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.
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.
Among political reporters and pundits, the fashionable take on Democratic presidential candidates is that they’re recklessly veering too far to the left, consequently putting their chances of defeating Donald Trump at risk. That critique is all the rage.
“But the Democrats are in danger of marching so far left that they go over a cliff. That’s not just my view. Mainstream reporters, who tend to be less sensitive to liberal positions that match their personal views, are openly acknowledging and debating the dramatic shift. It was even on the front page of The New York Times.”
“The Democratic debates this past week provided the clearest evidence yet that many of the leading presidential candidates are breaking with the incremental politics of the Clinton and Obama eras, and are embracing sweeping liberal policy changes on some of the most charged public issues in American life, even at the risk of political backlash. But with moderate Democrats repeatedly drowned out or on the defensive in the debates, the sprint to the left has deeply unnerved establishment Democrats, who have largely picked the party nominees in recent decades.”
“That sound you heard in Miami on Wednesday evening? El partido demócrata dando un fuerte giro a la izquierda. The screech of a Democratic Party swerving hard to the left. As the first 2020 Democratic debate wrapped here, there was a palpable sense that the 10 contenders on stage were reflecting the sentiments of the most liberal corners of the party.”
Yes, Democrats are more liberal than they have been in my lifetime. Yes, it’s possible that they could eventually go too far. But I disagree with the punditosphere that Democrats have hit that point.
Why Moving Left?
The explanation of aghast pundits has been that Democrats are supporting progressive policies for two primary reasons:
Echo Chamber Parrots. First, they argue that Democrats are more liberal because they spend too much time in self-reinforcing “echo chambers” — social media and cable news channels where like-minded ideologues radicalize each other and get isolated from opposing viewpoints. Pundits say candidates spend too little time in the habitat of “real people,” which they usually identify as Mayberry-esque Main Street cafes.
Liberal Bidding War. Also, pundits explain that Democrats are now more liberal because they’re desperately trying to out-liberal each other to court ultra-liberal primary and caucus voters.
These are both very real occupational hazards for politicians, and valid contributory factors for the shift to the left. I don’t disagree with them, but they’re not the only explanations.
Democrats Are Listening To Americans
Many reporters and pundits are missing or under-emphasizing another explanation that is at least as important,:
Listening To Americans. Democrats are moving left because they are actually listening to Americans.
Democrats are not just marching in lockstep with Rachel Maddow, Moveon.org, Daily Kos, Paul Krugman, and Bernie Sanders. They’re not just trying to one-up each other. They’re also reading the survey research.
The American Prospect recently compiled a long list of recent survey polls showing overwhelming majorities of Americans embracing a broad range of progressive attitudes and policies, excerpted below. Remember, the following is dozens of independent statistically significant surveys speaking, not the liberal American Prospect magazine speaking:
The Economy
82 percent of Americans think wealthy people have too much power and influence in Washington.
78 percent of likely voters support stronger rules and enforcement on the financial industry.
Inequality
82 percent of Americans think economic inequality is a “very big” (48 percent) or “moderately big” (34 percent) problem. Even 69 percent of Republicans share this view.
66 percent of Americans think money and wealth should be distributed more evenly.
72 percent of Americans say it is “extremely” or “very” important, and 23 percent say it is “somewhat important,” to reduce poverty.
59 percent of registered voters—and 51 percent of Republicans—favor raising the maximum amount that low-wage workers can make and still be eligible for the Earned Income Tax Credit, from $14,820 to $18,000.
Taxes
76 percent believe the wealthiest Americans should pay higher taxes.
60 percent of registered voters believe corporations pay too little in taxes.
87 percent of Americans say it is critical to preserve Social Security, even if it means increasing Social Security taxes paid by wealthy Americans.
67 percent of Americans support lifting the cap to require higher-income workers to pay Social Security taxes on all of their wages.
Minimum Wage
54 percent of registered voters favored a $15 minimum wage.
63 percent of registered voters think the minimum wage should be adjusted each year by the rate of inflation.
Workers’ Rights
74 percent of registered voters—including 71 percent of Republicans—support requiring employers to offer paid parental and medical leave.
78 percent of likely voters favor establishing a national fund that offers all workers 12 weeks of paid family and medical leave.
Health Care
60 percent of Americans believe “it is the federal government’s responsibility to make sure all Americans have healthcare coverage.”
60 percent of registered voters favor “expanding Medicare to provide health insurance to every American.”
64 percent of registered voters favor their state accepting the Obamacare plan for expanding Medicaid in their state.
Education
63 percent of registered voters—including 47 percent of Republicans—of Americans favor making four-year public colleges and universities tuition-free.
59 percent of Americans favor free early-childhood education.
Climate Change and the Environment
76 percent of voters are “very concerned” or “somewhat concerned” about climate change.
68 percent of voters think it is possible to protect the environment and protect jobs.
59 percent of voters say more needs to be done to address climate change.
Gun Safety
84 percent of Americans support requiring background checks for all gun buyers.
