine because of a strike. The guy is legend, and it ís a treat to watch him work — even when he blows the end of games. Yes, that’s another dig.

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2. Mike McCarthy, Packers
There were some who wanted him fired the past two seasons. That was purely absurd. He has the second-best winning percentage (.651) of any active coach, behind Belichick. He has had double-digit victories in eight of his 11 seasons with the Packers, with only one losing season. He also has a Super Bowl win, but gets dinged some for his 10-8 playoff record. With Aaron Rodgers, some expect more. Maybe one more ring ends the debate.

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3. Andy Reid, Chiefs
He has had three losing seasons in 18 as a head coach, one of those in his first with the Eagles in 1999. He has had 11 seasons of 10 or more victories, including the past two seasons with the Chiefs. He has been to the playoffs 12 times, but reached the Super Bowl only once and has an 11-12 postseason record, which hurts. Even so, he’s a damn good coach. I know he doesn’t have a ring, but he has done some amazing things, which is why he’s in this third spot, above some guys who have won rings.

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4. Pete Carroll, Seahawks
He has been an NFL coach in three different spots, totaling 11 seasons. His has a .588 career winning percentage, but he has a .629 percentage in his seven seasons in Seattle, with one Super Bowl victory and was a yard away from a second. He has at least 10 victories in each of the past five seasons. His easy-going approach with players has paid off big. It’s hard to believe he turns 66 this September, but there is a lot of good coaching left in him.

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5. Mike Tomlin, Steelers
In his 10 seasons with the Steelers, he has never had a losing record. That’s impressive. He has seven seasons of double-digit victories and is 1-1 in Super Bowls and 8-6 overall in postseason play. There are some who question whether he’s just a guy who oversees everything rather than a hands-on coach. I don’t buy that. He knows what it takes to win, no matter how he gets it done.

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6. Sean Payton, Saints
There are some who will say three consecutive 7-9 seasons should drop him, but I don’t buy it. Take a look at the roster. Yes, he’s responsible for some of it, but I think the blame goes above him. The defense has lacked play-makers. Payton is still one of the league’s best offensive minds. If he were a free-agent coach, he would be signed in an instant. He has five seasons of double-digit victories and no season worse than 7-9. He also won a Super Bowl. If they fix the defense this season — and they’ve made strides — they will be in the mix again to get back to the Super Bowl.

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7. John Harbaugh, Ravens
He has five seasons of double-digit victories in nine with the Ravens, and he has one Super Bowl victory, that coming in the 2012 season. He has had only one losing season, a 5-11 stinker in 2015, and he’s only 13-19 the past two seasons without a playoff berth. It hasn’t helped that he has changed offensive coordinators like he changes underwear. That makes Ravens fans a little jumpy when it comes to their coach. This could be a big year for Harbaugh and his job status. Three non-playoff seasons would be tough to overcome.

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8. Adam Gase, Dolphins
He is a star in the making. Gase took over the Dolphins last season and got a team hardly stacked with talent to 10-6 and into the playoffs. He has great give-and-take with his players, knowing when to push and when to pull back. He is also a great offensive mind, which you need in this league today. One more thing: He is a maniac when it comes to working, which can be seen in his preparation. A few years from now, he might top this list when Belichick retires if he can keep it going forward.

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9. Bruce Arians, Cardinals
He had his first losing season as Cardinals coach in 2016, going 7-8-1 in what can only be described as a major disappointment. But, counting his interim stint with the Colts in 2012, Arians has a .648 winning percentage, third best among active coaches. His players love him, and he’s a keen offensive mind. If there’s one criticism, he needs to fix his special teams.

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10. Bill O’Brien, Texans
O’Brien has gone 9-7 in each of his first three seasons with the Texans, making the playoffs the past two and winning a playoff game last season. That’s unreal considering the quarterback situation since he has been there. He has coached the heck out of this team without a true franchise passer. Imagine if he gets one? He’s a smart offensive mind who plays without a true weapon under center. That’s the definition of frustration. Yet he’s 27-21 over three seasons (.567). That is coaching.

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11. Chuck Pagano, Colts
Does this seem high for a guy on the hot seat after last season? Maybe, but he has a .613 winning percentage and still hasn’t had a losing season in five with the Colts. This is a team that hasn’t had a lot of talent, yet it has been to the postseason three times during Pagano’s tenure. The past two 8-8 seasons, coming in a bad division, don’t help his ranking. But the talent level wasn’t good and Andrew Luck has suffered nagging injuries. If he had been fired, I think another team would have hired him quickly.

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12. Dan Quinn, Falcons
He took the Falcons to the Super Bowl in his second season, and was a blown 28-3 second-half lead away from winning a ring. The decisions made late in that game will help him grow, and he has shown amazing maturity getting past it. One of the hidden stories behind last season’s Super run was how he became more involved with the defense in the second half of the season, spurring the turnaround. He has a great temperament to be a long-term success. In two years, I bet he’s much higher on this list.

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13. Mike Zimmer, Vikings
It’s hard to evaluate him based on an injury-decimated 2016. No coach, not even Belichick, could have sustained success through that, and yet Zimmer got the Vikings to 8-8. The year before, Zimmer led the Vikings to a division title in his second season. I think that’s more of who he is as a coach than last season. His fiery approach is perfect for the modern NFL player. The offensive coordinator issues last season — with Norv Turner walking away — stain his résumé a little.

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14. John Fox, Bears
In his 15 seasons with Carolina, Denver and Chicago, he has been to two Super Bowls, losing both, and has five seasons of double-digit victories. He has had a rough go of it in Chicago the past two seasons, going 6-10 and 3-13, but he has had some injury issues. Even so, his belief that running the football wins games is out of date. Failing to change with the times on offense has held his teams back. His .533 winning percentage isn’t that impressive, but he was 38-10 in his final three seasons in Denver. If only they had won a Super Bowl.

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15. Marvin Lewis, Bengals
He has the exact same winning percentage as Fox (.533) but has never reached a Super Bowl. In 14 seasons with the Bengals, he has six seasons with double-digit victories and four losing seasons, including 2016 when his team went 6-9-1 and missed the playoffs for the first time since 2010. There’s pressure to win this season, or he could be out. There are a lot of Bengals fans who want him out, but ownership has been patient, and understandably so until last season. It’s hard to argue with his record the past six seasons.

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16. Ron Rivera, Panthers
He led the Panthers to an NFC title in the 2015 season before a Super Bowl loss to the Broncos. Carolina had a Super hangover last season and fell to 6-10 after going 15-1 the previous season. In five seasons with the Panthers, he has two seasons of 10 or more wins, but losing records in the other four. His winning percentage is .557, thanks in large part to the 15-victory season. He is a defensive-minded coach, and he loves to run it and play great defense to win games. That’s his style.

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17. Jason Garrett, Cowboys
Garrett has a .558 career winning percentage and led the Cowboys to a 12-4 record and a division title last season. He has had only one losing season in seven as Cowboys coach, including his interim stint in 2010. He is 29-19 the past three seasons and overcame the loss of quarterback Tony Romo in training camp last season to make the playoffs with rookie Dak Prescott. That was impressive. Early in his Cowboys career, he was criticized for game management and play-calling, but he has improved those areas the past few seasons.

