Category Archives: Patient Protection and Affordable Care Act

Does Walz Care About ONECare?

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So far, Minnesota Governor Tim Walz has largely been a responsive caretaker governor, responding to the crises du jour rather than than actively pushing a progressive agenda and building a legacy for himself.

Governor Walz’s legacy is essentially “pissed off all sides while consumed with thankless pandemic management.” I think he did a reasonably good job managing the pandemic, but he definitely had to make enemies doing it.

One partial break from caretaker mode was his poorly named “ONECare” proposal, which would give Minnesotans the option to buy into MinnesotaCare. MinnesotaCare is a longstanding program serving low-income individuals and families who can’t get employee-sponsored health insurance and don’t quality for Medicaid, which is called Medical Assistance (MA) in Minnesota.

Giving Minnesota health insurance consumers of all income levels this additional option would ensure that every Minnesotan in every county had at least one health insurance option available to them. That’s a big deal. It also would bring more competition to an individual market that sorely needs more competition. Over time, this could result in lower premiums for consumers.

Walz has not pushed his proposal particularly hard. Meanwhile, other states’ Governors are leading their states forward.

Colorado and Nevada this year passed public option plans—government-run health insurance plans—that are set to launch in 2023 and 2026, respectively. They join Washington state, which enacted its law in 2019 and went live with its public option in January.

The early results from Washington state’s experiment are disappointing. In many parts of the state, premiums for the public option plans cost more than premiums for comparable commercial plans.

Many of the state’s hospitals have refused to take part in the public option, prompting lawmakers to introduce more legislation this year to force participation if there aren’t sufficient health insurance options in a geographic area. And consumer buy-in is also meager. In its first year of operation, the state health insurance exchange sold only 1,443 public option plans, representing fewer than 1% of all exchange policies.

Michael Marchand, chief marketing officer for the Washington Health Benefit Exchange, the state’s health insurance marketplace, said it’s premature to judge the program by its first year.

During the earlier years of Obamacare, the premiums for many commercial plans were high, he pointed out. Eventually, as insurers became more knowledgeable about the markets, prices dropped, he said.

If Governor Walz would get re-engaged in this issue and actively market his plan, they could learn from the experiences of Washington and avoid it’s mistakes. For instance, in areas where there is insufficient health insurance competition, Walz could require hospitals to participate.

A MinnesotaCare buy-in option is extremely popular — only 11% oppose it, according to a Minnesota Public Radio survey. This is probably in part because it is an option. Any Minnesotan who opposes buying into MinnesotaCare — because of conservative ideology or because MinnesotaCare turns out to be expensive or poor quality — they can vote with their feet, as consumers in the state of Washington are doing.

Fighting for a MinnesotaCare buy-in option makes sense for Walz. The polls consistently show that health care is a top issue for voters, and huge majorities consistently trust Democrats over Republicans on that issue.

Moreover, in the 2022 gubernatorial general election campaign Walz may very well be running against a physician, Scott Jensen. This will ensure that health care is high profile in the race. Therefore, candidate Walz needs to be seen fighting for better health care, and this proposal gives him that platform.

If a MinnesotaCare buy-in option passes, Walz finally has a legacy beyond pandemic management. If Senate Republicans kill it, which seems likely, Walz has a great political argument to make while running for reelection and trying to retake the Senate: “I worked my ass off to give you another health insurance option and bring you some price competition, but Republicans like Scott Jensen opposed it on orders from private insurance lobbyists. If you want to more options and more price competition, vote for me and change the Senate leadership.”

Pushing a public option is a great political option for Walz. So why is he so damn cautious about it?

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.

MN GOPers Aren’t the Health Care Saviors They Claim To Be

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Exuberant Minnesota Republicans seem to think they have a winning health care issue for the 2018 election season–reinsurance. And they do deserve a great deal of credit for helping to enact a state reinsurance program that is reducing premiums for Minnesotans in the individual market. The individual market is for the 162,000 Minnesotans who can’t get insurance from their employer or the government.

While their claim that premium increases in 2016 and 2017 were due to DFL policies is ridiculous, it is true that the Minnesota reinsurance program they helped pass is helping those consumers. As the Star Tribune reported:

Jim McManus, a Blue Cross spokesman, said that were it not for the state’s reinsurance program, the carrier’s Blue Plus HMO would be seeking an average individual market premium increase of 4.8 percent as opposed to the 11.8 percent decrease cited Friday by Commerce

Impressive, and Republicans deserve credit for this.