77 percent of gun owners support requiring background checks for all gun buyers.
Criminal Justice
60 percent of Americans believe the recent killings of black men by police are part of a broader pattern of how police treat black Americans (compared with 39 percent who believe they are isolated incidents).
Immigration
68 percent of Americans—including 48 percent of Republicans—believe the country’s openness to people from around the world “is essential to who we are as a nation.” Just 29 percent say that “if America is too open to people from all over the world, we risk losing our identity as a nation.”
65 percent of Americans—including 42 percent of Republicans—say immigrants strengthen the country “because of their hard work and talents.” Just 26 percent say immigrants are a burden “because they take our jobs, housing and health care.”
64 percent of Americans think an increasing number of people from different races, ethnic groups, and nationalities makes the country a better place to live. Only 5 percent say it makes the United States a worse place to live, and 29 percent say it makes no difference.
76 percent of registered voters—including 69 percent of Republicans—support allowing undocumented immigrants brought to the country as children (Dreamers) to stay in the country. Only 15 percent think they should be removed or deported from the country.
Abortion and Women’s Health
58 percent of Americans believe that abortion should be legal in all or most cases.
68 percent of Americans—including 54 percent of Republicans—support the requirement for private health insurance plans to cover the full cost of birth control.
Same-Sex Marriage
62 percent of Americans—including 70 percent of independents and 40 percent of Republicans—support same-sex marriage.
For people who suffered through eras when the NRA, the Catholic Church, the health insurance lobby, the Moral Majority, the National Federation of Independent Businesses, the U.S. Chamber of Commerce, Americans for Tax Reform, and trickle downers like Reagan, Gingrich and Bush dominated politics and policymaking, these findings are pretty stunning.
Make no mistake, America has changed. A solid majority of Americans now are supportive of left-leaning policies, whether or not they self-identify as “liberal.” In a representative democracy, public opinion is supposed to have a powerful impact on candidates and policymakers, and it is.
“Scaring the Independents”
“Harumph,” say the grizzled veteran pundits and reporters. Hubris-laden Democrats are going to scare away the Independent voters and be responsible for four more years of Trump.
That’s certainly a danger, and an important thing to monitor in coming months. But remember, all of those polls listed above have a representative number of Independent voters in their samples, and breakouts show that on most issues a solid majority of Independents also are backing very progressive policy positions.
In addition, when you look at how Independent voters are currently leaning, they are leaning in the Democrat’s direction by a net nine-point margin.
Obviously, these polls are just a snapshot in time, so Democrats could still lose Independent voters after they are exposed to hundreds of millions of dollars worth of attacks. However, it’s worth noting that, after watching Democrats being lambasted for embracing progressive positions in recent years, Independents are still leaning fairly decisively blue.
Expanding the Electorate
Finally, let’s not forget that it will be easier for Democratic candidates to win if they can expand the electorate. That is, Democrats need to make the overall size of their electorate larger than it has been in past presidential election by motivating and activating the parts of their coalition that have traditionally voted in relatively low numbers, such as low-income people, people of color and young people. Even just a few percentage points improvement with those groups could impact the outcome of the 2020 elections up and down the ballot.
Positions in the “mushy middle” — ACA stabilization tweaks, incremental tax reform, inflation adjustments only to the minimum wage, semi-punitive immigration law changes, Pell Grant adjustments, etc. — probably won’t particularly motivate and activate these important voters.
Bolder progressive policies — Medicare-for All, Medicare buy-in option, repealing Bush and Trump tax cuts for the wealthy to fund help for struggling families, increasing the minimum wage to $15 per hour, family medical leave benefits, bold immigration law changes, higher education loan forgiveness — might.
Short-term Needs. So even if supporting progressive policies were causing Democrats to lose amongst Independent voters — and remember, so far the data seems to indicate that they aren’t — there is an argument for Democratic candidates to take those progressive stands anyway, in order to keep young people, poor people, and people of color from sitting out election day in large numbers, or backing a left-leaning third party candidate.
Long-term Needs. Appealing to those lightly voting groups with progressive policies is also important for the long-term future of the Democratic Party, not just the 2020 election. That’s because people of color are the fastest growing portions of the population, and today’s young people obviously will be voting for many years. Making those groups into committed members of the Democratic coalition would pay long-term dividends.
More Room To Grow. Still, some maintain that voter turnout is going to be so large in 2020, due to the polarizing nature of President Trump, that the size of the electorate will be maxed out without having to motivate lightly voting groups with progressive policies.
But when you look at the dramatically lower than average turnout figures for loyal Democratic constituencies in 2018, when their turnout levels were actually very high compared to 2014, it’s clear there is still much room for growth with these groups. For instance, 36% of young people voted in 2018, compared to 53% of the total population. Again, even an increase of a point or two in some of these categories could be decisive.
Who’s Out of Touch?
