Category Archives: Medicare buy-in option

Harris Strikes Right Balance On Health Care Reform

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Democratic presidential candidates have been having a white hot debate about whether to support Medicare-for-All, which would move people onto Medicare and eliminate private health insurance plans, or a Medicare buy-in option, which would allow Americans to choose between government-run Medicare and corporate-run health plans.

Substantively, Medicare-For-All is Best

Substantively, Medicare-for-All makes more sense.  Going to a government-run single payer system would be the fastest and most effective way to cover all Americans, reduce administrative overhead, stop excessive profiteering, reduce medical costs, make the American economy more competitive, incentivize better health care best practices, and produce better outcomes. 

Compared to health systems used by other developed nations that are to varying degrees more like Medicare-for-all would be, the current U.S. system is worst.

Yes, a large tax increase would be needed to finance Medicare-for-All, and Democrats should be honest about that. At the same time, Americans would no longer be paying premiums, deductibles and copays.  Many Americans who have subsidized employer-based coverage should see higher pay as employers are freed of that enormous expense.  Because of these kinds of issues, 200 independent economists recently signed a letter stating that Americans would be paying less overall with a single government-run system than they pay under the current system, not more.

Politically, Medicare Buy-In Option Is Best

Politically, however, a Medicare buy-in option makes much more sense.  Because many Americans get extremely nervous about not having the option to stick with their familiar private health plan, about 75% of Americans support a Medicare buy-in option compared to about 56% who support Medicare-for-All.   Given how difficult it will be to defeat Trump in 2020 and pass something in the Senate in 2021 and beyond, political marketability and sustainability is no small consideration.

Harris’s Hybrid

After initially indicating support for Medicare-for-All, Senator Kamala Harris yesterday proposed a thoughtful hybrid approach.  While Harris still calls her proposal “Medicare-for-All,” it’s more accurate to call it “Medicare-for-All-Who-Want-It,” since it allows Americans to choose private plans that are required to have the same benefits as Medicare.  After a 10-year phase-in to limit transition-related bumps, all Americans would have the kind of coverage Medicare currently offers, with some coverage upgrades.

This approach would achieve much, but not all, of the substantive benefit of Medicare-for-All, and it has enormous political advantages over Medicare-for-All.  Importantly, when Trump and the corporate insurance interests attack “government-run health care that takes away your insurance coverage,” those critics can be disarmed with very simple and compelling rebuttals: “If you don’t like it, you don’t have to choose it.” “If it’s as bad as they claim, no one will choose it.” 

Those simple, powerful rebuttals, which can only be used with a buy-in option, de-fang the “they’re taking away your health insurance” bite.

Progressive critics like Sanders are criticizing the Harris plan as too “moderate.” It certainly is moderate compared to the Sanders Medicare-for-All plan.  But when compared to ACA repeal/Trumpcare, where 20 million lose their coverage and all Americans would lose popular and effective ACA protections, the Harris proposal represents huge progress.  Also, the Harris plan offers an important quantum leap forward from the current ACA-driven system. 

Importantly, the Harris proposal offers Americans a consumer-driven path to the future.  When given a choice, it’s very likely that most Americans will choose the cheaper and better Medicare option over corporate care. Corporate care won’t be competitive with Medicare, because of its higher overhead and the need to make profits. But giving all Americans the ability to comparison shop and vote with their feet is key, so that Medicare-for-All eventually comes to American by popular mandate, rather than government mandate. Taking that consumer-driven approach ultimately will make Medicare-for-All more politically durable.

Though I don’t know all the details yet, I like the general balance Senator Harris has struck.  Obama’s former chief Medicare/Medicaid administrator Andy Slavitt said it well:

“Sen. Harris’s plan balances idealism and pragmatism. It says in effect: We have a mandate to get everyone affordable health care and put people over profits — but we don’t need to tear down the things people have and they like in order to do it.”

That’s what Democrats need: Idealism to stay true to their progressive values and excite lightly voting Democratic constituencies such as young people and people of color and pragmatism to smooth over political and logistical challenges and win over critically important moderate swing voters. 

