Category Archives: ACA

Fact-Checkers in the Trump Era

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I’m a fanboy of journalist fact-checkers. With all of the myths floating around politics and social media, that service has never been more necessary.

But in many ways, Trump has fact-checking journalists unable to make sense of his dizzying manipulations. Tom Tomorrow’s “This Modern World” explains in this insightful ‘toon.

At least two things are in play with fact-finding in the Trump era. First, journalists are confronted with a steady stream of tens of thousands of Trump’s lies — over 30,000 lies in Trump’s first four years alone. Because there are so many Trump lies to run down, journalists seem to feel obliged to scold Harris in roughly equal measure.

Trump era reporters want to appear balanced, even if the amount of lying and misleading between the two major party candidates is clearly out of balance. For this reason, some of the Harris scolds sometimes get to be a stretch, as the Tom Tomorrow cartoon satirizes.

The other Trump tendency that ties fact-checkers into knots is this: Trump famously takes multiple conflicting positions on many issues. His policy positions are consistently inconsistent.

Therefore, a Trump opponent attempting to characterize Trump’s record and positions perfectly accurately would require them to articulate lengthy explanations of Trump’s dizzying number of contradictions. That simply isn’t practical for a Trump opponent trying to be clear and concise on the campaign trail.

Abortion is a recent example. Trump has repeatedly boasted about overturning Roe abortion rights. But now that this “achievement” is clearly unpopular with impacted women, two-thirds of whom want abortion to be legal in all or most cases, Trump is claiming he will oppose policies that continue to limit or block abortions on a national level.

Forget that Trump’s record of overturning Roe says more about his position than any spin he subsequently uses. Forget that the Project 2025 playbook written by 28 of Trump’s top aides clearly lays out new ways for Trump to ban more types of abortions in more states, and that Trump has never specifically said he wouldn’t implement those things.

No, now when Harris points out that Trump wants to take away reproductive freedom, the ever-earnest fact-checkers have declared that she must point out that Trump has also taken a different position recently. They say that Harris’s failure to note Trump’s walkback spin makes her less than truthful.

That kind of fact-checking inadvertently misleads readers, many of whom only read the fact-checkers’ headlines and labels (e.g. “Kamala Harris’s Attack of Trump on Abortion Is Misleading”). The headline fails to note that Trump’s frequent lies are at the heart of Harris’s struggle to concisely characterize Trump’s ever-changing positions.

The New York Times’ David Leonhardt explains the strategy behind Trump’s walkbacks that aren’t walkbacks.

It’s become a pattern: President Trump says something outrageous. He later grudgingly retracts his statement, or members of his administration retract it on his behalf. And then he quickly undermines the retraction.

So what explains it? What could Trump possibly be accomplishing with this blatant dissembling?

Something important and devious, actually. He is sending two different messages, each intended for a different audience.

With the initial statement, he’s talking to his primary audience. Often, that audience is his political base, and Trump is signaling that he’s with them…

And then, in short order, come Trump’s walkbacks. But I think it’s crucial to understand the value that these walkbacks have to Trump. Almost no matter how silly they are, much of the media coverage tends to treat the walkbacks as serious. The walkbacks — and the credulous repetition of them — allow Trump’s fellow Republicans to pretend that he never really meant the initial statements.

Leonhardt is focusing on how Trump manipulates Republicans, but Trump similarly manipulates fact-checking journalists.

The Affordable Care Act (ACA) is a different kind of example. In his first term, Trump promised he would eliminate the ACA and replace it with a secret plan that he promised would be better than the ACA. After getting elected on this promise, Trump tried and failed over 70 times to kill the ACA, and never produced a replacement health reform plan that would be better for Americans.

(Only very late in the debate did Trump share a detailed “TrumpCare” plan. It would have caused more than 20 million Americans to lose their health protections. It was so destructive that only 17% of Americans supported it.)

Now, after that very telling history from Trump’s first term, in the 2023-24 campaign, Trump is again saying he would eliminate the ACA and replace it with a plan to make things even better. Sound familiar?

When Harris uses shorthand and explains to voters that Trump again wants to take away ACA protections, she gets scolded by fact-checkers who want her to give Trump credit for his latest promise to produce his latest secret plan. Given Trump’s long history of deception on this issue, it’s perfectly reasonable for Harris to assume that Trump has no viable ACA replacement plan. If he did, he would surely be happy to share it with Americans.

Again, I loves me some fact-checkers. They’re vitally important. We need more of them. But they do need to do a better job of understanding and explaining Trump’s manipulative games.

How Trump’s Legal Delaying Tactics Could Hurt Him

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Politics is sometimes shaped by the Law of Unintended Consequences (LUC). The actions that politicians take expecting a particular result can sometimes lead to unanticipated outcomes.

For instance, in 2011 Minnesotans saw the Law of Unintended Consequences come into play when Republican political hacks in the state legislature voted to put a same-sex marriage ban on the ballot. Their thinking was that a majority of Minnesotans, who they assumed were as eager as they were to outlaw marriage equality, would turn out in the 2012 elections to pass the amendment. They then hoped that the voters attracted by the marriage ban would elect anti-LGBTQ Republicans.

It didn’t work out that way. To the surprise of many, the Republican’s same-sex marriage amendment was rejected by 51.9% of Minnesota voters. This made Minnesota the first state to reject such a ban at the ballot box. To make matters worse, Republicans lost control of the Minnesota Legislature. 

This allowed state Democrats to pass a statute legalizing same-sex marriage in 2013. 

In other words, the heated debate over the Republican-generated ballot measure made Minnesotans more accepting of same-sex marriage, not less. In this way, the Republicans’ ban plan led to a legalization law. Go Law of Unintended Consequences!

Similarly, at the national level, the 70 times congressional Republicans tried and failed to repeal the Affordable Care Act (ACA)/Obamacare forced previously cowed and muted ACA supporters to finally explain the tremendous value of the ACA.  As a result of their pro-ACA advocacy during those 70 debates, an overwhelming two-thirds of Americans now support the preexisting conditions protections of the ACA.  Support for ACA repeal is now just 17%.