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18. Jack Del Rio, Raiders
Del Rio has turned the Raiders into a legitimate Super Bowl contender. If quarterback Derek Carr didn’t go down last season, they could have pushed the Patriots in the AFC. Del Rio was previously the coach in Jacksonville and led the Jaguars to the playoffs twice in nine seasons. He has a .509 career winning percentage, but expect that to go up the next few seasons with this young, talented team.

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19. Dirk Koetter, Buccaneers
He went 9-7 in his first season with the Bucs, justifying ownership’s decision to fire Lovie Smith and make Koetter the coach after he served as offensive coordinator in 2015. Koetter is a bright offensive mind who has nice give-and-take with players. I always expected him to be a better NFL coach than college coach, where he served stints at Boise State and Arizona State. That’s because he’s a true football guy. He has no time for glad-handing the alums. I think Tampa Bay is finding that out, and his young team should push for a division title next season, which should move him up the list. I think he’s the right guy and will have long-term success in Tampa.

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20. Jay Gruden, Redskins
He has done a nice job turning the Redskins around, going from 4-12 in his first season in 2014 to 9-7 the next and 8-7-1 in 2016. He made the playoffs in 2015, but missed out last season with a Week 17 home loss to the Giants that hurts him some on this list. His winning percentage is .448, which isn’t pretty, but the first year drives it down. He is a smart offensive coach who needs to figure out how to get his team to play better defense. A change in coordinators this season might help.

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21. Jim Caldwell, Lions
Going into 2016, many expected Caldwell to struggle and maybe get fired with first-year GM Bob Quinn bringing in his own guy. But Caldwell got the Lions to the playoffs, where they lost a wild-card game to the Seahawks. If not for a late-season collapse, they would have won the division. They finished 9-7. In his three seasons with the Lions, he is 27-21. Before that, he was coach of the Colts when they went to the Super Bowl in 2009, his first year with the team. They lost to the Saints in that game. The Colts let him go after they went 2-14 without Peyton Manning in 2011.

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22. Ben McAdoo, Giants
He took the Giants to the playoffs his first season as coach in 2016, going 11-5 before losing to the Packers in the wild-card round. McAdoo, who was the offensive coordinator before taking over for Tom Coughlin, continued as the team’s play-caller. The offense struggled in 2016 with McAdoo handling both roles. That will be something to watch going forward.

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23. Mike Mularkey, Titans
The Titans are Mularkey’s third team after previous stops with the Bills and Jaguars. Those two stints didn’t end well. He was 14-21 in two seasons with the Bills and 2-14 in one season with the Jaguars. After taking over as interim coach of the Titans in 2015, he was hired as the full-time guy last season and led the Titans to a 9-7 record. His outdated belief in running the football paid off last season as the Titans nearly won the division. The question is whether this team can continue to push for a playoff spot with that style.

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24. Hue Jackson, Browns
It’s unfair to grade Jackson by his first season with the Browns. They had little talent, quarterback issues and understandably finished 1-15. He was 8-8 in his only season as the Raiders’ coach in 2011. I still think he can be a darn good coach, but the body of work is so small. The Browns need to be patient and let him coach a few more seasons before passing judgment.

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25. Doug Marrone, Jaguars
He was 15-17 in two seasons with the Bills, including 9-7 in 2014 before he quit. He was 1-1 as Jacksonville’s interim coach after taking over for Gus Bradley last season, which led to his hiring on a full-time basis. He is a no-nonsense guy who will bring discipline to the team, but how much is he going to be a puppet for Tom Coughlin?
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26. Doug Pederson, Eagles
When a guy starts a rookie quarterback his first season as coach, it’s tough to evaluate him. But Pederson did a nice job getting the Eagles to 7-9, although they did start fast before fading. Even so, the former quarterback who learned under Andy Reid seems to have a good feel for being a head coach. As quarterback Carson Wentz improves, Pederson will look a lot better as well.

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27. Todd Bowles, Jets
In 2015, it looked like the Jets struck gold with Bowles when he led them to a 10-6 record in his first season as their coach. He did it with Ryan Fitzpatrick at quarterback, which is even more impressive. But then last season, it all came apart. The Jets finished 5-11 and many were questioning Bowles. Can he turn it around? The talent isn’t good on his roster, and the quarterback situation is a mess. It will be a miracle if he does — no matter what type of coach we think he can become.

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28. (tie) Sean McVay, Rams; Anthony Lynn, Chargers; Vance Joseph, Broncos; Kyle Shanahan, 49ers; Sean McDermott, Bills
We have no idea how these first-year guys will perform, even if you think you do, so they land here. There is a lot to be excited about in these cities, but isn’t it always that way for first-time coaches?

Rams Head Coach Sean McVay – – April 10, 2017

(Opening remarks)

“I think starting out this has been a long time coming for us. I know our whole coaching staff was really anxious to get to this day. Get around our players – start to get to know these guys. Really what Phase 1 represents for us is a chance to meet with our players and then they’ll get familiar with our strength and conditioning staff. It’s exclusively meetings for us as coaches and then a lot of strength and conditioning –getting themselves ready for Phase 2. But really the emphasis for us right now is on learning our systems and establishing our identity. We feel like today was a good start for us.”

(On the first impression he had of his team in terms of their general football IQ and the first impression he wanted to convey to the team)

“I think when you really look at it, you walk into that first team meeting – I was definitely very excited for it –but there was full attention, guys were locked in, they were engaged, they were ready to go, we had everybody there. I think it was definitely, exactly the way that we wanted to come off as a coaching staff. Really right now, it’s about building relationships with these guys. We got a chance – within the framework of offense, defense and special teams – to just kind of get the general things. Offensively, we’re talking about our style of play, our approach. Then we’re introducing formations, motions, and personnel groupings to the skilled players. It’s very early in the process. We’ve got some time right now, so we want to make sure we do a great job establishing a foundation so that it can be conducive for that long term success. But I think today went as well as we could’ve hoped and looking forward to tomorrow already.”

(On what the core message was when he first addressed the team today and how much time he spent thinking about what he wanted to say in that first team meeting)

“I think it’s really important, like we talked about, establishing our identity. We’ve sat down as a coaching staff, as an organization and really going back to the interview process. Talking about what we felt like was going to be conducive for having a long-term vision for our players – what was going to help us have that sustained success over time and it’s about establishing our identity. You see the t-shirts that people are walking around with, with the ‘We not Me’. It’s always going to be about the team. All the decisions that we want to make are going to be from a standpoint of what’s in the best interest of the team, before any personal agendas and that’s what we want to embody as a coaching staff and with our players as well.”

(On whether the t-shirts were his idea)

“It was a collective idea – the ‘We not Me’ approach. It was our idea.”

(On whether the whole team was present today)

“We did. Everybody was accounted for, as far as I know. It was the turnout that we expected. I think the players felt as excited as we were as a coaching staff. Getting that feeling from those guys was exactly what we were hoping for and that’s what we got.”

