Trumpcare’s Terrible, Horrible, No Good, Very Bad Week

America currently has a health reform model that has given it the highest rate of health insurance coverage in history, covering more than 20 million of its most difficult to insure citizens.  It has helped those 20 million Americans avoid having their lives ruined by crushing medical bills, or shifting those costs onto other Americans.

Gallup_uninsured_chartAnd despite years of heavily-financed and relentless attacks on the model, most Americans now have a favorable impression of it.

The Affordable Care Act (ACA) system isn’t perfect.  Yes liberals, a Medicare for All system would be much more effective and efficient than the current ACA system. Yes conservatives, this ACA needs adjustments, though, to borrow from Mark Twain, the reports of its death spiraliness have been greatly exaggerated.

Fact Check:  Obamacare Is Not In A Death Spiral

“You could, I think, relatively simply address the issues that the exchanges have,” said Dan Mendelson, president of Avalere Health, a health consulting firm, noting that other major programs including Medicare have been tweaked repeatedly since their creation.

Now President Trump and the Republicans want to blow up the ACA model — the one that covered the most Americans in history — in favor of a model that will cause an estimated 6 million to10 million Americans to lose their coverage. Their alternative particularly hurts the low-income, rural and elderly.  To add insult to injury, it shoehorns in a grotesquely large tax cut for the wealthiest Americans, at a time when we have the worst inequality in incomes since the 1920s.  The alternative is vehemently opposed by doctors, nurses, hospitals, seniors, conservatives, and liberals. And Republicans promise to pass it within three weeks, without cost estimates if necessary, after complaining about the ACA being “rammed through” over 13 months.

This is the political and policymaking genius that is Trumpcare.

Will Rogers said, “this country has come to feel the same when Congress is in session as when the baby gets hold of a hammer.” Never has that been more true than now.

Hillary, the ACA and the Art of the Possible

Cursor_and_hillary_clinton_-_Google_SearchThough I’m a solid Hillary Clinton supporter, I don’t particularly relish defending her at water coolers, dinner tables and social media venues.  When defending Hillary Clinton to those who hoped for more, I often feel like I do when defending the Affordable Care Act (ACA) to those who hoped for more.

To be clear, neither Hillary nor the ACA were my first choice. Elizabeth Warren and single payer were my first choices.

Neither Hillary nor the ACA are as bold as I’d prefer. They both promise modest incremental change, rather than the more revolutionary change that is needed.

Neither Hillary nor the ACA are, shall we say, untouched by special interests. The ACA is the product of accommodations made to private health insurers, physicians and the pharmaceutical industry, while Clinton is the product of accommodations made to corporations, unions and military leaders.

Also, neither Hillary nor the ACA are easy to understand. Hillary is a wonk’s wonk whose eye-glazing 20-point policy plans don’t exactly sing to lightly engaged voters.   Likewise, the ACA has given birth to 20,000 pages of the densest regulations you’ll ever find. (By the way, a primary reason the ACA is so complex is that conservatives and moderates insisted that it accommodate dozens of for-profit insurance companies instead of  using the more linear single payer model that has been proven effective and efficient by other industrialized nations. In this way, the need for much of the ACA complexity was created by conservatives, not liberals.)

At the same time, neither Hillary nor the ACA are anywhere near as bad as the caricatures created by their demagogic critics. Hillary is not a serial liar and murderer any more than the ACA led to “Death Panels” and force-fed birth control.

The bottom line is that both Hillary and the ACA, for all their respective flaws, are far superior to the alternatives. The steady, smart, savvy, and decent Clinton is much better than the erratic, ignorant, inept and vile Trump. The current ACA era, with a 9.2% uninsured rate (4.3% in Minnesota, where the ACA is more faithfully implemented than it is in many states) and all preexisting conditions covered is much better than the pre-ACA status quo, with an uninsured rate of 15.7% (9% in Minnesota) and millions denied health coverage because of pre-existing medical conditions.