Left of Eden

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Guest post by Noel Holston

On the first night of the first round of debates among Democratic presidential aspirants, Julián Castro, who was Secretary of Housing and Urban Development in the Obama administration, had a spotlight-grabbing moment when he upbraided fellow Texan Beto O’Rourke for not supporting his plan to end criminal penalties for undocumented immigrants crossing our southern border from Mexico.

On the second night, when a different 10 hopefuls fanned across NBC’s Wheel of Fortune stage, the impact of Castro’s attack was obvious. Aked if they backed Castro’s plan, nine candidates raised their hands. All 10 said they would back federal health subsidies for undocumented immigrants, an idea President Barack Obama nixed a decade earlier.

The candidates’ stampede to out “left” each other reached its most bizarre point when Castro volunteered that his universal healthcare plan would cover abortions, including abortions for trans women. At least this would not be a benefit that would significantly affect the deficit.

Since those nights, one of the hottest topics among the commentariat has been whether Democrats are going to blow their opportunity to dethrone President Trump by catering to their most progressive constituents.

Writing in The Atlantic, Peter Beinart asked, “Will the Democratic Party go too far?”

“I’ll vote for almost any Democrat, but lurching left won’t beat Trump,” read the headline on a USA Today editorial by Tom Nichols, a national security professor at the Naval War College and a self-identified “Never Trump”-er.

“Democratic candidates veer left, leaving behind successful midterm strategy,” read the headline on a Washington Post analysis piece by Michael Scherer, one of its national correspondents.

Hogwash, say others, among them Keith A. Spencer, writing in Salon.com about “hard evidence” that supposedly proves a centrist Democrat will belly flop in 2020.

Other op-ed’s have warned Democrats to beware of Republican trolls trying to trick them into pursuing foolish moderation.

So, what are Democrats to do?

Well, what if they borrowed a phrase from “A Clockwork Chartreuse,” Loudon Wainwright III’s tongue-in-cheek paean to an anarchist: “Let’s burn down McDonald’s/Let’s go whole hog.”

Here are few things Democratic candidates can advocate at the next round of debates – July 30 and 31, CNN — if they really, really want to test the notion that the way to deny Donald Trump a second term is not moderation but a triple jump to the left. In no particular order:

Claiming “originalist” interpretation, ban private ownership of all firearms designed after 1789, the year the U.S. Constitution was ratified.

Ban bacon and big-ass pick-up trucks.

Remove slave owners’ heads from Mt. Rushmore.

Outlaw Mountain Dew.

Expand national park acreage to include Texas.

Along with abolishing private health insurance and replacing it with Medicare for All, reimburse patients for parking at hospital ramps.

Mandatory kale consumption.

Stop construction of Trump’s wall; commence construction of automated “people mover” walkways.

Change national anthem to Neil Diamond’s immigrant-friendly “(Coming to) America.”

Abolish apple pie as the national dessert. I’m thinking rhubarb.

Note: Noel Holston is a freelance writer who lives in Athens, Georgia. He’s a contributing essayist to Medium.com, TVWorthWatching.com, and other websites. He previously wrote about television and radio at Newsday (200-2005) and, as a crosstown counterpart to the Pioneer Press’s Brian Lambert, at the Star Tribune  (1986-2000).  He’s the author of “Life After Deaf: My Misadventures in Hearing Loss and Recovery,” which is scheduled for publication fall of 2019 by Skyhorse.

Championing Both Medicare-for-All and Buy-in Option

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During last night’s Part I of the Democratic Presidential debate, moderators and candidates acted as if candidates must make a choice between advocating for Medicare-for-All and a Medicare buy-in option.  It was one of the few areas of division among the progressive candidates

Why?  Progressives should be simultaneously advocating for both policies. 

Stop Bashing Buy-In Option

Medicare-for-All advocates like Sanders and Warren need to stop taking cheap shots at a Medicare buy-in option. 

The reality is, without a filibuster-proof Senate majority, Medicare-for-All simply can’t pass for a while.  Therefore, progressives need a Plan B that helps as many Americans as possible, shows that Democrats can deliver on their health care rhetoric, and advances the cause of Medicare-for-All. 

That’s what a Medicare buy-in option does. 

It helps more Americans in the short-run by bringing much more price competition to the marketplace and ensuring every American has at least one comprehensive coverage option available to them, even in poorly served areas. 