The Rest of the Story

But as Ricky Ricardo would say, before Minnesota Republicans can credibly brand themselves health coverage saviors, they still have some splainin to do.

Why Not National Reinsurance? First, they need to explain why their party – in complete control of the U.S. Senate, U.S. House and the Presidency and entire U.S. Executive Branch of the federal government – doesn’t enact reinsurance to help all Americans. Because of economies of scale and the need for market consistency, a national reinsurance program makes much more sense than a hodgepodge of variable state programs.

Moreover, if stabilizing the market and helping consumers pay less is good for Minnesotans, wouldn’t it be even more awesome to do that for all Americans?  That’s likely why 75% of Americans support enacting reinsurance at the national level.

Why Sabotage the ACA?  So why aren’t Rep. Erik Paulsen, Rep. Jason Lewis, Rep. Tom Emmer, Jeff Johnson or former Governor Tim Pawlenty pressing for reinsurance at a national level? Because they and their White House puppet master would rather sabotage the remarkably effective Affordable Care Act (ACA) than improve the ACA to help American families.

The list of things Trump and his congressional Trumpbulicans are doing to irresponsibly sabotage American families benefiting from ACA protections is long and breathtakingly irresponsible.  This is hurting tens of millions of struggling Americans.  Republicans are ignoring the 71% of Americans who say the Administration should do all it can to make the the ACA work, compared to just 21% who support efforts to make the ACA fail and replace it later.

Why Oppose Adding A MinnesotaCare Buy-in Option?  The other thing Republicans boasting about the state reinsurance bill need to explain is this: Why aren’t they supporting giving the 162,000 Minnesotans in the individual market a MinnesotaCare buy-in option?

The MinnesotaCare buy-in option would achieve much of what Republicans profess to support — more plan and doctor choices for consumers in sparsely populated areas, guaranteed coverage for all Minnesotans in sparsely populated areas, and more competition to control prices.

The fact that Minnesota Republicans won’t support the common sensical MinnesotaCare buy-in option proposal, won’t push for a national reinsurance program, and continue to actively sabotage the ACA makes their gloating about being health care saviors ring very hollow.

Strib Poll Uncovers Dark Clouds For Republicans

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Cursor_and_minnesota_republicans_-_Google_Search 2As the 2017 Minnesota legislative session heads into the home stretch and President Trump is creating a constitutional crisis, the news for Minnesota Republicans in the recent Star Tribune survey is not  great.

To recap, most Minnesotans are…

Digging Dayton. An overwhelming 62% of Minnesotans approve of the job being done by Minnesota Republicans’ primary antagonist, DFL Governor Mark Dayton. Less than half as many Minnesotans (29%) disapprove of the job Dayton is doing.

  • Implication:  He’s grumpy, boring, wonky, and unabashedly liberal, but Governor Eyeore remains quite popular with a strong majority Minnesotans.  Despite Republicans’ best efforts to frame Dayton as being metro-centric and out-of-touch with Greater Minnesota, a majority in every region of the state approve of the job he is doing.  As high stakes budget and policy negotiations between Dayton and legislators begin, Dayton is in a relatively strong position to push his progressive agenda.

In the Dumps About Trump. Only 40% approve of the Republicans’ national leader, President Donald Trump. This marks an all time historical low-point among Presidents, at a time that is supposed to be a President’s “honeymoon period.” For context, eight years ago, during dire economic times, the newly elected President Obama had a 62% approval rating.

  • Implication: To state the obvious, “all time low” is not good.  Republicans who remain steadfastly loyal to their party’s unpopular President could be more vulnerable in the upcoming 2018 mid-term elections. While the conventional wisdom would be for Republican incumbents to distance themselves from the toxic Trump, it’s difficult for them to do so, because Trump remains popular with the narrow band of Trump diehards.  Republican incumbents need those voters on their side in order to survive 2018 primary and general elections. With Trump this unpopular, Republican incumbents are in a political bind.

Swooning for DFL Senators. In comparison to Trump’s 40% approval rating, 58% of Minnesotans approve of DFL Senator Al Franken, and 72% approve of Senator Amy Klobuchar.

  • Implication: Franken and Klobachar remain popular as they relentlessly criticize Trump and his policies, which should embolden other DFLers to do the same. Also, Klobuchar looks difficult for Republicans to defeat in 2018, and both Franken and Klobuchar should be helpful surrogates for down ballot DFL candidates in 2018.