Hillary and the ACA both bring progress, but they are hardly the final word.  The fact that I am supporting the ACA in 2016 doesn’t mean I’m going to stop advocating for ACA improvements, a Medicare-for-All option and ultimately a single payer system. The fact that I am supporting Hillary in 2016 doesn’t mean I’m not going to push for more progressive, bold, compelling and independent leaders in the future.

But politics is the art of the possible.  Hillary and the ACA are what is possible at this point in the history of our imperfect democracy.   As such, I can champion both comfortably, if not entirely enthusiastically.

Progressives and Moderates Intrigued By Gary Johnson Should Look Deeper

Cursor_and_gary_johnson_funny_-_Google_SearchWhen I started seeing ads and social media chatter about former Republican Governor Gary Johnson running for President, I went to OnTheIssues.org to learn more.

I liked some of what I saw on foreign policy and law enforcement reform, but one line jumped out at me as particularly disturbing. It said Governor Johnson wants to:

“cut the federal budget by 43%.”

Just to be clear, a 43% cut in federal spending would constitute a major conservative revolution.  That would bring a much deeper reduction in government services than has been proposed in the past by ultra-conservative firebrands such as Barry Goldwater, Ronald Reagan, Pat Buchanan, Newt Gingrich, John Boehner, Mitch McConnell, Ted Cruz, or Michele Bachmann.

Still, I realize that a 43% cut has surface appeal.  After all, nobody feels a deep affinity for the abstract notion of “the federal government budget.” But budgets are collections of individual programs that deliver individual sets of services and benefits to Americans,  so we need to evaluate Johnson’s radical austerity plan on a program-by-program basis.

So, my fellow Americans, which federal services are you willing to cut by 43%, as Gary Johnson proposes.

Cut Infrastructure by 43%?  For instance, are the American people willing to cut infrastructure investments by 43%?  Do we want to slash investment in roads, bridges, transit, trains, airports, water and sewage systems, and the like?  A GBA Strategies survey finds that an overwhelming 71% of Americans want to spend $400 million more on infrastructure, not less.  Only 13% oppose such a massive federal government spending increase.

Cut Medicare by 43%?  Do the American people want to cut Medicare by 43%? After all, Medicare is a huge and growing part of the federal budget.  Americans not only don’t want to cut Medicare, more than three-fourths (77%) of Americans want to fund a new, massively expensive Medicare-for-All option.  Only 17% oppose such an expansion of government services and spending.

Cut Social Security by 43%?  Maybe Americans want to cut Social Security benefits by 43%?  While Social Security represents an enormous slice of the federal pie, the vast majority of Americans not only don’t want to cut Social Security benefits, a whopping 70% want to strengthen them.  Only 15% oppose expanding Social Security benefits.

Cut National Defense by 43%?  What about a 43% cut in national defense spending? Gallup finds that only 32% of Americans support national defense budget cuts.

Cut Other Programs by 43%?  Similarly, the GBA survey finds that an overwhelming majority of Americans want major government spending increases for green energy technology (70% support, 20% oppose), debt-free public higher education (71% support, 19% oppose), and subsidies for high quality child care  (53% support, 33% oppose) . There is no public appetite to cut any of those federal programs by 43%, as Governor Johnson proposes.

In other words,  only a thin slice of the most deeply ultra-conservative voters support Johnson’s fiscal austerity ideas.  Therefore, more moderate voters who are concerned about the nation’s poor, middle class, national security and global competitiveness need to learn about the implications of Johnson’s fiscal proposals before they jump on the Johnson bandwagon.

Sanders Drawing Wrong Parallels To Explain Democratic Socialism

Cursor_and_Denmark_flag_-_Google_SearchWhen presidential candidate Bernie Sanders explains why Americans shouldn’t fear his “democratic socialism,” he usually points to Scandinavia.

“I think we should look to countries like Denmark, like Sweden and Norway, and learn what they have accomplished for their working people. In Denmark, there is a very different understanding of what “freedom” means… they have gone a long way to ending the enormous anxieties that comes with economic insecurity. Instead of promoting a system which allows a few to have enormous wealth, they have developed a system which guarantees a strong minimal standard of living to all — including the children, the elderly and the disabled.”