Beyond helping Americans in the short-term, a buy-in option also advances the cause of Medicare-for-All. Americans have been brainwashed by decades of conservatives’ vilifying of “government run health care,” but a buy-in option will give younger generations of Americans first-hand evidence showing that Medicare is not to be feared. It will show millions of Americans that Medicare is cheaper and better than conservatives’ vaunted corporate health plans.

And that will help disarm conservatives’ red-faced criticisms of “government run health care” and Medicare-for-All.

Stop Bashing Medicare-for-All

At the same time, champions of a Medicare buy-in option like Biden and Buttigieg need to stop railing on a Medicare-for-All. 

Even though Medicare-for-All can’t pass right away, progressives need to keep explaining what the world’s other developed nations figured out a long time ago, that a single payer government-run is the only real solution for any nation that hopes to control costs, cover everyone, and improve health outcomes.

For far too long, progressives have been afraid to educate Americans about why a single-payer system is needed.  When fearful progressives sensor themselves from explaining why Medicare-for-All is needed, they leave the stage to conservative and corporate demagogues relentlessly spreading myths about the evils of “government-run health care.” 

And when progressives leave the stage to conservative demagogues — surprise, surprise – progressives lose the debate.

Start Pushing Both

What would it sound like to advocate these two positions simultaneously? It could sound something like this:

Ultimately, we must cover everyone, control skyrocketing costs, and improve health outcomes. And you know what? Ultimately, the only way to do that is Medicare-for-All. 

In America, Medicare has proven effective and is popular with those who use it. In developed nations around the world using government-run systems like Medicare, everyone is covered, costs are much lower and health outcomes are much better. 

So Medicare-for-All must to be our ultimate goal. We have to keep our eyes on that prize. We need it as soon as possible.

At the same time, the Republican-controlled Senate won’t pass Medicare-for-All.  That’s reality folks.

Given that reality, what can Democrats do right now to both help the American people and pave the way for Medicare-for-All in the long-run?  A Medicare buy-in option.  A buy-in option has lots of public support among Republican voters, so it has a much better chance of passing the Senate than Medicare-for-All.

Let Americans choose between corporate care and Medicare. If they want to keep their private health insurance, they can. But given them another option.

President Trump is afraid to give Americans make that choice. I’m not. He knows Americans will like Medicare better, and doesn’t want to give them that option. I’m not afraid, because I know that a Medicare plan that isn’t required to profit off of patients will be cheaper and better that corporate care. So let Americans choose.

Enacting a buy-in option now will show more Americans that they have nothing to fear from Medicare coverage. And that will help us move the American people towards embracing Medicare-for-All.

Pols and pundits keep framing this issue as if it must be a battle to the death for progressives. But Medicare-for-All versus a Medicare Buy-in Option is a false choice.  Progressives should be advocating for both, and stop savaging each other on the issue.

Medicare Buy-In Option: The Next Span in the Bridge to Medicare-for-All

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Democratic presidential candidates are lining up in support of Medicare-for-All, and I’m glad they’re making that case to Americans.  Around the world, single payer systems like Medicare-for-All are delivering better and cheaper health care than Americans are getting, and we need to adopt such a system as soon as possible.  As William Hsiao, Ph.D., professor of economics at the Harvard School of Public Health puts it:

“You can have universal coverage and good quality health care, while still managing to control costs. But you have to have a single-payer system to do it.”

But for reasons I’ll explain below, I don’t believe Medicare-for-All can pass in 2020, even if Democrats control Congress and the White House.  So, we need to extend a meaningful bridge to Medicare-for-All.

So what could Democrats pass to make Medicare-for-All possible in the relatively near future?

The 74-Year Battle

Before we get to that, let’s back up to reflect on how we got here.   In 1945, Harry Truman wanted what we today would call Medicare-for-All.  For 20 years, it went nowhere.  What was dubbed “socialized medicine” by Ronald Reagan and other Republicans just didn’t prove to be politically feasible.

In 1965, Lyndon Johnson had a partial breakthrough. He passed Medicare for 65 and older, but it wasn’t as comprehensive as today’s Medicare. As support for Medicare grew, improvements were made.  In 1972, Republican Richard Nixon agreed to expand coverage. In the Reagan years, home health care, hospice services, and a limited prescription drug benefit were added.  In the George H.W. Bush era, the prescription drug benefit was expanded.