(On how he keeps from going too fast too soon to start the offseason)

“I think it’s important for you to lay out a foundation, have a long-term vision, (we know) that we have 10 weeks with this offseason program. We’ve laid out the first two weeks, knowing that today we had an hour and a half with the meetings and then for the next three days this week, we’ll have an hour and 40 minutes. I think it’s very important for us, within the framework of each position, to allocate that time accordingly. If we have that foundation built, then it can kind of allow us to stay on track. For me, the excitement is something where you get excited to come in here and really getting these players in here, you feel like a coach again. We’ve all been chomping at the bit and I think I share the same feeling as our entire coaching staff, that’s it’s nice to feel like a coach again, get these guys in here and get into the meeting room. And then really, Phase Two will represent getting to be on the grass with them and start to teach and work some drill work on the field.”

(On if he got a chance to meet with QB Jared Goff)

“We’ve had little conversations here and there. Today really represents that first time where you’re meeting. It was all kind of skill-based, we were together the entire time with our quarterbacks, tight ends, receivers and our running backs. Once we get further into it, then we will start to have more individual time. I think those times are great opportunities for me, (offensive coordinator) Matt (LaFleur) and (quarterbacks coach) Greg (Olson) to get to know those guys. You want to be able to allow your coaches to coach, empower those assistants. I think when we start to have that individual time allocated to the meetings, that’s when the position coaches can get their things going.”

(On how much of a feel he thinks Jared Goff has for the offense right now and how much work is ahead of him)

“I think for our quarterbacks as a whole, there’s a lot of work. It’s just making sure we have that one day approach. If you look at it where you want to go from A to Z, then you end up getting overwhelmed with the amount of information. But I think as long as you just take little steps at a time, that continuous improvement one day at a time, then I feel like that will lead to the things that we want. But we’re just focused on making sure that these guys have a good ownership and we’re trying to get these guys, ultimately, to be an extension of our coaching staff. It’s going to be a process, we have to be patient and committed to it, but I think with the demeanor and the disposition that I sense from all three of our quarterbacks, we feel good about that happening.”

(On if bringing in CB Nickell Robey-Coleman means that DB Lamarcus Joyner will move to safety)

“I think when you look at it, just evaluating the tape, you flip the tape on, you watch Lamarcus Joyner, this guy is a football player. He shows up and you want to find as many ways to get him on the field as possible. Whether that’s him at nickel – which I think he’s one of the elite players at that spot in this league – or the safety, I think you see an instinctual player that has a great feel for the game. And I think our coaching staff has done a nice job targeting him as a player that we have to make sure that he’s on the grass, he’s competing. And anytime that you add depth like a Nickell (Robey-Coleman) does add, where he’s played a lot of football, it gives you some versatility to move a special player like Lamarcus around potentially.”

(On how much of a premium he puts on receivers with speed)

“It’s extremely important. I think one of the things you felt fortunate looking at some of the receivers they have in Washington, guys that could take the top off coverage. When you’re trying to operate with some of your play-action game where you have your three-level throws – the top-shelf, the intermediate and then that flare-control underneath – somebody that can stretch the field vertical, and if a team isn’t honoring it, then you make them pay with those big plays. The offenses that I’ve been fortunate to be a part of, we’ve done a nice job creating explosives. And that’s definitely something that we’re looking to do here and those speed guys give you the best opportunity to be able to do that.”

(On the adjustment for Lamarcus Joyner to move to safety)

“I think it will be an adjustment. I think our coaching staff has done a nice job figuring out ways we can make that transition smooth. There are some different exit angles when you’re talking about playing a deep half or the middle of the field. I think, from an underneath defender, he’s been doing things like that. A lot of those things that you ask a down safety, when you’re playing in your single-high defenses, to do are very similar to what he’s done the last couple of years from that nickel spot. I think it’s just getting comfortable, he is an instinctual player, and just understanding some of those exit angles, some of those break points, based on starting from 15 yards off as opposed to down where you’re 10-yards within the line of scrimmage will be a little bit different. But I think you’ve seen examples of great guys be able to do both across the league and we’re hoping that he’ll be able to do the same thing for us.”

(On if there are other guys he anticipates making positional shifts like OLB Robert Quinn)

“I think when you really look at a 3-4 to 4-3, with Coach Phillips’ system, like we’ve talked about a little bit, they are a one-gap penetrating front. For all intents and purposes, Robert will line up as the Will linebacker, but he’s a rush player, he’ll play a similar role to what DeMarcus Ware did in Denver for Wade the last couple of years. I think he’s going to still be, he’s going to be an elite rusher in this league for years and that’s what we’re hoping to do with him moving forward. I don’t think his role will change too much. I think you look at some of the additions that we made on the offensive line with (T) Andrew Whitworth, we’ll shuffle some guys around and then bring a veteran with (C) John Sullivan in. I think it’ll allow us to be able to move some guys around, get a feel to see if this is a position that they’re a little bit more comfortable with and will ultimately make us better as a unit up front. Defensively, I think Lamarcus is probably the best example of a guy that will have to do that transition. Other than that, we feel good about where the guys are at and the personnel we have on defense.”

(On if OL Rob Havenstein could play right guard)

“I think when he was coming out, you looked at Rob as a potential guy to be able to move inside and do some of those things. Really, going back two years, I thought he’s put some excellent tape out there as far as playing that right tackle position. You talk to people that have been around him – we’ve got (assistant offensive line coach) Andy Dickerson, who will working with our offensive line again this year – him being able to communicate what a sharp guy Rob is, how he’s able to process things above the neck. I think he and (OL) Greg (Robinson) working in coordination, in unison, will be able to help both of those guys. And then you add John Sullivan to the mix, I know from being with him in Washington, he did a great job communicating, has a really impressive big picture understanding from that center spot. And then looking at ‘Rog’ (OL Rodger Saffold) at left guard and Whitworth at left tackle – and you see good things out of (OL) Jamon Brown. I think we’ve got some good depth up front and I’m excited to see how these guys process that information and then translate it to the grass once we get the OTAs started in Phase Three.”

(On how healthy John Sullivan was last year and if his back issues are behind him)

“Yeah, that’s what we’re hoping. When you really look at it, if you didn’t know any better, you wouldn’t have known he had any back issues. I think he’s put great tape throughout the course of his career on film and when he played for us last year, it was 130-or-so snaps, I thought he did an excellent job. You really can’t undervalue or underappreciate that communication from that center spot – handling the cadence, handling the calls up front – because it all starts with that spot, most of our calls fit off of that. John was a guy that I was really impressed with, Being around him in Washington, you almost felt like you were talking to a coach. You talk about your quarterback wanting to be an extension of the coaching staff, the center position is very similar where he’s got to have a big-picture ownership of what we’re trying to get done, what we’re trying to accomplish up front. And John is certainly someone that’s shown he is capable of handling that.”

(On if there will be any give and take as far as terminology is concerned within the schemes)

“I think when you really look at it, from our systems, what’s very important, we’ll talk about our language that we’ll use now. I think it does help to have an understanding of what something was called prior to this, to help with that communication. But we are going to utilize Coach Phillips’ system with the defensive terminology. And then we’ve kind of collaborated with some of the coaches that we have offensively. And then you also try to make sure, when you’re teaching it, does this make sense? You get a chance to really go back and evaluate some of the terminology that we might’ve used in Washington and how we can make a couple of tweaks – from a starting point, if you know nothing, this at least makes sense from a teaching progression. So that’s something that we want to be aware of that we will do. And then when you look at what ‘Bones’ (special teams coordinator John Fassel) will do, that’ll be very similar. I think the success that they’ve had on special teams is something that we feel good about. And now the challenge is, can we take it to the next level for those guys. That’s kind of how we’ll approach that. But I think you always just want to make sure that, from a teaching progression, your words mean something so that it can resonate and stick with the players.”