As with same-sex marriage in Minnesota, the once-unpopular ACA became quite popular, thanks to Republicans’ efforts to kill it.

With these LUC examples in mind, I’m hoping that the LUC might come to the rescue when it comes to Team Trump’s relentless efforts to delay his pending criminal trials. Through a series of legal maneuvers, Trump’s army of lawyers has been pushing out the start of trials, presumably so that verdicts and appeals can’t be finalized prior to the November 2024 election. 

U.S. News and World Report, March 15, 2024

The chances are good that Trump’s delay tactics will largely do exactly what they are intended to do, help him once again escape legal and electoral accountability. But maybe, just maybe, they could hurt him. Here’s how:

If Trump’s criminal trials were happening this winter or spring, as originally hoped, the damaging information spotlighted during the heavy coverage of the criminal trials could by November be largely forgotten by lightly engaged, easily distracted swing voters.  On issue after issue, we’ve seen that swing voters have the attention spans of gnats. The news they’re casually focused on today could easily get forgotten by the time they vote seven months from now.

But if Team Trump’s delay tactics cause the insurrection-related testimony to be dominating the news in early fall, that could make those issues much more top-of-mind for voters during the closing days of the campaign.

Imagine a September and/or October dominated by wall-to-wall news of insurrection trial coverage.  This coverage is constantly showing voters alarming images of Trump supporters assaulting police. Imagine swing voters seeing the mountain of evidence showing Trump doing nothing to stop the bloody assault and subsequently praising the rioters.  Imagine them hearing law enforcement officers and Trump’s most loyal supporters and staff giving damaging blockbuster testimony about the bloody chaos that Trump created, relished, and glorified.

Imagine that this is what swing voters are hearing in the immediate lead-up to the election, rather than Trump’s most effective criticisms of Biden about the economy and immigration. And all of this is coming to them via a judicial setting, which feels more weighty and credible to them than the 2022 congressional hearings.

Even though the verdict and appeals wouldn’t be completed by Election Day in this scenario, these are hardly the final images Trump’s campaign strategists want in undecided voters’ minds as they head to the ballot box.  If the trial timing worked out this way, the delay tactics could unwittingly keep the insurrection nightmare fresher in voters’ minds than would have been the case if the trials hadn’t been delayed and were happening now.

Again, this is a long shot. The more likely outcome is that Trump’s delay tactics will cause him to largely push his law-breaking out of voters’ minds until after the election.

But who knows, maybe we will have a little LUC.

5 New Year’s Resolutions for Liberals

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The 2020 elections are the most important elections of my lifetime, and potentially the most important in American history.  Will we replace the most corrupt, bigoted, and incompetent President of our times, and his shameless congressional enablers, or will we go further down the road to authoritarianism and corporatism?  That sounds melodramatic, but given what we’ve learned about Trump over the last three years, it’s not an exaggeration.

The stakes are high, so liberals need to step up their game. 

This isn’t about trashing liberals.  Liberals have done a lot of great things for America.  At a time when all of these things were quite unpopular, liberals had enough vision, courage, and commitment to pass Social Security, Medicare, Medicaid, the minimum wage, marriage equality, civil rights, voting rights, environmental protections, and the Affordable Care Act (ACA). 

But we grassroots liberals also can be also our own worst enemies.  To win in 2020, we need to make five New Years resolutions to do better than we did in 2016.

STOP THE PETTY, PERSONAL ATTACKS.  With hundreds of substantive reasons to criticize Trump and his lackeys, there is no reason to stoop to snotty attacks about personal issues like the President’s complexion, hair, waistline, hand size, penis size, verbal slips, and misspellings.  The same goes for personally insulting his supporters.

Among the moderate swing voters who will decide the outcome of this election, those kinds of personal shots inadvertently create sympathy for Trump and others who don’t deserve swing voters’ sympathy. I get that they are cathartic, and sometimes tongue-in-cheek.   But they’re also and self-defeating in the end, and therefore self-indulgent, so liberals need to get better at taking a pass on the personal shots.

STOP THE CANNABILISM.  Liberals also need to be mindful of Ronald Reagan’s 11th Commandment, “thou shall not speak ill of other Republicans.” 

I understand the temptation to wage civil war.  My top presidential candidate, Kamala Harris, has already dropped out of the race, and my second choice, Cory Booker, doesn’t look like he will last much beyond Iowa.  Having to go to Plan C is deeply disappointing to me. Having to go to Plan D, E, F, G, H, I, J, or K, a distinct possibility in a field this large, likely will be even more disappointing to me. 

In the end, I realize that I am unlikely to be in love with my Democratic Party nominee.  But if I can’t be with the one I love, honey, I’ll love the one I’m with. Unless we learn something dramatically scandalous about one of the Democratic candidates in the coming months, I’m pledging to myself that I won’t trash other Democratic candidates, vote for a third party candidate, or sit out the election.  For a long time, I’ve even been making monthly donations to the eventual nominee, whomever that ends up being, via the Unify or Die fund.  

All liberals should make a resolution to forgo intra-party cannibalism, because it greatly increases the chances that we have four even more catastrophic years with the most corrupt, bigoted, and incompetent President of our times.  That can’t happen, so we all have to suck it up and pledge to support the candidate that prevails in the nominating process.

STOP THE SHINY OBJECT CHASING.  We all know that President Trump is going to do and say hundreds of things before the election that are mock-worthy and outrageous, but probably are not issues that are going to sway swing voters or motivate non-voters.  Every moment we spend talking about those side issues –say, a funny golf story, a boneheaded gaffe, a stupid joke at a rally, a silly exchange with an athlete or celebrity–is a moment we’re not talking about issue differentiators that are more likely to influence voting decisions.

What Trump actions are more deserving of our focus? His giving lavish, deficit-spiking tax cuts to the wealthy. His separating young children from parents and caging them. His taking birth control and other types of reproductive health care away from women. His blocking legislation to control pharmaceutical prices. His cowardly refusal to cross the NRA to support common sense gun safety laws. His erratic Russian-friendly foreign policy decisions in dangerous places like Iran, Syria, the Ukraine, and North Korea. His repeated attempts to repeal Affordable Care Act protections, such as preexisting condition protections for 133 million Americans.