The historical lesson:  Health care reform in a nation dominated by powerful private health insurance companies has been supremely arduous, and therefore incremental.  This is true even though Medicare has proven popular and efficient.

Medicare-for-All Next?

Unfortunately, three-quarters of a century after Truman started advocating for Medicare for All, the debate still is treacherous. In 2019, the Medicare expansion debate boils down to essentially this:  Should progressives push for 1) publicly financed, mandated Medicare-for-All; 2) voluntary, consumer-financed Medicare buy-in option; or 3) a publicly financed, mandated “Medicare at 50.”

Many progressives, myself included, point to the polls showing strong support for Medicare-for-All, and say now is the time to push for it.

Indeed, progressives should continue to make the case for making Medicare-for-All the goal. At the same time, we have to recognize that in the current political environment, Medicare-for-All has much less popular support than a Medicare buy-in option.  A January 2019 Kaiser Family Foundation (KFF) poll finds that  56% of Americans support Medicare-for-All, while 77% support a Medicare buy-in option.  So when conservatives and insurance companies start attacking, the buy-in option would be much more politically bullet-proof than Medicare-for-All.

Moreover, as the debate heats up Medicare-for-All and Medicare-at-50 will be vulnerable to two of the most deadly attacks in all of American politics.  First, opponents will say they’re “massively expensive.” Second, they will say consumers would be “forced to give up your current coverage.”

We shouldn’t discount the political power of those two critiques.  When it comes to taxpayer expense and mandated change, American voters have historically been very easily spooked. Those two attacks, which would be greatly amplified via hundreds of millions of dollars worth of the most intensive political and special interest propaganda the nation has ever seen, will be very effective at eroding support.

Therefore, today’s poll numbers for Medicare-for-All and Medicare-at-50 will not hold up, and when they shrink, congressional votes will disappear.

Advantages Of A Medicare Buy-In Bridge 

A Medicare buy-in option, however, is much more politically durable, and not just because it has 21 points more support in the KFF survey than Medicare-for-All.

Not Expensive. First, a Medicare buy-in option wouldn’t have a big taxpayer price tag like Medicare-for-All or Medicare-at-50, because consumers under age 65 would be paying premiums, not taxpayers.

Not A Mandate.  Second, a buy-in option wouldn’t force any consumer to give up their current coverage, which they would need to do with either Medicare-for-All or Medicare-at-50.  Under the buy-in option, consumers who want to continue to pay more to keep their private coverage could still choose to do so.

The fact that a Medicare buy-in option is voluntary and self-financing would largely disarm the most potent political attacks that have been working since 1945.

A Bridge To Medicare-for-All. But make no mistake, passing a Medicare buy-in option would constitute dramatic progress that would make Medicare for All much more likely in the future.  Let me count the ways:

  • More Affordable for Millions.  Because Medicare has much lower overhead than private health insurance, it would give millions of Americans more affordable coverage than they have today. By the way, if private insurance somehow turns out to be cheaper and/or better than the Medicare option, as conservatives have long claimed, consumers obviously will choose it.  If that happens, Republicans will be proven correct. So let patients decide, not politicians. Conservatives should have nothing to fear from giving this option to consumers.
  • Aid Cost Control.  A Medicare buy-in option would give Medicare a bigger pool of consumers, which would give Medicare officials much more leverage to negotiate cost control with hospitals, doctors, device makers and pharmaceutical companies. “Medicare-for-more” would not be as effective at leveraging lower costs as “Medicare-for-All” will be, but it will bring important progress.
  • Deepen Medicare Support. As more Americans voluntarily switch from private insurance to the cheaper Medicare buy-in option without experiencing worse service and coverage, it will show Americans that this “government-run health care” is not the horrific bogeyman Republicans have made it out to be.
  • Broaden Generational Support. Finally, while Medicare currently mostly only has senior citizen champions, newly converted believers in Medicare would be in their 20s, 30s, 40s, 50s, and early 60s. This would dramatically strengthen the Medicare-for-All base of support.

So, a Medicare buy-in option would be much more politically feasible than Medicare-for-All or Medicare-at-50, and it is the next logical span of the bridge to Medicare-for-All to add. Progressives shouldn’t be hesitant to build it.