(On why accountability was important for him to emphasize in the team meeting)

“I think any time that you’re really just looking at football as a whole, I think it’s very important for each player, each coach, to be accountable, take full responsibility for our performance, for your actions, no excuses, no complaining. We’re looking for mentally tough players, mentally tough coaches – you take accountability, you take full responsibility for whatever was done. And if it’s something that we need to get corrected and fixed, we all do that and we move forward and we don’t blink. That was kind of how we implemented the accountability process and why that’s so important for us moving forward.”

***

Rams QB Jared Goff – – April 10, 2017

(On his initial reaction to the first team meeting with Head Coach Sean McVay, as well as his first impressions of him)

“Yeah, it’s been a great day. I think there’s some really good, new energy here. Coach McVay and the rest of his staff have done a great job exuding that energy and really letting us feel it. I think it’s really a fresh start for a lot of people. I think it’s a really good feeling. Just freshness is the best way to describe it.”

(On if this “freshness” makes him want to get on the field faster than he can, with respect to the league rules)

“Yeah, of course. You always want to get out there and do your thing, but a lot of the ground work we need to do first, and learning the new stuff. Getting on the same page, with not only the coaches, but with each other, and just knowing what we need to do on the field before we get out there.”

(On how much of an adjustment it is for him to learn a new offense)

“There’s going to be, obviously, some time to put in for everyone. That’s part of a new staff. I think the league sets it up to where you get to start earlier, and get a chance to get in there and get a head start on it a little bit, which does help. The next few weeks, we’ll dig into it, and pick it up as fast as we can until we get on the field.”

(On how much of a feel he has for Coach McVay’s new offense)

“Good feel, good feel. From what I know, and from what I’ve seen, it’s obviously a great offense. And from what I’ve heard, I’ve talked to quarterbacks around the league and coaches and what not, and I haven’t heard a bad word about it. So, I’m excited for it.”

(On if the changes made to the offensive line this offseason reassures that the team is committed to protecting him)

“Yeah, I think so. Anytime they make any sort of investment on the offensive side of the ball, especially, it’s always helpful for myself and for everyone on the offensive side of the ball. I think that all of the additions we made offensively and defensively were all great. Obviously, (LT Andrew) Whitworth is going to be great for me, as well as (C) John (Sullivan), and (WR) Robert (Woods), and even (RB) Lance (Dunbar) will be great. All of those guys, I’m excited for them, and they’re excited to be here.”

(On his experience working with Tom House and Justin Dadue on his throwing mechanics this offseason)

“It was great. It was down in Newport (Calif.), so not too far. Nice little drive down there, it was fun. It was great. I had a lot of people recommend it, coaches included, and I went down there and did a lot of work for them. I felt like I came away a lot better player. I’m excited to continue to work with them”

(On anything in particular he took away from working with Tom House and Justin Dadue)

“Just the way they explain things makes so much sense. I was able to get so much out of it. I don’t know any particulars as far as mechanically. There’s just so much that goes on in a throw that you really didn’t know until you go down there and can experience it, and can go through it. Now you know when you do make a bad throw, you want to limit them. But when you do, you know why. It’s not just, ‘Oh, that was a bad one,’ and move on. You know why and how to fix it.”

(On how will going through this phase of OTAs be different for him as opposed to last, in terms of establishing leadership)

“Obviously, I’m much more comfortable with the guys. I’ve been here for a year. I know everyone’s name. They all know my name. I can talk to, basically, anyone. I have a really good feel for everyone. That’ll obviously help. As well as just being comfortable around the facility. Knowing where everything is, comfortability – you can’t overstate it. It’s really important, as for the quarterback position, and leadership overall.”

(On knowing he’s the presumed starter, as opposed to this point last year, and if that changes the way he approaches this season)

“Same thing, it’s great. Day-in and day-out, I’m going to do my best to continue to get better and continue to improve, and be the best player I can be. Obviously, it’s helpful knowing coming into it that who I’ll be working with – the (offensive) line, the receivers, all the people I’ll be working with is helpful. At the same time, it’s a daily process to continue to get better.”

(On his expectations for the impact that can be made as a result from the changes that were implemented in the offseason)

“I think I speak for the whole team, I think we’re a lot closer to where we want to be than people may think. We’ve got the players, we’ve got the talent, we’ve got all the pieces we need, really. It’s just about putting it together now. The coaches and the system we’re going to run is going to be the glue for everything we need. I know everyone is excited to be here, excited to be back. Like I said, I think we’re a lot closer than a lot of people may think.”

***

Rams Linebacker Alec Ogletree – – April 10, 2017

(On the first day back for the offseason program)

“It’s exciting. First day back, everybody’s excited to be here, to get back to doing football. It was a long offseason – and ours kind of got shortened this year because you can come in earlier (with a new head coach). It was a good first day, got good work in. Just great to get back around the building.”

(On how much communication he’s had with defensive coordinator Wade Phillips)

“I’ve talked to him throughout the offseason, a little bit here and there. The guy is a legend coach. For me, as a young linebacker, to be under a guy like him is definitely going to help me out a lot. Like I said, first day and I’m definitely excited to get back in the building and just kind of start the install and learn different stuff.”

(On his first impression of Head Coach Sean McVay in the team meeting)

“Very energetic – he’s a guy that brings a lot of emotion and he wanted to set a different culture for us. I felt like, for day one, coming in as a new head coach, he did a great job of addressing the team and letting us know what he expects from us and what we should expect from him.”

(On Coach McVay’s message to the team)

“Like I said, just a whole different culture. Just making sure we’re accountable and dependable, all kind of different stuff like that to set a different culture for us and get us on the right step going forward.”

(On if accountability was missing last season)

“I think we didn’t do what we needed to do last year, obviously. But this is a new year and that’s what our focus is on now. We have a whole new coaching staff – even new players in the building. For me, going on my fifth year, I’m definitely excited for this opportunity now.”

(On if he has already noticed a different culture)

“Yeah, it could just be from having a new coaching staff or whatever. But just meeting Coach McVay and the rest of the coaches, you can definitely tell it’s a different culture, as far as what they expect from us and how things are going to go. It’s exciting for me and some of the guys that have been on the team for a while. We feel like something that’s kind of been missing from us, from this organization. It’s going to be good, we’re definitely excited about it and ready for move forward.”

(On if he knows enough about Coach Phillips’ defense to know what might be different)

“I don’t know a ton about this defense, but I’ve actually played a little bit in college. I guess with (former defensive coordinator) Gregg Williams kind of last year, we kind of would interchange as far as 3-4 and 4-3. With this defense, it’s definitely going to open up a lot of guys on the front end to have one-on-one pass rush – me and the other linebacker, Mark (Barron), to be in coverage and help rush also. It’s definitely exciting and we’re just ready to get to it.”