Polls show those kinds of issues work against Trump with swing voters and non-voters, so those kinds of issues should be the primary focus of conversations at the break room, bar, barbeque, or online chat. 

With such a steady stream of Trump’s outrages, it’s difficult to not take the bait from the ever-outrageous tweet stream. I’m far from perfect on this front.  But we liberals have to get better about focusing on the issues that matter the most to swing voters and non-voters, and that means shrugging off a lot of the side issues.

FOCUS ON ROOT CAUSES.  When deciding how to spend time and resources, liberals should also consider focusing on the root causes of Trump’s electoral success.   For instance, rather than only supporting individual candidates, consider supporting groups like Stacey Abrams’ Fair Fight 2020 and the ACLU. Those groups are battling Republicans’ relentless voter suppression efforts aimed at people of color, which threaten to swing close elections to Trump and his political toadies now and for decades to come. 

Ensuring that every vote counts and voting is easier will help progressive local, state and federal candidates up and down the ballot. It will help preserve our representative democracy for future generations. Supporting those groups isn’t as obvious to most of us as supporting parties and candidates, but it’s every bit as important.

SPEAK OUT EARLY AND OFTEN.  Speaking out against Trump and Republicans in person and on social media is frowned upon by Americans who are “non-political,” ignorant, and/or in denial about what is happening to America.  That can make speaking out about Trump unpleasant and exhausting.  Goodness knows, no one relishes being called, gasp, “political,” and being accosted by trolls. 

But in America today, we have politicians who are all too willing to separate brown-skinned kids from their parents and put them cages indefinitely.  We have politicians trying to repeal health protections for 133 million Americans. We have a party that gave a massive, deficit-ballooning tax gift to the wealthiest 1% at a time when we have the worst income inequality since 1928 and record deficits.  We have a President taking birth control and other reproductive rights away from women. If we don’t vote out this crew, we could easily have much worse developments on the horizon in a second, even more unhinged Trump term.  

All of which is to say one person’s “politics” is another person’s life, livelihood, and rights.  A while back, writer Naomi Shulman helped put this issue in proper perspective for me:

“Nice people made the best Nazis.  My mother was born in Munich in 1934, and spent her childhood in Nazi Germany surrounded by nice people who refused to make waves. When things got ugly, the people my mother lived alongside chose not to focus on “politics,” instead busying themselves with happier things. They were lovely, kind people who turned their heads as their neighbors were dragged away.”

I’m not saying liberals have be jerks and nags to their friends and relatives. We don’t have to be the turd in the punch bowl.  In most cases, we should be calm, respectful, factual and measured when we speak out, even when the respect isn’t deserved and returned, because that’s usually the best way to win hearts, minds, and votes. 

But we do have to speak out, because silence implies consent.  As Martin Luther King  famously said of another movement in another time:

“In the end, we will remember not the words of our enemies, but the silence of our friends.”  

The same is true of the movement to save America from Donald Trump and his Republican enablers.  I’m about as conflict averse as they come, but unfortunately that excuse just is not going to cut it with so many lives hanging in the balance.

So my fellow liberals, this New Years Eve raise a glass of your favorite truth serum, and make some challenging resolutions that nudge you outside of your comfort zone.  Your country needs you now more than ever.

Washington Passed A Public Option That is NOT a Model For Minnesota

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Give leaders in the state of Washington a lot of credit.  Governor Jay Inslee and the Washington Legislature recently passed legislation to create a public health insurance option that will save Washingtonians an estimated 5 percent to 10 percent compared to private health plans.   Starting in 2021, the privately administered “CascadeCare” plan will be available to Washingtonians in the “individual market,” those under age 65 who can’t get insurance through their employers or another public insurance plan.

That’s significant progress, much more progress than Minnesota Governor Walz and the Minnesota Legislature made during the 2019 session when they failed to even seriously consider a plan to give Minnesotans in the individual market the option of buying into MinnesotaCare.  President Trump and his followers are working overtime to sabotage and try to repeal popular Affordable Care Act (ACA) health protections, while Inslee is strengthening the ACA.

We need that kind of leadership in Minnesota.  In the 2020 session, champions of the popular MinnesotaCare buy-in option should hold critics accountable for trying to block an initiative that could save consumers at least 10 percent of their health insurance costs. 

The Fatal Flaw With Washington’s Law

I say “at least 10 percent,” because Washington leaders caved to medical lobbyists in order to get the law enacted. In the process, they sacrificed significant consumer cost-savings.

One of the primary reasons to give consumers a public option is because public health insurance programs with a huge pool of patients are in a relatively strong position to leverage lower medical costs.  You know, like Medicare does. Here’s what a recent Urban Institute study found about Medicare’s ability to control medical costs.

 “…average spending on private health insurance per enrollee grew 4.4% per year between 2006 and 2017—faster than the growth of spending per enrollee in Medicaid and Medicare, and faster than the growth of the gross domestic product per capita, which grew an average 2.4% each year.

Per-enrollee spending in Medicare grew an average 2.4% per year while per-enrollee spending in Medicaid grew 1.6% each year. Holahan said Medicare and Medicaid experienced slower spending growth than private insurance because public programs have more leverage over provider payment rates, helping them to keep costs down. Private payers end up paying higher hospital and physician prices.”

In the face of such findings, what do Washington leaders do?  They guarantee reimbursements at a rate that is much higher than Medicare.  The Seattle Times explains:

The (Washington) law will require health plans to reimburse medical providers and facilities at up to 160% of the federal Medicare rate. That is a higher rate than the original version of the bill, which capped the reimbursement at the Medicare rate.

CascadeCare champions had it right in their original bill.  The reimbursement rate for the MinnesotaCare buy-in option should be set at the Medicare rate to allow savings to be passed on to Minnesotans.  Washington leaders apparently were spooked by lobbyist threats that caregivers would deny care to patients if they got paid Medicare reimbursement rates.