Minnesota’s Trumpublican Trio Owns The Trump Damage

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This week, statewide coverage featured Minnesota Republican Congressman Erik Paulsen, Tom Emmer and Jason Lewis mugging with President Donald Trump’s lead partner in crime, Vice President Mike Pence.

The news coverage serves as a helpful reminder to Minnesotans that these three gentlemen have enabled Donald Trump’s disastrous presidency every step of the way. They have slavishly voted for the mean-spirited Trump agenda about 90% of the time. It reminds us that the reelection of Minnesota’s Trumpublican Trio is effectively a referendum on Trump’s corruption, chaos, incompetence, and extremism.  A few things that Minnesotans should be reminded of during campaign season:

WEAKENING OUR HEALTH PROTECTIONS. These three congressmen repeatedly supported Trumpcare, which would have stripped health protections from 51 million Americans, and only had the support of 17% of Americans. They are also complicit with Trump’s ongoing sabotaging of the historically effective Affordable Care Act protections. Moreover, they oppose efforts that would make health protections much more available and affordable, such as with a national reinsurance program, restoration of the Cost Sharing Reductions (CSR) they cut, and giving Americans the option of buying into the popular and efficient Medicare program.

DEFICIT SPENDING TO ENRICH BILLIONAIRES. Paulsen, Emmer, and Lewis brought us Trump’s trickle down tax code, which gives a huge tax break to the wealthiest 1% at a time when we are suffering from the worst wealth inequality since 1928. The top 1% got an obscene 83% of the benefits provided in the tax bill, creating the largest transfer of wealth to the richest Americans in the nation’s history.

Oh, and by the way, these self-proclaimed “deficit hawks” put the $1.5 trillion cost of their lavish tax giveaway to the wealth on the federal credit card that our kids and grandkids now have to pay.  Absolutely shameless.

PUTTING TRUMP ABOVE THE LAW. They have turned a blind eye to Trump’s repeated obstruction of justice during the investigation into Russia’s attack on America’s democratic jewel, our free and fair elections. This obstruction of justice is far more extensive than the actions that forced President Nixon out of the White House, but the Republicans of 1972 had enough integrity to fulfill their oversight duties and push Nixon out, while these contemporary Republicans are cavalierly shrugging it off.

PUTTING NRA CONTRIBUTIONS OVER COMMON SENSE GUN PROTECTIONS. They have blocked common-sense gun protections that enjoy overwhelming public support, because they and their guy Trump value NRA donations over the wishes of the people they were elected to represent.

PUTTING CORPORATIONS’ NEEDS OVER ENVIRONMENTAL PROTECTIONS. They have marched lockstep behind Trump as he has racked up the worst environmental record in our lifetime.  For instance, Trump made the United States the only nation on the planet to not sign the Paris accord on climate change.

These are just a few examples, but the list of pro-Trump votes is a long one. According to FiveThirtyEight, Rep. Emmer votes with Trump 87% of the time, Rep. Lewis votes with Trump 90% of the time and Rep. Paulsen votes with Trump 97% of the time. Clearly, a vote for Emmer, Lewis, and Paulsen is effectively a vote for the historically unpopular Trump.  Minnesotans who are fed up with Trump need to be speaking out, donating and organizing against them.

Five Reasons Democrats Should Push A Medicare-for-All Option

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As the next iteration of Trumpcare/Ryancare is finalized by warring conservatives, it’s fair to demand that Democrats share their post-Obama vision for health care.

Yes, Democrats need to be fighting efforts to repeal and replace the increasingly popular Obamacare/Affordable Care Act (ACA) system with Trumpcare/Ryancare. Though the ACA is the spurned love child of the Heritage Foundation, Orin Hatch, Newt Gingrich and Mitt Romney, it’s much more humane than Trumpcare/Ryancare, which would cause at least 24 million Americans to lose their Obamacare health coverage, and many more if states choose to further weaken protections.

Cursor_and_medicare-for-all_jpg__360×216_But for the long haul, Democrats need to set their sights higher than Obamacare. They must become full-throated champions for allowing Americans the option of buying into the Medicare system.  Here are five reasons why:

Reason #1. Medicare is popular “government run health care.” For decades, Republicans have robotically vilified “government run health care” and “socialized medicine,” presuming that Americans agree with them that government will screw up anything it undertakes.  And Democratic politicians have cowered in fear.