(On if Sean McVay seems like the youngest coach in NFL history when he’s addressing the team)

“He definitely seems like a guy that’s been around a while. You can gravitate toward a guy like that because he’s young, energetic and you can definitely tell he has a lot of wisdom about him. He’s got coach Wade (Phillips), got (assistant head coach/linebackers) Joe, all these different coaches that have been in the league a while to help him along. Like I said, he’s going to do a great job for us.”

(On how much responsibility he feels to learn everything quickly and help out as the middle linebacker)

“I feel a great deal of responsibility. What I did last year, in my first year starting at middle linebacker, that’s what I did, I took pride in getting ahead of the curve and trying to learn as much as I can before the meetings actually took place. I tried to do that this offseason as well, to learn a couple of things here and there before the first day we get here. Like I said, it’s been good, pretty easy install, it’s not as complicated as it was for us last year. It’s going to be good.”

(On how OLB Robert Quinn can adapt to his new role in the 3-4 defense)

“It’s really kind of the same for him. From my understanding, what we’re going to ask him to do is going to be pretty much the same – do you and do your ‘Bernie’ (sack dance celebration) and all that stuff. It’ll be good, we’re definitely looking to get him back and stay healthy. Having him on the edge and (OLB) Connor (Barwin) on the other, just all the guys out there is going to be real good for us.”

(On how much it will change the defense if Quinn can stay healthy)

“He’s a game-changer. When he’s on the field, you have to account for him. like you said, to get him back and make sure he stays healthy is definitely going to help our defense out a lot and help our team out a lot – just having him on the field and out there contributing.”

(On if he has had any communication with the team regarding his contract situation)

“It’ll happen when it happens. Right now, my focus is being here for OTAs and going through the install. I’ll be here, not really worried about the contract thing.”

(On his first impressions with the new additions on defense)

“Great guys. Meeting them for the first time, actually seeing them on TV on other teams and seeing how well they did. Definitely thrilled to have them on the team here with us.”

***

Rams Running Back Todd Gurley – – April 10, 2017

(On how he thinks the offense is shaping up after free agency and how it may help him)

“I’m just focusing on what’s now, not really focusing on the future. We added some great guys from other teams. Taking it day-by-day, let that come when it comes.”

(On how he thinks he fits in with Coach McVay’s offense and if he’s had the chance to familiarize himself with the offense)

“No not really. But I know he’s had successful offenses in the past. We wouldn’t have hired him if we didn’t think he was a good coach. Definitely looking forward to it. ”

(On what kind of impressions Coach McVay has made on the team so far)

“You just see the energy out of him. It’s his first head coaching job and I’m pretty sure he’s excited. Has a great offensive scheme and like I said, we’re just ready to work with him. He’s hyped up about it, just like we are.”

(On whether there is anything he is looking to focus and work on during the offseason program)

“Just getting better, just getting better every day. Taking it day-by-day and making it a better offseason than I’ve had in the past.”

(On whether this year’s offseason has been different than how he spent last year’s offseason)

“Yeah, different than last year. Obviously, a long process. Last offseason, I took a lot more time off than this year – just getting back into it.”

(On how easy it was to flip the page on 2016 and move on to 2017)

“It’s easy. It’s another year. I’ve been playing this game my whole life. It’s just another offseason. Each offseason you want to make it better than the previous year – just focus on getting better.”

(On what the first team meeting with Coach McVay was like)

“Just the typical team meeting – putting in all the rules, what we expect out of this season, what he expects from us. We’re just excited. He’s a great guy, great coach. We’re just ready to work with him.”

(On if he’s had the chance to look at the offense Coach McVay intends to put in place and what he’s excited about in terms of Coach McVay’s approach offensively)

“No, not really. Obviously, like I said I’m just focusing on day one installments. When practices come, then we’ll have a chance to get a feel for it and see what we like. But like I said, we’re just excited.”

(On if Coach McVay seems like a realty young guy compared to coaches he’s played for in the past)

“Yeah, I mean he is a young guy (laughs). But, he’s got that energy about him, that swagger about him that you like in the coach and it’s definitely great to see that. Just the energy, his background, what he’s done with offenses the past couple of years. It’s always a good thing to see that.”

(On what stands out to him as the reason for not being able to get the running game going last year and what he thinks needs to be done to prevent that from happening again in 2017)

“We just all lost and didn’t win our one-on-ones as much as we should have won them. Kind of just move on from there.”

***

Rams DT Aaron Donald – – April 10, 2017

(On if the team needs to prove anything this year)

“I think that’s the mindset you’ve got to have anytime you’re starting fresh, new coach and everything. We all left with a nasty taste in our mouth. I’m pretty sure everybody was grinding out there, preparing ourselves to get ready for the OTAs and upcoming season, so this won’t happen again. That’s what the change was for. I got to sit down and talk to these coaches, and get to pick from their brains a little bit. I’m just excited to get started.”

(On what it means for him to work under defensive coordinator Wade Phillips)

“Same thing, we’re still going to be a three technique, and still penetrate, get up field type of guy. I got to come here during the offseason and go to sit down and talk with him. I like his game plan and how he’s going to use us, and the position he’s going to put us in to have success, and try to make plays, and try to win games.”

(On how the transition into a 3-4 scheme impact the defense, and if he expects any complications or adjustments from the returning defensive starters)

“It’s a 3-4, but like I said, it’s still a nose tackle, it’s still a three technique, and things like that. It’s called a 3-4 because, I guess the guys on the side are standing, but like I said, it’s the same for us. We’re still doing what we’re doing, penetrating, getting up field, and trying to make plays in the backfield.”

(On how exciting it is working with defensive coordinator Wade Phillips)

“Real exciting. He’s coached a lot of big time players, and he’s one of the best to do it. Anytime you go from one great defensive coordinator in (former defensive coordinator) Gregg (Williams), and then go to another one, it just makes me a better football player. I get to learn from these guys.”

(On the difference in temperament from Williams to Phillips)

“Yeah, he’s more laid backed than Gregg. But, he’s still a great coach.”

(On if he’s had prior playing experience in a 3-4 defensive scheme)

“My sophomore year in college, it was the same as this defense. It was a 3-4, but really a 4-3. I played a little bit of (defensive) end. I moved around a lot, so I’m used to it.”

(On if he thinks Phillips will move him around more than what he’s used to in the past)

“We’re going to see. I’m comfortable wherever he puts me. Like I always say, rushing the passer – it doesn’t matter if it’s outside, inside, nose tackle, I can do it. I did it before, so I’m just comfortable wherever he puts me.”

(On his impression of Coach McVay during the first full team meeting)

“He’s got the mindset to win, and like he said about holding everybody accountable. I think that’s what we need to do. Not letting each other get comfortable, not letting each other slack, pushing each other so we can have success on the field come game time.”

(On if he’s noticed a different culture around the organization)

“Yeah, everybody came with a fresh start, a different mindset. Like I said, we left with a real bad taste in our mouths last year, horrible taste. I’m pretty sure everybody is ready, and I’m ready too. So, we’re going to push each other, hold everybody accountable, and try to get ready through this process to get ready for upcoming games.”

(On how much he prides himself on holding his teammates accountable)

“Anytime you can sit there as a leader, you got to. You got to do things a certain way. I’m not the vocal guy, so I lead by example. Me doing what I got to do on the field, off the field, and letting these guys watch what I do, and just trying to lead by example. And that’s not making bonehead mistakes and things like that. You got to be a little smarter at times, and not let frustration get to me. But, it’s a part of growing.”