His opponent, Senator Hillary Clinton, who clearly understands American exceptionalism biases, quickly shuts down Sanders’ arguments with a smug shrug: “We are not Denmark.”

By continually citing countries other than America to explain democratic socialism to Americans, Senator Sanders is hurting his case. Instead of pointing to Norway, he should more consistently cite the New Deal.

First, let’s consider the definition of “democratic socialism” offered by Democratic Socialist’s of America:

“Democratic socialists believe that both the economy and society should be run democratically—to meet public needs, not to make profits for a few. To achieve a more just society, many structures of our government and economy must be radically transformed through greater economic and social democracy so that ordinary Americans can participate in the many decisions that affect our lives.”

Truth be told, the United States of America is no stranger to this kind of democratic socialism. It was brought to us during some of the most successful and popular presidencies of the past century. Teddy Roosevelt, Franklin Roosevelt, Harry Truman, and Dwight Eisenhower enacted a whole series of popular measures that fit under this definition of democratic socialism.  At the time their ideas were proposed, they were criticized as infeasible, un-American and socialistic, just as Sanders’ ideas are today.

Therefore, Senator Sanders should be explaining his democratic socialism with American examples that a large majority of Americans already know and love. Sanders might say something like this:

You want to know what democratic socialism is? When the great Republican Teddy Roosevelt dissolved 44 corporations to protect the middle class, and when he protected ordinary Americans from the railroad companies and other big corporations, his critics said “you can’t pass that, because it’s socialism.”  But he passed them anyway, because the American people demanded it.

When the enormously popular Franklin Roosevelt used government funding to put Americans to work building community infrastructure, they said “you can’t pass that, because it’s socialism.” When FDR proposed a Social Security system of government-run pensions that lifted millions of American seniors out of poverty, conservatives said “you can’t pass that, because it’s socialism.”  But he passed those things anyway, because the people demanded it.

When Harry Truman enacted Medicare, people like Ronald Reagan called that socialism too.

And you know what? When Republican Dwight Eisenhower invested in an enormously expensive interstate highway system and had 90% income tax rates on the ultra-wealthy, they said it again: “You can’t pass that, because that’s socialism.”  But he passed those things anyway, because the American people demanded it.

And despite the dire predictions from critics, America’s economy prospered under these policies that were all predicted to be catastrophic for the economy.

So in 2016, when the defeatist “no you can’t” crowd tells Americans “you can’t pass bills to provide higher education and health care to all, because that’s socialism,” I get my inspiration and courage from Teddy, FDR, Give ‘em hell Harry and Ike.  Because of them, I know America can overcome the cynics’ name-calling and naysaying to do great things for the middle class now, just as we did then.”

Democratic socialism is already in America, and it is enormously popular. Surveys consistently show that Americans are vehemently opposed to cutting or eliminating democratic socialist programs such as Medicare, Social Security, and the minimum wage.

Americans not only have embraced democratic socialism in the past, they strongly support it for the future. A recent GBA Strategies poll shows that likely 2016 voters overwhelmingly support a whole range of Sanders’ ideas being dismissed as socialist ideas lacking sufficient political support:  Allowing governments to negotiate drug prices has 79% support. Medicare buy-in for all has 71% support. A $400 million infrastructure jobs program has 71% support. Debt-free college at all public universities has 71% support. Expanding Social Security benefits has 70% support. Taxing the rich at a 50% rate — the rate under conservative icon Ronald Reagan — has 59% support, and only 25% in opposition. Breaking up the big banks has 55% support, and only 23% in opposition.

This is hardly a portrait of a nation that opposes democratic socialism.  Overwhelming support for democratic socialism is already there, ready to fuel a 2016 presidential candidate.  But for two reasons, Senator Sanders needs to cite American parallels to explain his approach, not European.

First, citing examples of American policies will help build confidence that bold measures can be enacted over fierce opposition now, just as they were in the days of Teddy, FDR, Truman and Ike.  Second, citing American examples will paint Sanders’ democratic socialism label and his policy ideas red, white and blue, rather than just red.  It will show that such ideas have been embraced in the past by idolized Republicans and Democrats.  It subsequently will normalize democratic socialism.