So yes, Democrats have indeed moved left in recent years. That much is obvious. But given this consistent stream of survey research from a wide variety of sources, I can’t agree with those who conclude that Democratic candidates are the ones who are “out of touch” with the pulse of the American people.
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.
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.
If you want to defeat Trump in 2020, I’d argue one of the worst things you can do right now is donate to Democratic presidential candidates. I’m serious.
Bear with me.
Last time I checked, Democrats have something like two dozen candidates in the race. That means any given donor’s chances of picking the winning candidate who ultimately runs against Trump are poor. Therefore, the contribution you give today could be, for the purposes of defeating Trump, pretty much wasted.
But what if you really feel strongly about a candidate?
Look, the policy differences between most of the candidates are not very significant. The differences get artificially magnified in heated primaries, but let’s keep things in the proper perspective. If you feel strongly about Issue X, the odds are very good that you are going to have several candidates in the race who agree with you, if not all of them.
So, donating now won’t particularly help promote Issue X. That’s why it’s very difficult to pick a Democratic candidate deserving of your donation.
Finally, making a contribution to an individual candidate now could inadvertently prolong the portion of the campaign season where Democrats have so many candidates in the race that their message is pretty much incoherent. Candidate winnowing is particularly needed with a field of 24, because a crowded, contentious field muddles the eventual nominee’s message and probably muddies the nominee’s reputation.
Candidates typically leave the race when they run out of money to pay for staff and ads, so giving to candidates now could simply delay the badly needed winnowing phase of the campaign.
So, which candidate or candidates should get your contributions? None of them.
Instead of contributing to one of the Democratic presidential candidates at a stage of the process when the race is essentially a roulette wheel, direct your contributions to Unify, Or Die.
Unify, Or Die was started by the hosts of the excellent podcast Pod Save America, in partnership with Swing Left. The idea simple and brilliant. People who want to defeat Trump can Donate to the Unify, Or Die Fund now, and the minute there is a Democratic Party nominee, all of the accumulated funding immediately will go to the Democratic nominee, so they can hit the ground running post-Democratic Convention against Trump and his massive war chest
So before you write that next big Hickenlooper check, stop, think big picture strategy, and redirect your money to a unified movement to remove the most corrupt, incompetent, and bigoted President of our times.
Arguably Senator John McCain’s finest moment came in Minnesota, when he corrected a Minnesota woman who called Barack Obama an Arab, a shockingly widespread belief at the time among Republicans. With the audience chuckling, and an easy cheap-shot applause line tempting the candidate, McCain showed political discipline, courage and integrity when he famously corrected her. “No ma’am, he’s a decent family man and citizen that I just happen to have disagreements with…”
(By the way, it would have been much more admirable had Senator McCain added something like: “And ‘Arab’ should never be used as a criticism or slur, because most people of Arabic descent are decent family men and women, and many are American citizens who love this country every bit as much as we do.” That would have been even more courageous and constructive. But I digress.)
Very soon, I suspect Democratic presidential candidates will have their own McCain moment in front of them. For instance, eye-for-an-eye Democratic activists at rallies will surely echo and mock Trump supporters by chanting “lock him up.” Though that chant isn’t as racist or removed from reality as the “Arab” remark, it’s also ugly in its own way.
In that same moment, Trump shamelessly promoted ignorance, disinformation, and mob rule by leading the chant, because he is a petty, short-sighted and dishonest authoritarian. But Democrats should show swing voters that they are better than Trump and his sycophantic Trumpublicans, and should not further normalize Trump’s abhorrent behavior by aping it.
A primary problem with the Trump supporters’ “lock her up” chants was not just that Secretary Clinton hadn’t been found guilty of any jailable offense, or even charged with one. It also was that politicians should never be making incarceration decisions and declarations about political opponents, Putin-style. In our American democracy, those are decisions that should be reserved for the independent judicial branch of government, after due process has been completed.
So when the “lock him up” chants inevitably start at Democratic rallies, Democratic candidates and party leaders should immediately stop their crowds and gently but firmly say something like this:
“No my friends, that’s them. That’s not us. That’s not how it works in this great democracy of ours. Incarceration is for the judges and juries in the judicial branch to decide, not for us. But here is something that we can do, and must do. Vote them out! Vote them out! Vote them out!”
That will show swing voters — Independents, moderate Democrats and moderate Republicans — that Democrats are the adults in the room. It will show them that it’s not true that “both sides do it,” as moderates frequently assert. It will show them that Democrats are focused on democracy and not being an authoritarian lynch mob. It show them that Democrats are leaders not demagogues.
For a country suffering extreme Trump fatigue, those things will matter a great deal in the 2020 elections.
Barack Obama showed Democrats the way. At campaign rallies, his fired up supporters often started booing their opponents. But Obama firmly redirected his supporters in a more constructive democratic direction. “Don’t boo. Vote.”
In other words, Obama was a moral leader, not a demagogue. His wannabe successors will have a similar moral test in front of them in the upcoming campaign. They need to follow President Obama’s lead.