Old argument getting new legs these days.

—

Many Doctors Prefer Single-Payer Health Care Because of Demands by Insurance Companies
MDs are increasingly becoming collection agents for insurers, who pad their higher incomes.

Steven Rosenfeld / AlterNet

http://www.alternet.org/economy/stunning-many-doctors-prefer-single-payer-health-care-because-demands-insurance-companies?akid=15398.1084699.iudWY1&rd=1&src=newsletter1075215&t=14

After the House bill defunding Obamacare and Medicaid failed, progressives in Congress and activists have been pushing for what they’ve wanted all along—to open up Medicare enrollment as a step toward a single-payer health system.

A new poll of 500 physicians by the business networking website LinkedIn found that nearly half, 48 percent, were in favor of a single-payer system, with 32 percent opposed and 21 percent undecided. What’s stunning about LinkedIn’s survey was not just the show of support for single-payer, but the comments and explanations from physicians about their industry’s greed-driven codependent relationship to insurers.

“As a doctor, it’s really against my best interest to support single-payer healthcare,” said Sean Kivlehan, the associate director of the international emergency medicine fellowship at Boston’s Brigham and Women’s Hospital, in LinkedIn’s report about the poll by Beth Kutcher. “It reduces my earning potential. At the same time, it’s about human rights and taking care of people that need help—that is why I do this work.”

Anyone who’s been surprised by medical insurance bills, high deductibles or spoken to the non-medical specialists after seeing physicians to try to find less expensive ways to access new drugs has crossed paths with this often-hidden codependent relationship. What’s never discussed by caregivers or insurance companies is how insurers rely on physicians’ offices as collection agents—and then in turn, pay these providers more money than they might otherwise earn in a single-payer system.

Kutcher reported that many medical professionals said they would accept earning less if it meant fewer dealings with insurers (which averages four hours a week), less insurance bureaucracy, more time with patients, and a freer conscience as a result.

“Even though doctors acknowledged that they might take a financial hit under a single-payer system, many respondents said it would be more than mitigated by getting out of the collection business,” she writes. “In other words, even if they earned less, there would be more patient care and less of the aggravation that comes with negotiating with and tracking down payment from multiple insurance companies.”

What’s stopping more physicians from supporting single payer? Some cited the political arguments about free markets, saying that competition and financial rewards in medicine have driven new advances and that could be stymied. More telling, however, was a trap awaiting medical school graduates. Many owe $100,000 or more in student loans, and partnering with private insurers as collection agents helps them get out of debt.

“Unlike other countries with single payer healthcare, medical school in the United States is very expensive—79% of med students were graduating with more than $100,000 in debt, according to the Association of American Medical Colleges,” Kutcher writes. “U.S. doctors need to generate a substantial income to pay that off—something that doctors in other countries don’t need to worry about.”

The way this ends up working goes to the heart of why for-profit healthcare is bad for physicians, bad for their staffs and bad for patients—bad for everyone except insurers and others whose profits come from pressuring doctors to collect more in fees.

Incredibly, the poll’s interviews with doctors suggest this nasty cycle is getting worse.

“While commercial insurance providers may be the most lucrative payers, they’re increasingly moving toward plans that require doctors to collect more money from patients before they can even submit a claim for reimbursement,” Kutcher wrote. “As many as 29% of people with employer-sponsored health insurance are enrolled in a high-deductible plan, according to the Kaiser Family Foundation. And people with high-deductible plans are more likely to delay care for financial reasons.”

The way patients see this system is when they interact with the billing staff at doctor’s offices. A study in the peer-reviewed journal, BMC Health Services Research, found that billing and insurance expenses totaled $70 billion for medical practices in 2012. The poll found two-thirds of the 500 doctors surveyed “implemented measures” to collect from patients with high-deductible plans. A fifth said they had to hire financial counselors.

It’s not new to hear doctors complain about arguing with insurers after their treatments are rejected or health plans don’t cover certain drugs. It’s also not new to hear doctors complain that it’s hard to get to know patients after they change insurers and medical records get lost in that transition process.

But the reality is a stunning snapshot of healthcare in America: Private insurers are increasingly treating physicians’ offices as their collection agents, pushing medical office front desks to grab more money from patients, while doctors have little choice but to go along to pay off their student debts, or accept it as the way to earn a six-figure income.

No wonder the prescription from nearly half of the physicians surveyed by LinkedIn is to get private insurers out of the healthcare field. The for-profit system is sick and isn’t allowing too many doctors to practice medicine the best way they know how.

Jay Gruden eyeing three ways to fix Redskins’ red-zone woes

https://www.washingtonpost.com/news/football-insider/wp/2017/04/04/jay-gruden-eyeing-three-ways-to-fix-red-zone-woes/?utm_term=.96c01ebd8e7b

Meaningless stats. Yards to nowhere. That was the chief gripe against a Redskins offense that last season rolled up the third most yards in the NFL (6,454) yet ranked 29th in red-zone scoring.

Despite all that productivity, with quarterback Kirk Cousins topping 4,000 passing yards en route to a second consecutive single-season franchise record, the offense was among the league’s least effective when it mattered most.

Once inside the opponents’ 20, the Redskins scored touchdowns just 45 percent of the time. A respectable goal for red-zone efficiency is above 60 percent — something achieved by 10 of the league’s 32 teams in 2016 and three of the four to reach the conference championships. (New England, Atlanta and Green Bay were 64 percent or better; Pittsburgh was just above 54 percent).

Based on offseason moves, it might seem the Redskins’ front office has addressed the problem by adding height to the receiving corps — 6-foot-4 Terrelle Pryor, for starters, and 6-3 Brian Quick, who’s expected to add depth.

But in remarks at last week’s NFL owners meeting in Phoenix, Coach Jay Gruden conceded that other fixes are required for the Redskins to finish more drives this season rather than settle for field goals. The coach highlighted three things he believes will help: In addition to bigger wide receivers, a more impactful running game and continued progression by Cousins.

“There’s other issues, without a doubt,” said Gruden when asked whether height was the solution. “Our running game has got to improve down there, or what runs we call down there have to improve. And some of the pass concepts, we’ve got to get our quarterback more comfortable. And sometimes when you call a pass down there, when they drop eight guys in coverage, it’s hard. The windows are very few and far between. It’s something Kirk can work on as far as buying time and keeping plays extended for a little while longer. So there are a lot of things we can work on as coaches and the players can work on and we can get them fixed.”

Given the number of offseason changes — a new play-caller (Gruden), new offensive coordinator (Matt Cavanaugh), new quarterbacks coach (Kevin O’Connell) and the radically overhauled receiving corps, the offense must come together quickly in minicamp and the preseason.

Here’s a closer look at how Gruden intends to cure the red-zone woes:

>> Bigger receiving corps: After allowing the combined 2,000 receiving yards of Pierre Garcon and DeSean Jackson to depart via free agency, the Redskins made a conscious decision to reload with height and length, signing Pryor and Quick during free agency. Second-year player Josh Doctson, at 6-2, is the wild card. Limited to two catches his rookie season before Achilles ailments landed him on injured reserve, last season’s first-round pick has proclaimed himself “100 percent” on social media.