Cursor_and_Minnesota_mexico_wall_-_Google_SearchNot Feeling The Mandate. Trump mandate?  What mandate?  Most Minnesotans don’t like Trump’s policies any better than they like him personally. About two-thirds (65%) oppose Trump’s signature campaign issue – building a Mexico wall. Only 29% support that idea.  The survey also found that Minnesotans oppose Trump’s proposals to accelerate deportations, and his Muslim travel ban.

The only ray of hope in the survey for President Trump was that 70% of Minnesotans support his drive-by Syrian missile strike, proving once again that Americans still love military actions, as long as victory can be declared within a matter of days.

  • Implication. It turns out those “real Americans” at the Trump rallies who cheered wildly about the Mexico wall and Muslim ban are not very representative of most Minnesotans. Therefore, stressing those issues would seem to hurt Republicans more than help them, at least with moderate swing voters. However, the one thing that perhaps could make Trump more popular is a quick, easy military victory.  Don’t think for a moment that a drive-by war has not crossed Trump’s compulsively self-promotional mind.  In other words, it’s probably not a good time to plan a vacation to Grenada.

Nyet On Russiagate Coverup. Republicans steadfastly maintain that no one cares about the Russian controversy. But even prior to the disturbing Comey firing, a majority of Minnesotans (55%) indicated that they would like to see an independent investigation of the Trump campaign’s ties to the Russian interference in the U.S. presidential election, while 39% say there should be no such investigation.

  • Implication: If Republicans continue to cover up and downplay the Russia controversy, it will not pass the smell test with a majority of Minnesotans.

All Aboard On Trains. By a strong twenty-point margin (54% support to 34% oppose), Minnesotans support building two extensions of light rail transit (LRT), from Minneapolis to the southwester suburbs and Minneapolis to the northern suburbs.

  • Implication: Republicans should think twice about making LRT their poster child for wasteful spending.   Despite Republican operatives and talk radio jocks aggressively bashing LRT over many years, most Minnesotans, including plenty of voters in swing suburban districts, support LRT expansion.

Cursor_and_minnesota_tea_party_-_Google_SearchOkay With O’Care. Then there is Obamacare. Republicans seem supremely confident that Obamacare is wildly unpopular.  But a narrow plurality of Minnesotans actually is okay with it. Forty-nine percent of Minnesotans say Obamacare has been “mostly good,” while 44% say it has been “mostly bad.” This issue polled better for Republicans than most other issues, but this finding isn’t very encouraging for Republicans who are dead set on repealing Obamacare and replacing it with a Trumpcare plan that offers many fewer patient benefits.

  • Implication: As Republicans prepare to replace Obamacare with something that the nonpartisan Congressional Budget Office (CBO) says will erases all of the Obamacare coverage gains, these numbers spotlight the political risk that Republicans are taking.  Republicans are beginning to learn that the only thing many Americans hate more than Obamacare is lack of Obamacare.

Loving Local Control. By a whopping 34-point margin (60% oppose, 26% support), Minnesotans oppose the GOP-backed proposal to prevent Minnesota towns and cities from passing work-rule ordinances, such as minimum wage increases.   In every region of Minnesota, a majority oppose limiting local control.

  • Implication:  This is another loser issue for Republicans.  How in the world did the party that constantly preaches about the need for “local control” end up on this side of the issue?

Wrong Tax Cuts. Inexplicably, the Star Tribune apparently didn’t poll on what seems like the overarching question of this legislative session: What should legislators do with the state budget surplus? That is, should they spend it, cut taxes or save it for a rain day (i.e ask about “all,” “most,” “some,” or “none” for each category). Instead, the Star Tribune only asked how to cut taxes, as if tax cutting were the only thing being debated.

Even within that narrow fiscal category, the news wasn’t great for Republicans. Republicans propose tax cuts targeted to narrow constituencies — smokers, farmers, retirees, people with student loan debt, business owners and others. But most Minnesotans (45%) would rather just cut income taxes for all, perhaps because it’s simple and broad-based. Less than 20% of Minnesotans support the Republican-recommended constituency-by-constituency approach, while the rest support Jesse Ventura-style rebates (30%).