Americans are in a very nationalistic, ethnocentric and nostalgic mood. So, rather than continually pointing to the Rikstag, Storting, and Folketing to explain democratic socialsm, Sanders needs to point to the faces on Mt. Rushmore.

Note:  This post was chosen for re-publication in MinnPost’s Blog Cabin feature.

The Health Reform Middle Ground Between Bernie and Hillary

Cursor_and_bernie_hillary_debate_msnbc_-_Google_SearchTo hear Senator Hillary Clinton’s campaign tell it, you would think that there is absolutely no way to transition from the Affordable Care Act (ACA) world of today to an eventual Medicare-for-All world that her opponent Senator Bernie Sanders promotes.

The Clinton campaign asserts that the ACA and Medicare-for-All are effectively mutually exclusive. That is, they claim that if you support Medicare-for-All, you must be against the ACA. For instance, former First Daughter Chelsea Clinton was put out on the stump to play Chicken Little:

“Senator Sanders wants to dismantle Obamacare, dismantle the CHIP program, dismantle Medicare, and dismantle private insurance. I worry if we give Republicans Democratic permission to do that, we’ll go back to an era — before we had the Affordable Care Act — that would strip millions and millions and millions of people off their health insurance.”

Chelsea’s mom, a bona fide health care policy expert, knows better. She knows that Senator Sanders proposes to consolidate public insurance programs to make coverage better and more efficient, not eliminate public coverage.

The Clinton campaign’s dire warnings aside, there is a potential middle ground between Senator Sanders’ Medicare-for-All Model and Secretary Clinton’s Stick With The ACA Model.  It’s a middle ground that is more politically viable than what Sanders proposes, and more progressive than what Clinton proposes.

The middle ground is this: Amend the Affordable Care Act to allow ACA exchange shoppers the option of voluntarily buying into Medicare.

This middle ground approach would effectively empower patients to decide the fate of Medicare-for-All.  Here’s how:  If over the years enough ACA exchange shoppers choose of their own free will to buy into Medicare, we will be making progress towards a public single payer system, which in numerous other western countries has proven to be a more effective and efficient model than America’s current model.

On the other hand, if private insurance options prove to be the most attractive, on a quality and/or price basis, the Medicare buy-in option will die off, because it will be exposed as being as inferior as Republicans claim it to be.

But with this Medicare buy-in option, patients would effectively decide Medicare-for-All’s ultimate fate, not politicians.  That’s why it’s a middle ground position.

Senator Clinton maintains that a public option lacks sufficient congressional support to pass, and that is certainly a distinct possibility. But if she proves to be correct and it gets defeated, the ACA will still be there. At that point, we would simply stay with the status quo ACA model.

But I’d like to see an aspirational President who was willing to lead a campaign to enact this middle ground approach.  Because this would be merely optional for patients, it is much more politically feasible than Sanders’ proposal to mandate Medicare-for-All.  Even if a Medicare buy-in option loses, promoting the issue now may pave the way for eventual passage in the future.   It moves the national debate forward.

I actually think a passionate, committed President would have an outside shot of passing this.  After all, there already is a great deal of support for this approach. GBA Strategies recently asked 1,500 likely 2016 voters whether they supporting giving “all Americans the choice of buying health insurance through Medicare or private insurances, which would provide competition for insurance companies and more options for consumers.”

An overwhelming 71% supported this Medicare buy-in option, including 63% of Republicans and 71% of Independents. Only 13% opposed. 

After the special interests start their multi-million distortion and lobbying campaigns, the Medicare buy-in option may well get defeated in a Congress that defeats just about everything. (In fact, any of Senator Clinton’s ideas for incrementally improving the ACA also face a steep uphill battle with a Republican-controlled House).   But this survey tells me that there is a solid foundation of support to build on. So why not lead the American people towards this place halfway between Bernie and Hillary, and at least try to make some progress.

Note:  This post was featured in MinnPost’s Blog Cabin.