“I like big receivers personally, but I also like little ones like Jamison [Crowder, at 5-8],” Gruden said. “But I think it’s a great advantage to have, when you have 6-foot-5, 6-foot-3 with a guy that has a 40-inch vertical, then you throw Crowder in there with a great change of direction.

“… There are some things that you are more comfortable doing with a bigger [receiver], like watch them run under a catch and all that stuff. The physicality at the line of scrimmage and some of the route concepts might change a little, but not a whole lot.”

>> More potent running game: The depth chart heading into offseason workouts is clear: Rob Kelley finished the 2016 season as the Redskins’ starter, so he’ll start 2017 workouts in the same role. Gruden hasn’t written off Matt Jones, the third-round pick in the 2015 draft, whose fumbles exiled him to the bench for the final nine games of last season. But to earn back a spot in the rotation, he’ll have to regain Gruden’s trust in competition with Mack Brown and, quite possibly, a rookie added in the NFL draft.

For now, it’s Kelley’s starting job to lose.

“Not one time did I feel like it was too big for him, not once,” Gruden gushed of Kelley’s performance as a rookie free agent. “That’s a hell of a thing to say for a guy out of Tulane who only had a couple carries his senior year. He came right in, he competes on every play. He had some of the greatest two-yard runs that I’ve seen. He gets back to the line of scrimmage, he keeps his feet moving, he protects the ball, he’s going to get better in pass protection. Catching the ball, he does a nice job. He dropped a couple here or there, but for the most part he catches the ball. I really think, the vision that he has, I think he’ll be more patient as a runner this year.”

Chris Thompson’s role as third-down special appears secure. But drafting a back isn’t out of the question. Said Gruden: “There are some special players in this draft that if they’re available it would be hard to pass up, quite frankly.”

>> Cousins’s progression: This is largely out of Gruden’s hands. It’s on Cousins, in his third year as an NFL starter, to improve in the intangibles that distinguish great quarterbacks. It starts with timing and familiarity with his receivers, and Cousins has already started working with Pryor and Doctson in throwing sessions supervised by ESPN analyst Jon Gruden. Their height — with Pryor and Doctson six and four inches taller than Jackson, respectively, is something Cousins must adjust to.

Beyond that, a coach can’t do much more than call a smart play once a team is in the red zone. Given the cramped confines inside the 20, it’s on the quarterback to buy time, extend plays and improvise, if need be.

“I think [Cousins] will get better the more he plays, without a doubt,” Gruden said. “But it’s something that you can’t just say, ‘Okay, I’m going to work on this today.’ It’s just got to be a ‘feel’ thing and a patient thing. The more he plays, the more he feels it, the better he’ll be. … I think you can’t force the issue either. Then you’re asking for trouble — more interceptions and sacks and all that — so that will come more natural to him. But that’s part of the process of growing as a quarterback.”

from http://www.turfshowtimes.com/2017/3/30/15122154/la-rams-2016-nfl-draft-grade-mel-kiper-jared-goff

Post-draft grade: B-

I suspect a lot of people think I should hammer this draft class, given Jared Goff’s first-year struggles, but there’s a problem with that: We said all along that Goff would struggle early on based on the system he was coming from at Cal and the lack of help on this Rams roster, so should we be surprised? I wrote at the time, “I’m a fan of Goff … [but] they’ll need to be extremely patient and find ways to protect him.” When Goff played, the Rams had no run game to take pressure off him and didn’t pass-protect well, and his receivers were a parade of dropped passes, including some that bounced off hands and chests and right to a defender for a pick. Does this look good so far? Of course not. Is it all because of Goff? No way.

After Goff, that’s just about it. They like Tyler Higbee’s potential, but he had just 11 catches. Same story with Pharoh Cooper, who had 14. It’s all about Goff at this point, I just hope he gets a real shot — and some help.

New grade: C

from Inside the Minds of the NFL’s Six New Coaches
Understanding their football philosophies gives insight into the draft

Andy Benoit

http://mmqb.si.com/mmqb/2017/03/29/nfl-new-head-coaches-sean-mcvay-kyle-shanahan-sean-mcdermott-anthony-lynn-vance-joseph-doug-marrone

…

Sean McVay
Los Angeles Rams

As an offensive designer, McVay relies heavily on geometry, especially through the air. Many of his pass designs involve multiple routes working together to exploit a predicted defensive coverage. He tries to regulate those coverages with his receiver spacing and distribution. He’ll figure out what a defensive coordinator calls versus specific formations in certain down and distances, and he’ll align his receivers in places that compromise those calls. This can be very nuanced. For example, there’s a big difference between a receiver lining up, say, 12 yards from the sideline versus 10 yards from the sideline. Where receivers align in relation to each other is also huge, as is presnap motion. With this sort of approach, you need a variety of different styles of receivers. As the offensive coordinator in Washington, McVay had a true speedster in DeSean Jackson, an inside possession receiver in Pierre Garçon, a shifty slot weapon in Jamison Crowder and a mismatch-making tight end in Jordan Reed. The skill sets of all four players complemented each other. The Rams’ receiving corps is decidedly less diverse. (And less talented.) Ex-Bill Robert Woods is essentially Garçon minus some strength and Crowder minus some quickness. Tavon Austin looks like a slot receiver but isn’t patient enough to play there. The rest of the receiving corps is comprised of backups. To run McVay’s scheme, the Rams need several new wideouts.

The 7 Biggest Cons In The GOP’s Obamacare Repeal Pitch

http://talkingpointsmemo.com/dc/eight-biggest-cons-obamacare-repeal

In the face of bad reviews from health care policy experts, the insurance industry and providers, and a revolt from some members of their own caucus, Republican leaders are scrambling to sell their Obamacare replacement bill by employing a boat loads of half-truths, inaccuracies, contradictions and metaphors.

The legislation, the American Health Care Act, would pay for a major tax break for the wealthy with massive cuts to Medicaid, while shifting around the tax credits provided by Obamacare to the benefit of young people and middle-income earners, with the old and low-income earners bearing the burden.

Here are the seven biggest cons Republicans are peddling in their pitch to sell Obamacare repeal.

Obamacare is “collapsing.” –House Speaker Paul Ryan This is the con of yesterday, the con of today, the con of tomorrow. It plays twin roles of justifying Republicans’ rush to repeal the Affordable Care Act, and giving them cover if and when there is dissatisfaction with what they replace it with: You think this is bad, but it would have been worse if we let Obamacare collapse.

However, the CBO last week made clear — backing up what multiple other analyses have said — that Obamacare is not in or heading towards a death spiral.

“In CBO and JCT’s assessment, however, the nongroup market would probably be stable in most areas under either current law or the legislation,” the CBO said.

Yes, there have been some trouble spots, but the premium spikes seen this year were predicted by many to be one-time correction after insurers had underpriced their plans when first entering ACA marketplaces.

“Although most insurers will still report an underwriting loss for 2016, the losses will be smaller than in 2015. This means the changes made to network design and premium pricing are gaining traction, though more still needs to be done,” a report by S&P Global said late last year. “For 2017, we expect continued improvement, with more insurers reporting close to break-even or better results for this segment.”

To be fair, the CBO also said that the Republicans plan was not likely to lead to a market collapse either. It would, however, produce a new system of winners and losers, with insurance being more attractive and cheaper for younger people, as older consumers are pushed out.

