The cameras go off, and then comes the collapse

You might recognize this pattern, even if you don’t care about Puerto Rico and the suffering of the more than 3 million Americans there. Trump comes in with razzle-dazzle and self-congratulation, promising great things to come. Then, when the cameras are off, comes the quiet collapse.

The prototype is the Trump Taj Mahal Atlantic City. In April 1990, it opened with much fanfare as the world’s largest casino-hotel complex. Six months later, it defaulted on payments. Nine months after that, it filed for bankruptcy.

Now this happens on a world scale. Trump promises an easy peace in the Middle East but winds up setting off a new wave of violence. He promises a tax cut for the middle class and winds up with a giveaway to corporations and millionaires. He promises to improve upon Obamacare but ravages the program with no replacement.

Let Them Eat Paper Towels

And the Trump administration seems increasingly to see this tragedy as a public relations issue, something to be spun — partly by blaming the victims — rather than as an urgent problem to be solved.

.. And as The Washington Postnotes, there’s a very telling piece of editing: One segment showed Forest Service workers clearing a road, but it cut off just before the official being interviewed praised local efforts: “The citizens of Puerto Rico were doing an outstanding job coming out and clearing roads to help get the aid that’s needed.”

Puerto Ricans behaving well, it seems, doesn’t fit the official story line.

.. Meanwhile, it took almost three weeks after Maria struck before Trump asked Congress to provide financial aid — and his request was for loans, not grants, which is mind-boggling when you bear in mind that the territory is effectively bankrupt.

.. Puerto Rico was in severe financial and economic difficulty even before the hurricane, and some of that reflected mismanagement. But much of it reflected changes in the global economy — for example, growing competition from Latin American nations — reinforced by policies imposed by Washington, like the end of a crucial tax break and the enforcement of the Jones Act, which forces it to rely on expensive U.S. shipping.

.. Puerto Rico is hardly the only U.S. region suffering difficulties in the face of global economic change — and such regions can normally count on federal support to help limit the hardship. What do you think West Virginia would look like if Medicare and Medicaid didn’t cover 44 percent of the population? 

.. what would happen to employment in health and social assistance, which provides jobs to 16 percent of the state’s work force, which is vastly more than coal mining?

Loyalty to Trump isn’t enough

Trump demands not just loyalty but flattery, too. He insists that his courtiers treat his pronouncements, however absurd or offensive, as infallible holy writ. Members of his Cabinet have made a humiliating bargain: humor him, suck up to him, and maybe — just maybe — he will leave you alone and let you make policy.

.. Trump demands not just loyalty but flattery, too. He insists that his courtiers treat his pronouncements, however absurd or offensive, as infallible holy writ. Members of his Cabinet have made a humiliating bargain: humor him, suck up to him, and maybe — just maybe — he will leave you alone and let you make policy.

.. Retiring Sen. Bob Corker (R-Tenn.), chairman of the Foreign Relations Committee, encouraged Tillerson to stay on because he, Defense Secretary Jim Mattis and White House Chief of Staff John F. Kelly “are those people that help separate our country from chaos.”

.. other Cabinet members have made their peace with the Sun King’s demand for unctuous deference. Treasury Secretary Steven Mnuchin looked as if he were in physical pain as he went on the Sunday shows and defended Trump’s demand for NFL players who kneel during the national anthem to be fired.

Chief economic adviser Gary Cohn, who almost quit after Charlottesville, told reporters he stayed on for the “once-in-a-lifetime opportunity” to enact sweeping tax reform.

.. What these officials don’t seem to fully grasp is that their policy initiatives can be undercut by the president at any time, and probably will. Look at budget director Mick Mulvaney, who has big ideas about shrinking government and the deficit. He didn’t anticipate having to wipe away Puerto Rico’s debt, which Trump offhandedly promised to do.

Hurricane Damage in Puerto Rico Leads to Fears of Drug Shortages Nationwide

Pharmaceuticals and medical devices are the island’s leading exports, and Puerto Rico has become one of the world’s biggest centers for pharmaceutical manufacturing. Its factories make 13 of the world’s top-selling brand-name drugs, from Humira, the rheumatoid arthritis treatment, to Xarelto, a blood thinner used to prevent stroke, according to a report released last year.

.. drug companies and device makers are confronting a range of obstacles on the island: locating enough diesel fuel for generators to run their factories; helping their employees get to work from areas where roads are damaged and blocked

.. Thirteen of the drugs, Dr. Gottlieb said, are “sole-source,” meaning the product is only made by one company. Those include H.I.V. medications injectable drugs and sophisticated medical devices, although he did not name the products. The biggest problem, he said, was not damage to the factories, but the instability of the electric supply.

.. Ms. Fox said companies typically do not disclose where they manufacture their drugs because it is considered a trade secret. Several companies declined to list which products they made in Puerto Rico.

.. Pharmaceutical and medical manufacturing accounted for nearly three-quarters of Puerto Rico’s exports in 2016, of $14.5 billion