  • Implication: Tax-cutting remains the Republicans’ bread-and-butter issue, and it should be a pretty easy sell. Still, Minnesota Republicans can’t even seem to do that right.   They somehow managed to find the most unpopular way to cut taxes, which might somewhat limit the electoral benefits they stand to gain from the tax cuts.

Political tides ebb and flow, so today’s viewpoints could be very different at election time18 months from now. But as it currently stands in the dawn of the Trump era, Minnesota Republicans are not exactly winning so much they’re tired of winning.

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.

Mainstream My Ass

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Cursor_and_Trump’s_foreign_policy_goes_mainstream_-_POLITICOAfter a few TV-friendly bombings this week, many in the mainstream media and pundit-o-sphere are falling all over themselves to declare President Trump mainstream. That’s right, it seems our Muslim-banning, emoluments-pimping, Russia-colluding, climate change-denying, serial-lying President is now pretty much equivalent to Obama, the Bushes, the Clintons, Reagan and Ford.

For instance, Politico’s headline is “Trump’s Foreign Policy Goes Mainstream,” and it reports:

“(T)he substance of Trump’s decisions in his first 79 days in office reveals a surprisingly conventional approach, with personal quirks layered on top, according to a half-dozen foreign policy experts.”

Similarly, the Wall Street Journal headline reads “Five Big Players Steer Trump’s Foreign Policy Towards the Mainstream” and National Public Radio (NPR) offers “Trump’s Flip Flops on Economics Move Toward the Status Quo.”

Okay, so the President recently has said a few sane things, such as NATO shouldn’t be defunded after all and Russia really should stop enabling the gassing of innocent children. Super. But before we throw the President a ticker-tape parade, let’s remember it was utterly outrageous that a presidential candidate or President ever took the opposite positions in the first place.

ann_schrantz_horton_-_Facebook_SearchLet’s also remember that in the same week the media declared Trump mainstream, we learned that a federal judge found probable cause that Trump’s campaign may have colluded with the Russians to undermine American democracy, and that the President threatened to withhold lifesaving assistance from poor people if Democrats don’t back his extremely unpopular Trumpcare plan to take health coverage from 24 million Americans. We also read the Los Angeles Times, Newsday, Rolling Stone, and Wall Street Journal reporting and opining about the President’s unprecedented level of lying.

Yeah sure, but did you hear that the President failed to publicly praise his most empowered white nationalist? Moderate!

How does this happen? Former top aide for President George W. Bush David Frum explains:

“As President, Donald Trump benefits from two inbuilt biases of mainstream pundits:

“Bias 1 favors fair-mindedness: the wish to offer tips of the hat along with shakes of the finger. This bias exerts itself extra strongly with a bad actor like Trump. The worse he does, the more eagerly the pundit seeks something to praise. We’ve all experienced this. ‘There has to be something good to say about Trump. Even Hitler liked dogs!’

“Bias 2 is the bias in favor of surprise and novelty. Pundits don’t want – bookers won’t book – endless repeats of ‘He’s a liar & a crook.’ How much more interesting to say: “He’s a liar and a crook, but …” How boring to insist that the first part must always overwhelm the latter.

“And so TV punditry flits from one seemingly clever (but actually deeply false) pivot to another, chasing insight & missing truth.”

Say it with me people:  This presidency is lightyears away from normal.   An American President who bans people from entering a country that was founded on the principal of religious liberty because of the deity they worship…who empowers white nationalists that the neo-Nazis and Klansmen cheer…who praises murderous, democracy-hacking dictators as “strong” role models…who appoints his business-operating family members with no relevant experience to the most sensitive positions in the world…who covers up his tax returns so he can profit from policy positions and accept foreign bribes without Americans knowing it…and who lies at a rate that we have never seen in national history is not normal, moderate, or mainstream.

We have to judge presidents based on their overall body of work. And when a very high percentage of a President’s body of work is utterly outrageous and dangerous to the republic and world, we can’t give anything close to equal billing to the low percentage of his actions are not outrageous.  This week’s shamelessly fawning news coverage aside, Donald J. Trump remains the mother-of-all-abnormal Presidents.

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.

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.

Bernie Needs To Give Democrats One Final Parting Gift

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Sanders_from_behindPresidential candidate Bernie Sanders has already given much to the Democratic Party. But even though his chances of being nominated remain slim, he still has a bit more he could give to his adopted party.