Physicians Can’t Be Sacred Cows

We will never be able to significantly control health care costs until we demand savings from every part of the healthcare system — pharmaceuticals, medical devices, unnecessary procedures, administrative overhead, and, yes, caregiver reimbursements.  American physicians, particularly specialists, are being paid more than physicians around the world, so controlling that cost-driver also must be in the mix.  American doctors can no longer be treated like political sacred cows.

As long as lobbyist-cowed legislators keep carving out these kinds of special interest exceptions, medical inflation will continue to skyrocket and keep Americans from accessing health care.  Minnesota legislators need to pass the MinnesotaCare buy-in option in 2020, and they should do it without caving to any of the interests driving medical costs making health care unaffordable and inaccessible for millions.

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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. 

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.

Farewell Mark Dayton, The Un-Politician

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As we count down Mark Dayton’s final days as Governor of Minnesota, it’s worth reflecting on one of the more peculiar figures in recent Minnesota political history.

If mad political scientists had set out to create the perfect politician, rest assured it would look nothing like Mark Dayton.

In a profession where optimism sells, Governor Eeyore came across as perpetually gloomy.

In a job where gregariousness and charm are needed to build winning coalitions, Dayton wasn’t very willing or able to glad-hand with legislators or other power brokers.

In a business where glibness is an invaluable asset, Dayton was often difficult to understand and unpersuasive in his speaking style. (Some of this may have been due to an underlying health issue, but the political challenge remains.)

In a grueling endeavor where energy and stamina are needed, Dayton’s chronic health issues have slowed him in his job and on the campaign trail.

And in a job where charisma often wins converts, Dayton possessed all the charisma of a lump of lutefisk.

Poor Governor Dayton. He lacks the hard-wired optimism of Hubert Humphrey, charm of Tim Pawlenty, glibness of Norm Coleman, energy of Paul Wellstone and charisma of all of the above.

But somehow, some way, Mark Dayton became a successful Governor.

He raised taxes on the wealthiest Minnesotans and increased the minimum wage without crashing the economy, as his conservative critics had promised would happen.

He expanded Medicaid and faithfully implemented the Affordable Care Act (ACA), which led to Minnesota having the best rate of health insurance coverage in state history, and one of the best in the nation.

He paid back millions that Pawlenty had borrowed from schools, and increased investments in them.

He refused to use the budget gimmicks Pawlenty employed to avoid tough choices, which helped end Minnesota’s long run of budget shortfalls, and allow Minnesota to earn a coveted AAA bond rating, which will save taxpayers millions in future years.

While implementing these progressive policies, Minnesota’s economy has boomed, outperforming the national economy and the economy that conservative Governor Scott Walker built in neighboring Wisconsin.

It also should be noted that Dayton’s family inheritance made it possible for him to self-fund his rise to political power. Ordinary people with Dayton’s political disabilities could not have achieved what Dayton did in his career.  That’s a problem for our democracy.

But the fact remains, Dayton achieved all of this without a lot of political talent. He mostly accomplished those things due to his decency, candor, policymaking expertise, disciplined focus, and commitment to doing the right thing for vulnerable Minnesotans and our common good.

In the end, I’d take those things over all the optimism, glibness, gregariousness, energy, stamina and charisma in the world. Somehow, Dayton the un-politician made it work.

If You Like TrumpCare, You’ll Love JohnsonCare

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Minnesota gubernatorial candidate Jeff Johnson (R-Plymouth) is crying foul over an Alliance for Better Minnesota television ad that says Johnson’s health care proposals would take health care away from Minnesotans who need it.

But the Alliance’s ad is accurate. Without question, the health care “reform” approach candidate Johnson is promoting during his campaign would take health care away from Minnesotans who need it.

Let’s break down the proposed JohnsonCare plan, piece-by-piece.

Johnson Eliminating ACA Protections

Johnson wants to make the Affordable Care Act (ACA) a thing of the past in Minnesota, via a federal waiver granted by the Trump Administration. More specifically, Johnson wants to eliminate the ACA approach that has:

  • Protected Record Numbers of Minnesotans. Under the ACA framework, Minnesota achieved the highest rate of health care coverage in state history.
  • Made Previously Unaffordable Protections Affordable. For lower and middle-income Minnesotans who don’t get coverage through their employer, the ACA has provided hundreds of millions in financial assistance to reduce or eliminate premium costs.
  • Strengthened Minnesotans’ Protections. The ACA also banned the hated preexisting condition denials, insurance payment limits, and dangerous junk coverage.  Because fewer Americans are no longer living one illness or injury away from being crushed by a mountain of bankrupting medical bills, personal bankruptcies have decreased by 50 percent during the time the ACA has existed.

If Johnson eliminates the increasingly popular ACA protections in Minnesota, that all goes away.  So yes, in several different and dramatic ways, Johnson absolutely would take health care away from Minnesotans who need it. The ad is correct about that.

Johnson’s False Claims

Johnson’s criticism of his opponent’s health care proposal is also utterly ridiculous.  Johnson says claims opponent Tim Walz “wants to eliminate private health insurance and force all Minnesotans onto one government program.”

The reality is, Walz supports a MinnesotaCare buy-in option. Under that approach, Minnesotans would have the option of either buying private plans or buying into the MinnesotaCare program, which is a government program operated by private health insurance programs.

In other words, Johnson’s claims that Walz wants to “eliminate private health insurance” and “force all Minnesotans onto one government program” are flat wrong.

If Walz is proposing a government-run single payer plan in the short-term, I’m not aware of it. Even if that were true, Johnson’s inference that eliminating private insurance in favor of government run health care would hurt Minnesotans is also wrong.  After all, Medicare, a government-run health plan, is popular and effective.  Medicare is helping Minnesotans, not hurting them.

Moreover, government run health plans are used in many other developed nations. Compared to the United States, consumers in those nations have 1) universal comprehensive coverage, 2) lower overall health costs and 3)  better overall health outcomes.