“A lot of Obamacare, you really don’t have insurance because the deductibles are so high.” –President Donald Trump Republicans aren’t wrong in that there has been a trend towards higher deductibles, as consumers under the ACA have veered toward lower-premium, narrow-network plans. But as the CBO pointed, deductible and other out-of-pocket costs will rise even higher under their legislation.

There are a number of reasons that this stands to happen. One is that the bill repeals in 2020 the ACA’s cost-sharing reduction payments, which subsidizes insurers so that they can keep out-of-pocket costs down for low-income consumers.

It also repeals the ACA’s actuarial values requirement, which under the ACA set the standard for how much of a patient’s care plans have to cover. This will incentivize insurers to offer plans to that cover a smaller share of total medical costs, but with a cheaper premium that will be more attractive to young people. The repeal of actuarial values will also make it harder for consumers to compare the plans their shopping for, the CBO said.

We’re being more transparent than the Democrats’ “back-room deals, in the middle of the night, last-minute deals.” –Rep. Doug Collins (R-GA)

Even before Republicans had the opportunity to repeal Obamacare, a favorite GOP talking point is that the law was rushed through on a party line vote. This account skips over 15 months of of public hearings and the attempts by Democrats – led by the late Sen. Ted Kennedy (D-MA) and then Senate Finance Chair Max Baucus (D-MT) – to get Republicans to the table in health care reform, not to mention a presidential primary where some of the major questions Democrats were grappling with were extensively litigated in public.

Yes, towards the end of the process, some last-minute changes were made to the bill to shore up its needed 60 votes in the Senate. But that doesn’t compare to a process where a bill was dropped publicly on a Monday, marked-up in two simultaneous overnight committee hearings on a Wednesday, with the intent of bringing it to the floor two weeks later, and with a CBO score coming somewhere in between. “Medicaid is a program that by and large has decreased the ability for folks to gain access to care.” –Health and Human Services Secretary Tom Price

The GOP line about Medicaid, which stands to see the biggest changes of all the aspects of the Republicans’ legislation, is that it’s already useless for its enrollees – an assertion thats been contradicted by numerous studies, including Commonwealth Fund’s recent finding that states that expanded Medicaid saw greater gains in health care access than those that didn’t.

Here’s White House Press Secretary Sean Spicer trying to argue otherwise:
And I think it’s really interesting — I mean, one of the things that Dr. Price mentioned that is so apropos of this is, having a card does not mean you have insurance. It’s like handing someone a blank check — it doesn’t mean that you have money, it means you have a check. And I think what we’ve seen over the last few years with Obamacare is you can have an insurance card, but that doesn’t mean someone is going to take it, and it sure doesn’t mean that it’s going to be affordable. And there’s a big difference between having a card and having healthcare that’s affordable. And that’s the difference that we’re trying to solve right now.
Not only are Republicans misrepresenting Medicaid in its current state, their proposal to overhaul Medicaid stands to make coverage worse for enrollees.

Here’s why: the GOP bill transforms its federal financing from an open-ended match rate to a per capita cap where the funding states receive is limited by the number and types — in five broad categories — of enrollees in their programs each year.

Because the metric the bill uses to increase the cap rises at a lower rate than traditional Medicaid spending, and it doesn’t anticipate unexpected hikes in spending, like the introduction a new drug, the share of the program states will have the burden of paying will grow over time. States will either have to find new revenues — by way of taxes or budget cuts elsewhere — to make up for the shortfall, or cut their spending on the program. Shrinking the number of people on the program via work requirements, enrollment caps or otherwise, doesn’t make senses as a money saver in a per capita capped system because that means even less funding from the feds.

Instead, the pressure will be on states to reduce the benefits they offer enrollees, impose cost-sharing requirements, or squeeze providers on the payment side. All three options point in a direction where states will be less generous, less comprehensive and more narrow, in terms of providers, in the Medicaid programs they offer residents, instead of more.

“It will drive down reimbursement over time, and we’re going to start stripping care away,” Randy Oostra, president and chief executive of the provider network ProMedica Health System, told the New York Times. “They may have Medicaid, but it’ll be so stripped down that they basically won’t have coverage.”

The initial drop in coverage is no big deal, because “freedom.”

The CBO anticipated an immediate drop in coverage if and when the GOP plan is implemented due to the repeal of an individual mandate right way.

House Speaker Paul Ryan (R-WI) has spun this has a positive, arguing “[O]ur plan is not about forcing people to buy expensive, one-size-fits-all coverage.” The point has been echoed by other Republicans.

“CBO said that after we restore the freedom for people to buy health insurance if they want it, 14 million people will choose not to buy it. It will be their choice once again, no longer a mandate in Washington D.C.,” Rep. Jason Smith (R-MO) said at a mark-up of the bill last week.

But the lack of individual mandate has broader effects.

Healthy people will be the most likely to abandon their insurance plans without the mandates, creating sicker risk pools and driving up premiums for those who remain.

“In 2018 and 2019, according to CBO and JCT’s estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up,” the CBO said. CBO does a “pretty good job with numbers — coverage is not their strong suit.” –Tom Price

Not surprisingly, Republicans are cherry picking the news they want to tout from the CBO report. The ugly coverage numbers are not to be taken too seriously because the CBO is “notoriously bad at anticipating what’s going to happen in the marketplace,” according to Sen. Roy Blunt (R-MO). But the CBO’s findings concerning government savings – which the GOP needs, both to meet Senate rules and shore up conservative support – is “an accurate reflection,” Sen. Mitch McConnell said.

The distinction makes no sense because the two numbers are intricately linked. The CBO’s deficit analysis is derived from the same modeling that determines coverage levels, and thus, how much the government would be spending on tax credits for those on the nongroup market and other costs of the GOP legislation. So if Republicans are right, and the coverage loss isn’t going to be as bad as the CBO says, then the deficit reduction is also not going to be as good.

Republicans can use the “regulatory apparatus” to “make certain that patients are helped and that costs are decreased.” –Tom Price

Another vein of GOP CBO-bashing is that it was “not believable,” as Health and Human Service Secretary Tom Price said, because it did not study the effects of “phase 2,” meaning the regulatory reforms the GOP has also planned to take on alongside the legislation. For one, Republicans haven’t been very clear what Price intends to do regulation-wise — beyond a handful of small-scale insurer gimmes that probably won’t lower premiums much. So it’s hard to see how they expected the CBO to take that into account in their scoring.

But there is a bigger problem in Republicans’ reasoning, beyond what the CBO did and did not score. It’s widely assumed that Price’s approach to watering down the ACA’s requirements will focus on the the 10 Essential Health Benefits. Here, still, his abilities are pretty limited, at least in regards to moves that could actually bring down premiums. Anything too aggressive invites the possibility of a lawsuit.

“Because Price can’t exclude big categories from coverage, he’ll struggle to redefine the essential health benefits in a manner that will drive down costs,” University of Michigan Law School professor Nicholas Bagley wrote on the TakeCare Blog.

Ed. note: Due to an editing error, this piece was mistakenly published with an additional “con” listed, involving Medicaid flexibility for the states, that didn’t take into account the changes to the bill released Monday night. That item has been removed from the post.