However, Medicare is a notable exception to that rule. While the private sector-centric Trumpcare/Ryancare has 17% approval and Obamacare has 55% approval, Medicare has the approval of 60% of all Americans, and 75% Americans who have actual experience using Medicare.  It’s not an easy thing for a health plan to become popular, so Medicare’s relative popularity is political gold.  Democrats need to tap into it.

Reason #2. Medicare is better equipped to control medical and overhead costs than private plans. Medicare has a single administrative system, while dozens of health insurance corporations have dozens of separate and duplicative administrative bureaucracies.  That decentralized approach to administration is expensive.

Also, for-profit health insurance corporations have to build profits and higher salaries into their premium costs. For instance, the insurance corporation United Health Care, to cite just one of dozens of examples, pays it’s top executive $33,400,000.   That’s 135 times more than the not-for-profit Medicare system pays its top executive, about $247,000.

Medicare also is large enough that it has a great deal of negotiating leverage.  It could have even more if Congress empowered Medicare to more effectively negotiate pharmaceutical prices.

Because of all of that, the Center for Budget and Policy Priorities finds:

Medicare has been the leader in reforming the health care payment system to improve efficiency and has outperformed private health insurance in holding down the growth of health costs…  Since 1987, Medicare spending per enrollee has grown by 5.7 percent a year, on average, compared with 7.0 percent for private health insurance.

So, if Democrats want to better control health care costs to help the economy and struggling Americans, the Medicare model offers the best hope for doing that, not the corporate-centric model that we currently are using.

Reason #3. A Medicare-for-All option is very politically viable. Most Democratic politicians understand that a Medicare-for-All option makes good sense policy wise, but shrug it off as politically infeasible. They’re dead wrong.

By a more than a 5-to-1 margin, Americans support having a Medicare-for-All option. An overwhelming 71% support it, while only 13% oppose it. If you won’t try to sell a proven progressive idea that is supported by a 5-to-1 margin, you have no business being in progressive politics.

While “government-run health care” has been a weak brand for brand for Democrats, they have a clear path for rebranding their agenda.  Medicare brand equity is right there waiting for Democrats to take advantage it, if they’ll only open their eyes to the opportunity.

Reason #4. A Medicare-for-All option will expose private health corporations as uncompetitive. Right now, one of the Democrats’ biggest political problems is that too many Americans have been brainwashed by conservatives into believing that the private sector is always more efficient and effective than the public sector. In other areas that don’t involve “public goods,” that is true, but not with health insurance.

The best way to bust that “private is always best” myth is to allow Medicare to sit alongside corporate health plans in the individual marketplace. If American consumers choose Medicare over private plans, because Medicare proves itself to be the cheapest and best option, then the conservatives’ “private is always best” myth finally will be busted.

Reason #5. A Medicare-for-All option can serve as a bridge to the best health care model – a public single payer system. The research is clear that countries who have single payer health care financing have better and cheaper health care than the United States has with it’s substantially private sector based health care system. For example, the nonpartisan, nonprofit Commonwealth Fund finds:

Even though the U.S. is the only country without a publicly financed universal health system (among 13 high-income countries: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States), it still spends more public dollars on health care than all but two of the other countries. …despite its heavy investment in health care, the U.S. sees poorer results on several key health outcome measures such as life expectancy and the prevalence of chronic conditions.

Obscure research reports like this aren’t proving persuasive to American voters. But when younger Americans are able to see for themselves through their shopping that Medicare is cheaper and better than private health insurance options, Medicare will build a bigger market share.  After Medicare earns a larger market share, Americans may ultimately be much more open to shifting from a Medicare-for-all option to a Medicare-for-all single payer system that the United States ultimately needs in order to compete in the global marketplace and become a healthier nation.

It’s not enough for Democrats to only expose the reckless Trumpcare/Ryancare model and defend Obamacare status quo.  They must also promote a Medicare-for-All vision for moving America forward. With the current President and Congress, a Medicare-for-All option obviously can’t pass.  But aggressively promoting over the coming years will improve the chances that this Congress and President will soon be replaced and that a Medicare-for-All option can be enacted in future years.

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

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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

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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

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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

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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

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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.