JohnsonCare and TrumpCare

Instead of the ACA, Johnson wants to back a high risk pool program that was very expensive for both consumers and taxpayers when it was used pre-ACA. Minnesota Public Radio reported:

Craig Britton of Plymouth, Minn., once had a plan through the state’s high-risk pool. It cost him $18,000 a year in premiums.

Britton was forced to buy the expensive MCHA coverage because of a pancreatitis diagnosis. He calls the idea that high-risk pools are good for consumers “a lot of baloney.”

“That is catastrophic cost,” Britton says. “You have to have a good living just to pay for insurance.”

And that’s the problem with high-risk pools, says Stefan Gildemeister, an economist with Minnesota’s health department.

“It’s not cheap coverage to the individual, and it’s not cheap coverage to the system,” Gildemeister says.

MCHA’s monthly premiums cost policy holders 25 percent more than conventional coverage, Gildemeister points out, and that left many people uninsured in Minnesota.

Johnson also wants to promote “junk,” “short-term,” or “skinny” plans, which are cheap because they don’t cover basic protections.  Promoting junk plans to reduce health care costs is like promoting cheaper cars lacking seat belts, airbags, crumple zones, safety glass, and anti-lock brakes. They look good if you’re only considering the price tag, but they’re a disaster when you and your family are in dangerous situations and desperately need those life-saving protections.

On health care, as with so most other issues, Jeff Johnson is aping Trump. President Trump is obsessed with eliminating Americans’ ACA protections in favor of a skimpy TrumpCare replacement. Trump insists that TrumpCare will cover everyone and cut costs, while the nonpartisan Congressional Budget Office finds that 23 million Americans would lose their protections, and millions more would pay higher premiums.

So Minnesotans, if you like TrumpCare – and only 17% of Americans do – you’re going to love JohnsonCare.

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.

Improving Minneota’s Health Insurance Market With A “MinnesotaCare for All” Option

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For Minnesotans who can’t get health insurance from an employer, Minnesota Republican legislators have been demanding improvements.

where-mn-get-insurance-donut-graphic-254x300_jpg__254×300_Out on the campaign stump, Republicans say they want more health plan options than are currently available. They want health insurance companies to feel more competitive pressure to keep a lid on premiums. They want consumers to have a broad network of health care providers available to them. They want assurances that there will always be at least one solid coverage option available to every Minnesotan, even when health insurance companies decide to pull out of the marketplace, as they have in recent years. Those are all good goals.

To achieve them, Republican state legislators should work with Governor Dayton to give Minnesotans a MinnesotaCare for All option.

Background

Currently in Minnesota, those who can’t get health insurance from an employer can get coverage from one of three sources:

  • TOP TIER. For Minnesotans who can afford premium costs, they can purchase coverage from nonprofit health plans – UCare, HealthPartners, Medica, and Blue Cross. (As part of the federal Affordable Care Act, about 60% of those buying from these companies through the MNsure online shopping tool are offsetting premium costs with federal tax credits, which this year are averaging over $7600 per year.)
  • MIDDLE TIER. For Minnesotans who can afford some, but not all, of the premium cost, they can purchase MinnesotaCare at a subsidized rate that varies depending on household income.
  • LOWER TIER. For the poorest Minnesotans who can’t afford any of the premium cost, they can get Medical Assistance at no cost to them. Medical Assistance is Minnesota’s version of the federal Medicaid program.

MinnesotaCare for All Option

Governor Dayton proposes to give those in the top tier an additional option.  He wants to give those consumers the option of buying into that middle tier — the public MinnesotaCare program.

Adding a MinnesotaCare for All option would achieve what Republicans say they want – more options for consumers, more marketplace competition to drive down prices, a guarantee that at least one plan option will always be available to Minnesotans, and consumer access to a broad network of Minnesota health care providers statewide.

A fact sheet from the Governor’s office elaborates on the consumer benefit:

Purchasing quality health coverage through MinnesotaCare is less expensive than buying coverage directly from a private insurer, because it leverages the buying power of more than 1 million Minnesotans enrolled in public plans.

Minnesotans who purchase MinnesotaCare would get high-quality health coverage for approximately $469 per month, on average. That is more than 12 percent ($69) less than the average statewide premium of $538 for private insurance in 2017.

Under the Governor’s proposal, families would spend on average $838 per person less in 2018 than in 2017 on their health insurance premiums.

After a one-time startup investment ($12 million), the cost of Governor Dayton’s plan would be funded entirely by the premiums of Minnesotans who choose to buy MinnesotaCare coverage. If the Legislature enacted this proposal by April 1, Minnesotans could purchase MinnesotaCare coverage as early as the 2018 open enrollment period.

Having this MinnesotaCare option would likely be very popular with Minnesotans.  After all, a national poll found that an overwhelming 71 percent of Americans support a similar Medicare for All option, while only 13 percent oppose the idea.

Let Consumers Choose

Why would Republicans not want this for Minnesota consumers? If the Governor’s claims about the MinnesotaCare option turn out to be accurate, many of the Republicans’ stated goals for the individual market would be achieved.

At the same time, if the Governor’s MinnesotaCare-related claims about lower prices and better health care network turn out to be inaccurate or inflated, Minnesotans will surely reject the MinnesotaCare option. If it is to their advantage, consumers will choose a nonprofit health insurance company, or a for-profit health maintenance organization (HMO), which the Governor recently agreed to authorize as part of a compromise with Republican legislators.

With the addition of the MinnesotaCare option, private, nonprofit and public options all would be available to Minnesotans who are shopping and comparing via MNsure. Then the politicians could get out of the way, and let the consumers choose the option that works best for them.

Trump Resistance Roadmap

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For progressives aiming to win the hearts and minds of the 46% of American voters who supported Donald Trump in 2016, there is a  better and worse way to approach conversations and campaigns.

Slide1

For messages about the Trump policy agenda, the villain needs to be Trump flip-flops, not Trump voters.  The focus needs to be on Trump not keeping his 2016 promises, not on Trump voters being stupid for being conned in 2016.