Largely because of Clinton’s dominance when it comes to establishment-oriented super delegates, we’re being told by elite analysts like FiveThirtyEight’s Nate Silver that Hillary will likely be nominated, even after a likely Sanders win in Wisconsin today and a possible win in Clinton’s home state of New York. Sanders’ exit from the stage couldn’t come soon enough for frustrated supporters of Hillary Clinton, who see Sanders as an annoying speed bump on her trip down Inevitability Lane.

Bernie’s Gifts To Democrats

But the fact is, Sanders’ questioning of Clinton has helped her improve as a candidate. Though still too cautious and programmed, Clinton is a better candidate now than she was before Sanders joined her on stage.

Beyond changing candidate Clinton for the better, Sanders has also changed the Democratic party for the better. This longtime political independent has reminded Democratic partisans that it’s okay to dream of progressive policies that go beyond the cautious incrementalism ushered in during the 1990s by the Clintons and their center-right Democratic Leadership Council (DLC).

With every major western nation operating universal health care systems that are more fair, effective and efficient than today’s complex Rube Goldberg-style Affordable Care Act (ACA) machinery, Sanders reminded Democrats that it’s reasonable to both appreciate the progress being made under the ACA, while continuing to fight for the superior single payer models.

Sanders also reminded Democrats that a college degree is as vital today as a high school degree was at the time the American public education system was created, so we need to keep fighting to update our public education system by offering tuition-free public higher education.

Sanders reminded Democrats that even Republican presidents such as Bush, Reagan, Nixon and Eisenhower all required wealthy Americans to pay more to support their country than we do today, so it’s reasonable to ask more of the wealthy again to help rebuild the American dream for the lower- and middle-class.

Sanders reminded Democrats that the party that created a wide array of popular socialist programs that built the great American middle class — New Deal job programs, Social Security, the GI Bill, the Rural Electric Administration, Medicare —  doesn’t need to cower in fear every time conservatives label their proposals as “socialism.”

Finally, Sanders shined a light on the corrupting influence that big money has had on America’s corporatized Congress.

Democrats owe the Independent Senator a debt of gratitude.  The fact that many to most of Sanders’ proposals could not have passed in the short-term with a Republican-controlled Congress does not mean that progressives shouldn’t advocate for those policies, to improve their viability over the long-term.  It’s self-defeating to allow do-nothing congressional conservatives to limit how Democrats use the bullypulpit.

Bernie’s Parting Gift

But where does Sanders go from here? If delegate geeks like Nate Silver are correct that it’s impossible for Sanders to come from behind to win the nomination, should he just pull out of the race, as indignant Clinton supporters have been demanding?

Before Sanders leaves the stage, I’d ask one more favor of him:   Expose Trumponomics for what it is.   To limit the number of Sanders refugees who are tempted to support Trump over Clinton in November, Sanders should spend the next few weeks exposing the fraud Mr. Trump is attempting to perpetrate on Americans.

For instance, Sanders should explain that billionaire Trump may claim that his partial self-financing makes him independent from the uber-wealthy interests, but Trump’s tax plan exposes the truth. According to a Tax Policy Center (TPC) analysis, Trump’s tax plan would give an average tax cut of $1.3 million per year to the richest one-tenth of one percent.  Sanders should make sure his audience understands that billionaire Trump plans to further enrich his fellow billionaires.

Sanders should also explain how the businessman’s proposals will destroy the American economy, rather than make America “win so much will be sick of winning.” For instance, look at what Mr. Trump’s plan to lavish the mega-rich with tax breaks would do to the national debt:

“The Tax Policy Center estimates the proposal would reduce federal revenue by $9.5 trillion over its first decade and an additional $15.0 trillion over the subsequent 10 years, before accounting for added interest costs or considering macroeconomic feedback effects.”

Some have suggested that Sanders and Trump compete for the same type of voters, those most frustrated with the status quo. Therefore, before Sanders leaves the stage, he should conduct a seminar for “open to Trump” voters about the fraud Mr. Trump is attempting to perpetrate on them. Doing so could constitute Bernie’s greatest gift of all to the Democratic Party.

Note:  This post was also chosen to be featured by MinnPost’s Blog Cabin.

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.

Minnesota Senate Candidate Mike McFadden Wins Another Blockbuster Endorsement

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Molly_McFadden_adSaint Paul, Minnesota – In news that could shake up Minnesota’s previously sleepy U.S. Senate contest, Republican candidate Mike McFadden announced today that he has landed the endorsement of his young daughter Molly McFadden.