Trump voters need a face-saving way out of this, so avoiding polarizing “I told you so’s” is critically important.

Much of what I currently see on social media and progressive media is using the “Trump voters are dumb” approach to messaging.  We need to stop.  Believe me, I understand why people are going there.  It’s very cathartic to say “I told you so,” but you can feel it entrenching Trump voters more deeply and permanently into Team Trump.

The messaging nuance recommended in this chart won’t win every Trump voter, but it gives progressives a more hopeful shot at winning a modest subset of them, such as voters who were more anti-Clinton than pro-Trump.  If only a small slice of the 46% of 2016 Trump voters are angry at Trump congressional allies in 2018, the mid-term elections could deal a serious blow to the Trump agenda.  Winning in 2018 is worth taking a pass on cathartic “I told you so’s” over the next two years.

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.

The Wrong Bernexit

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So you, like me, voted for Senator Bernie Sanders for President. Now maybe you’re considering switching allegiances to the Libertarian presidential candidate, Governor Gary Johnson?

I respect your decision to shop around and do thoughtful research.  Here’s something to inform your decision.

Gary Johnson Bernie Sanders positions table2

(Source for Sanders positions here.  Source for Johnson positions here.  Source for estimate of Sanders spending increase total here.)

Yes, Governor Johnson would do some very smart and important things, such as scale back the war on drugs and be careful about entering military quagmires. But most of the centerpiece policies championed by Senator Sanders are vehemently opposed by Governor Johnson.

Ten Questions You Won’t Hear Asked By Intimidated Political Reporters

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With all of the horse race and insult-related content in the GOP presidential debates, there is a huge opportunity cost: A lot of substantive questions simply are going unasked.

Megyn_Kelly_bimboMaybe that’s because reporters are worried bullying candidates will give them the Megyn Kelly Treatment/Rebecca Quick Treatment. Maybe it’s because reporters don’t take the time to learn policy issues. Maybe it’s because reporters don’t respect voters’ intelligence enough to think that they will care about, or understand, policy issues

Whatever the reason, the most consequential questions simply aren’t being posed, and the result on the Republican side is the most vapid set of presidential debates of my lifetime. Here just a few of the questions that I would love to hear asked at the upcoming Republican debate:

  • PAYING FOR TAX CUTS FOR WEALTHY? Which Americans’ services are you going to cut or eliminate to pay for your proposed tax cuts, which go disproportionately to the wealthiest Americans?
  • PAYING FOR PENTAGON SPENDING SPREE? You claim President Obama has destroyed the military, despite the fact military spending is at historically high levels, and is 23% higher than under President Reagan.  But if you do want to further beef up the military, which specific Pentagon spending programs will you increase, how much will that cost and what service cuts and/or tax increases will you offer to pay for that large increase in spending?
  • BUSHONOMICS AGAIN? President George W. Bush’s tax cuts on the wealthy didn’t lead to economic growth and deficit reduction, yet your tax proposal is remarkably similar to the Bushonomics that didn’t turn out so well for Americans. Why do you think that approach will lead to a booming economy if it didn’t turn out that way under the last Republican president?
  • CAP-AND-TRADE. One solution for reducing greenhouse emissions is the cap-and-trade approach. The last three Republican Presidents, including conservative icon Ronald Reagan, embraced this market-based approach. But suddenly Republicans now oppose the cap-and-trade approach to protecting the environment. Has cap-and-trade changed since President Reagan, or has the oil industry’s control of Republican leaders gotten that much stronger?
  • ELIMINATE OIL COMPANY SUBSIDIES? Given that you oppose subsidizing alternative energy sources, and government spending in general, would you support eliminating the $4.8 Billion in subsidies the petroleum industry is given every year? If not, why give an unfair competitive advantage to dirty, non-renewable, and foreign sources of energy over cleaner, renewable, American-based sources?
  • MAKING BANKS SMALL ENOUGH TO FAIL? The largest banks in America are now actually even larger than they were in 2008, when leaders judged them to be too big to fail.  Will you break up the nation’s largest financial institutions so that they are no longer “too big to fail?” If not, aren’t you leaving American taxpayers wide open to another crippling bailout?
  • DETAILS ON DEPORTATION. Explain specifically how you would deport 11.2 million undocumented immigrants, an amount roughly equivalent to the population of the State of Ohio? For example, how would you pry 11 million people away from their lives and families, and get them onto trains or buses? Would you use the military, National Guard or police? How would you pay the estimated $400-600 Billion cost of deporting 11.2 million people?
  • VETERANS VOTING RECORD. You all talk a lot about needing to honor and help military veterans. But if you all love veterans so much, why do groups like the Disabled American Veterans of America (DAV) rate your voting records so low. For instance, the DAV says Senator Rubio and Senator Cruz supported veterans 0% of the time in their most recent rating of them, while Senator Sanders supported veterans 100% of the time and Senator Clinton supported them 80% of the time.   Don’t legislative actions speak louder than your words?
  • DEFICIT SPENDING FOR WARS? Your comments on foreign policy indicate that you are inclined to send American troops to another armed conflict in the Middle East. If you do, will you increase taxes to pay for those operations, or will you fund the conflict with deficit spending, as the last Republican President did? If you’d run up the deficit with trillions of dollars of war spending, how can you claim to be a fiscal conservative?
  • AFFORDABLE CARE ACT (ACA) ALTERNATIVE? What’s your specific plan for replacing the Affordable Care Act? No, really, it’s been six years since the ACA passed, so this time you are not going to get away with dodging the question. If you still can’t name an alternative you support, isn’t it fair to assume that the claimed “repeal-and-replace” rhetoric is actually just “repeal,” which would lead to 1) about 15 million Americans losing their coverage and 2) another 65 million losing their ACA protection from discrimination due to a pre-existing condition?

Oh, and here is one over-arching question I’d like them to add. “For every tax cut or spending increase you didn’t know the cost of today, will you pledge to the American people that you will disclose the estimated fiscal impact within the next month? If not, why won’t you shoot it straight to the voters.”