“With just two weeks left in the campaign, we decided to launch our October Surprise,” said McFadden, a CEO of an investment banking company from Sunfish Lake.

Ms. McFadden’s announcement was made through a new television ad produced by the McFadden campaign.  The transcript of Ms. McFadden’s ad follows:

My dad, Mike McFadden, is running for Senate.  He really tries.  But he’s not very good at this political stuff.

Problem is, dad’s super honest.  He works hard.  And he’d rather help people than attack them.

Dad’s been all over Minnesota telling people about his plan.

But I can tell you this:  He’s a good guy, with a great heart, and he’ll give everything for Minnesota.”

The announcement continues a red hot streak for the McFadden campaign, having secured the endorsement of the candidate’s Obamacare-hating peewee football players, fiscal analyzing son Conor, and now his political analyst daughter Molly.

“Amazingly, Mike is on the verge of getting endorsed by every one of his offspring, while liberal Al Franken hasn’t been endorsed by a single McFadden child,” said McFadden campaign spokesperson I.O. Koch.

In a rare moment of political harmony, the Franken campaign released a statement agreeing with Ms. McFadden:  “While we dispute the ad assertions that Mike is honest, doesn’t attack people, and has a plan that he is sharing,  we cannot disagree with the ad’s observation that Mike “is not very good at this political stuff.”

Note:  This post is satire.  Though Mike really did release a series of sappy ads featuring endorsements from his young players, son, and daughter, the reaction quotes are fabricated for my own amusement.

Where is The Vision of “Progress” From Minnesota Progressives?

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Can someone please tell me what Governor Mark Dayton, Al Franken and the DFL Legislature plan to do with another term in office?  Because I have no earthly idea.

I know what they have done in the past, and it’s impressive – an improved economy, health care system, and fiscal outlook.

franklin_roosevelt_new_deal_campaign_button-_Google_SearchBut progressives are also supposed to lead the way forward.  The dictionary says a “progressive” is “a person advocating or implementing social reform or new, liberal ideas.”

Where is the “new” part?  Where is the “advocating” part?

It’s entirely possible that I’m not paying close enough attention, because this campaign season is putting me to sleep.  But I can’t discern where these top DFLers propose to take Minnesota.

  • ACHIEVEMENT GAP PROGRESS?  For instance, the education achievement gap is a morally shameful and economically perilous problem.  What specific solutions does the DFL offer that are sufficiently bold to at least narrow that persistent gap?
  • CLIMATE CHANGE PROGRESS?  Climate change is the most urgent problem of our times, and Minnesota remains hopelessly addicted to dirty coal-fired power plants and cars dependent on environmentally destructive fracked petroleum.  I know the DFL supports more renewables and less fossil fuels, but how exactly are they going to realign financial incentives to make that more of a reality, and not just rhetoric.
  • COLLEGE AFFORDABILITY PROGRESS?  College is increasingly important for earning a good living, and increasingly out-of-reach for middle- and lower-income families.  What progressive ideas does the DFL offer to address this important challenge?
  • RETRAINING PROGRESS?  Many unemployed and underemployed workers lack the career skills to thrive in a fast-changing economy.  While increasing the minimum wage and funding job-creating bonding projects are great steps, what specific education and training help does the DFL offer to help those workers adjust to our economy’s new normal?

Does the DFL have a “secret plan” for more progress on any of these issues, like the secret plan President Nixon promised to end the Vietman War?  If so, why is it secret?    I just finished watching the PBS televention series about the Roosevelts, and I was reminded that Teddy, Franklin and Eleanor reaped political rewards by fearlessly advocating for bold solutions to society’s toughest problems.

Again, Minnesota DFLers  have earned reelection.  They have a strong record of paying back schools, implementing reforms that have a record 95% of Minnesotans with health insurance,  improving tax fairness, increasing the minimum wage, passing marriage equality, funding job-creating infrastructure improvements, delivering all-day kindergarten, and balancing the budget on-time, in a fiscally responsible way.  That’s very impressive work, at a time when extreme Tea Party-backed Republicans have offered only mindless obstructionism.

But we live in an impatient “what have you done for me lately” world.    To prevent an electoral setback a few weeks from now, DFLers need to fire up their progressive base enough to get them to vote at higher rates than they typically do in non-presidential year elections.  And in terms of a bold new progressive way forward, Minnesota DFLers haven’t offered much to fire them up.

– Loveland

Note:  This post also was also published by MinnPost.