There are dozens of other questions that need to be asked by reporters, but this would be a very helpful start. Yes, such questioning will cause reporters to get booed, heckled and bullied by the candidates and their cheering sections. But frankly that happens even when they ask softball questions, so what exactly do they have to lose?

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.

“Trump Wave” Is Only In A Very Small Pond, Except When It Comes To The Issue of Terrorism

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Cursor_and_trump_supporters_-_Google_SearchWatching the news coverage of the Republican presidential campaign, you get the feeling that there is a wave of support for the ideas of leading Republican candidates like Donald Trump, Ben Carson, Ted Cruz and Marco Rubio. For example, Talking Points Memo recently reported:

GOP Campaign Official to Senate Candidates: Ride That Trump Wave

The Republican Party is preparing Senate candidates for the very real possibility that Donald Trump could be the party’s presidential nominee.

According to a seven-page memo obtained by the Washington Post, National Republican Senatorial Committee Executive Director Ward Baker is encouraging Senate candidates to understand Trumpmentum, use it to their advantage, and then ignore Trump’s most bombastic positions.

But is there really a national wave in support of the positions of Trump and the other extremely conservative contenders? Remember, only about one-third of the general election electorate votes in Republican primaries, so even front runner Trump is only winning about 31% of one-third the overall electorate. So, yes, Trump is riding a wave of sorts, but it is still a relatively modest wave on a relatively small pond.

Ideological Wave?

So, in the midst of all of this Republican primary coverage, it’s important to keep an eye on what the nation as a whole — as opposed to the narrow slide of Republican primary voters — thinks of the positions of the Republican contenders. Public opinion surveys show that there is no wave of support for most of their extremely conservative positions.

  • Americans oppose deportation of undocumented immigrants. While bombast about mass deportation of immigrants fueled Trump’s rise to the top of the Republican heap, Gallup finds that only 14% of Americans support deporting all undocumented immigrants to their home country. Among the Independent voters Republicans need to persuade in order to win in November, only 19% support such deportation.  In the general election, this position is a liability, not an asset.
  • Americans oppose repealing the Affordable Care Act (ACA). Every major Republican candidate wants to repeal the ACA, and primary voters love them for it.  But among all Americans, a November 2015 Kaiser survey finds that 42% either want to expand the ACA (26%) or keep it as is (16%), while only 30% support the Republicans candidates’ repeal position.
  • Americans oppose tax cuts for the wealthy and corporations. Every major candidate’s tax proposal dramatically cuts taxes for the wealthiest Americans and corporations. But an April 2015 Gallup survey finds that 62% of Americans say that upper income people pay too little in taxes, not too much. The same survey found that 69% of Americans think that corporations are paying too little in taxes.  Americans want to increase taxes on the wealth and corporations, while Trump, Carson, Cruz and Rubio all want to cut them.  Again, in the general election, this position will be a leg iron for the Republican nominee.
  • Americans want stricter gun control laws. Every major Republican candidate opposes stricter gun control laws, a wildly popular position at Republican rallies. But an August 2015 Pew survey finds that Americans actually overwhelming support a wide range of stricter gun control laws. For instance, there is huge support for background checks for gun shows and private sales (85% support), laws to prevent the mentally ill from obtaining guns (79% support), a federal database to track gun sales (70% support), and a ban on assault-style weapons (57% support).

So for the most part, the Republican candidates’ ideas are extremely unpopular with the Americans who will pick the next President less than a year from now.

The Anti-Democratic Wave

But there is one major exception to this trend, and it’s a very significant one.  According to a November 2015 ABC News/Washington Post poll, battling terrorism is currently the second most important issue to Americans.  It ranks just behind the economy, and ahead of health care, immigration and tax policy. On that issue, a majority of Americans are much more aligned with Trump, Carson, Cruz and Rubio than they are with Clinton and Sanders.

  • Americans want military intervention to counter terrorism. In the direct aftermath of the Paris terrorist assaults, an NBC News poll finds that 65% of Americans want to send troops to fight ISIS in Iraq and Syria. Also, 58% believe that “overwhelming military force is the way to defeat terrorism,” while only 38% believe that “too much military force creates hatred that only leads to more terrorism.” Similarly, Democrats have a losing position when it comes to Syrian refugees, with 56% of Americans opposed to increasing the number of Syrian refugees in the nation.

Public_Attitudes_Toward_the_War_in_Iraq__2003-2008___Pew_Research_CenterIn other words, the national mood is much like  when America rushed into the Iraq War in 2003.  Pew found that public support for that military action was 72% in 2003, but ultimately decreased to 38% by the end of the war.

While Vice President Dick Cheney estimated that war would cost about $80 billion and end quickly, the last Iraq War lasted seven years and the nonpartisan Congressional Budget Office says it cost about $1.9 trillion, or about $6,500 per American.  The human toll for America was also high – 4,487 American troops died and at least another 32,226 were seriously wounded.  Still, almost three-fourths of Americans are ready to do it all over again.

Overall, this notion of a Trump wave is not supported by public opinion data. Americans are not buying most of what Trump and the other Republican contenders are selling. But if the election becomes dominated by the need to combat terrorism with military interventions, such as if there are a steady stream of ISIS attacks, Democrats could be in big trouble.

Dirty Job Dayton Dusts Himself Off

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Dayton_dirty_2Governor Mark Dayton is Minnesota’s political version of Mike Rowe, the star of the Discovery Channel television show “Dirty Jobs.” Rowe’s show is all about him taking on difficult, disrespected and grotesque jobs that others avoid, such as being a sewer inspector, road kill scavenger, worm dung farmer, shark repellent tester, maggot farmer, and sea lamprey exterminator.  Who knew that worm dung needed farming?

Dirty Job Dayton

Governor Mark Dayton may not be farming worm dung, but consider just a few of the filthy tasks Dirty Job Dayton has already embraced in his five year’s in office.

Taxing Most Powerful Minnesotans.  Before Dayton, non-partisan analyses were showing that the wealthiest Minnesotans were not paying their fair share of taxes.  So Dayton ran for Governor unabashedly championing tax increases on the state’s most wealthy citizens, which earned him some very powerful enemies. At the time, progressive political consultants considered advocating almost any kind of tax increase political suicide for candidates. But Dayton ran on a platform of large tax increases, won a razar thin victory at the polls, and then promptly passed the tax increases into law as promised.

Implementing Unpopular Obamacare.  Dayton wasn’t done there. One of his very first acts of Governor was to champion Obamacare, which many politicians were extremely nervous about at the time. In contrast to his fellow Governors in neighboring Wisconsin, Iowa and South Dakota, Dayton embraced Obamacare’s Medicare expansion to cover 35,000 of the most vulnerable Minnesotans.   The Governor had Obamacare protesters shouting him down in his announcement news conference, but he let them have their say and stuck to his principles without looking back.  As a result of taking on a number of controversial Obamacare implementation tasks, Minnesota now has the second best rate of health insurance coverage of any state (95%).

Resolving Vikings Stadium Quagmire.  Then there was the Vikings Stadium debate that had been festering for almost a decade before Dayton came to office. Despite polls showing that subsidizing the stadium was unpopular, Dayton provided active backing for legislation to publicly subsidize the Vikings Stadium.  While noting that he is “not one to defend the economics of the NFL,” he plugged his nose and embraced a job he didn’t welcome, but felt was necessary to keep the Vikings in Minnesota and boost a then-suffering construction sector.

Cutting Coveted Social Safety Net.  Early in Dayton’s tenure as Governor, he even made significant cuts in state safety net programs, which is one of the very worst jobs any progressive can ever get.  Faced with a large budget shortfall, he proposed cutting $950 million in planned spending, told agencies to cut their budgets by up to 10 percent, and cut the state workforce by 6 percent.  That work had to leave even Dirty Job Dayton feeing grimy.

Love these positions or hate them — and Dayton himself didn’t relish many of them — no one can accuse Dayton of political timidity.

Dirtiest Job Yet

But this winter, Dirty Job Dayton finally met his Waterloo. With no political allies in sight, he attempted to push through salary increases for state agency commissioners, who are making less than their peers in many other states.   Dayton said he “knew there would be negative reaction,” but, as is his habit, he plugged his nose and pushed forward anyway.

How did that go for him?  Well, in the last few weeks Dayton learned that attempting to raise bureaucrats’ pay makes shark repellent testing look like a walk in the park.

Fresh off that experience, one might expect that Dayton would now stick to clean, safe, and easy jobs for the remainder of his time in office.  But if you believe that, you obviously don’t know Dirty Job Dayton very well.

Next Up:  Slinging Asphalt

After the salary increase shellacking Dayton endured, he has already found a new thankless task to champion – fixing Minnesota’s deteriorating roads and bridges.  While Republicans want a modest short-term fix funded out of the current budget surplus, that would be much too easy for Dirty Job Dayton. Dayton is attempting to put in place an ambitious decade-long $11 billion solution. Such a long-term fix necessitates a 16 cent per gallon (at current prices) increase in the gas tax. Not surprisingly, the polls are looking a little rough at the moment.

But Dirty Job Dayton doesn’t care. Like Mike Rowe, if the assignment stinks, scares, or stings, he’s in!

Americans Support An Actual “Government Takeover of Health Care,” And I Don’t Mean Obamacare

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Government_takeover_of_health_careOn the heels of the closing of the second year of open enrollment for Obamacare coverage, expect to hear a lot of “government takeover of health care” ranting from conservatives.

That phrase is heavily used by anti-Obamacare zealots, and that is no accident.  In 2009, Republican political consultant and celebrated wordsmith Frank Luntz advised his conservative clients to portray the proposed Affordable Care Act, also known as Obamacare, as “a government takeover of health care.”

Conservatives did as they were told. If you Google those words, you’ll see that the usage of that phrase, and close variations, has been widespread among conservatives ever since.

In a 28-page strategy memo, Luntz explained why stressing a Washington “takeover” was so important:

“Takeovers are like coups.  They both lead to dictators and a loss of freedom.”

In other words, the Affordable Care Act shouldn’t be talked about as it were a legislative proposal in a representative democracy.  Instead, it should be talked about as if it were a Stalin-esque freedom grab.

There are two problems with conservatives parroting the Luntz-recommended phrase “government takeover of health care” to make Americans fearful about health care reform: First, It’s demonstrably false.  Second, It doesn’t scare most Americans.

False.  I’m not going to go into detail about why it is false, because it’s pretty self-evident.  But suffice it to say that ‘government takeover of health care” as a descriptor for the Affordable Care Act was named by the non-partisan editors of Politifact as their 2010 “Lie of the Year.”   In a lie-intensive election year, “government takeover of healthcare” was named by both editors and readers as the Pants on Fire of all Pants’s on Fire.  Politifact notes the obvious:

“It is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers.

It’s true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.”

Not Scary.  But beyond being false, the more surprising thing to me is that “government takeover of health care” is not all that scary to a  majority of Americans.

While Obamacare is not remotely close to a government takeover of health care, putting Americans into the government-run Medicare program would be exactly that.  And you know what? Most Americans are just fine with even that level of government takeover of health care.

Medicare_for_All

A January 2015 GBA Strategies survey asked Americans if they support enactment of “a national health plan in which all Americans would get their insurance through an expanded, universal form of Medicare.” By a 15-point margin, a majority of Americans (51% support, 36% oppose) supported that kind of government takeover of health care.

The same survey then asked Americans about giving people the option of having government take over their health care.   Specifically, the survey asked if respondents would support giving “all Americans the choice of buying health insurance through Medicare or private insurers, which would provide competition for insurance companies and more options for consumers.” An amazing 71% of Americans support having the option of a government takeover their health care, including 63% of Republican respondents.

So it turns out that, after six years of intensive Luntz-led vilification of “government takeover of health care,” backed by hundreds of millions of dollars of political advertising and public relations efforts, there are very few issues in America today with as much public support as there is for the federal government taking over American health care.

– Loveland

Note:  This post was republished on MinnPost.