“Sanders’ ‘Medicare For All'”: The Devil Is In The Details
Bernie Sanders is a proud and self-described socialist, a veteran Vermont senator who wants to bring some European ideas to the United States. One of those ideas is a single-payer health care system: a government-funded program in which the patient bears little to no cost. Sanders describes it as “Medicare for all.”
It’s an excellent idea. The United States is the richest country in the world, and it ought to grant every citizen guaranteed access to doctors and hospitals. That’s what Canada, Japan and the countries of Western Europe have all done.
But Sanders is vague — and his supporters quite naive — about the prospects of bringing a single-payer system to the United States. He insists that he could accomplish that in a prospective first term “if many millions of people demand it.”
Here’s the rub: They won’t — at least not in the systematic and sustained manner that would be required to bring about that sort of, well, revolutionary change to the American medical-industrial complex.
There’s a reason that the U.S. doesn’t have “Medicare for all”: politics. Do Sanders and his supporters remember the epic battle to pass the Affordable Care Act?
Democrats have been trying to pass a version of universal health care since the days of Franklin Delano Roosevelt. But conservatives have fought every proposal that would increase access for ordinary Americans, including Medicare; Ronald Reagan, then a neophyte political activist, toured the country campaigning against it.
Bill Clinton made universal health care a cornerstone of his presidential campaign in 1992, and he appointed his wife, Hillary, to head a task force to propose legislation after he won. They tried mightily to pass it, but conservatives denounced it, and the insurance industry spent millions to defeat it.
That’s why President Barack Obama brought the insurance industry on board when he started toward the Affordable Care Act. He knew he needed their support to have a prayer of passage. So the ACA preserves the business of selling health insurance through private companies.
Still, it has helped millions of families; nearly 9 million more Americans had health insurance in 2014 than the year before, according to government data. Moreover, the ACA prevents insurance companies from banning patients because they are sick and prohibits insurers from placing “lifetime caps” on the amount of money any person can collect for health care.
Would a single-payer plan have been even better? You bet. But listen to Obama’s former aide, David Axelrod, describe the difficulties of trying to pass such a proposal.
“I support single-payer health care, but having gone through health reform, we couldn’t even get a national consensus around the public option! It was Democratic votes that were ultimately missing on that issue,” Axelrod remembered. (The public option was a proposal for a government-run health insurance plan to compete with private health insurers.)
History shows that Obama and his allies spent months trying to make the ACA more palatable to conservatives to entice a few GOP votes. Actually, the mandate requiring that all adults have health insurance was originally a conservative idea. While the federal government provides subsidies to help families with modest incomes buy insurance, it doesn’t pay the full cost. (Obamacare also sets aside billions for states to expand Medicaid, but the Supreme Court made that optional, and many states have refused to expand.)
Still, the ACA did not get a single Republican vote in the end — not one. Republicans are still trying to repeal the law, taking more than 60 votes in Congress and going to the Supreme Court with challenges. Most of those Republicans will be easily re-elected to Congress.
Given recent history, it’s clear that Sanders’ plan would face very long odds — and that’s before details become clear. The Vermont senator proposes an extraordinary range of patient care — dental and vision coverage, mental health care, long-term care — while, he says, saving trillions of dollars. Many health care experts say that can’t be done, so health care spending would likely increase. You don’t have to be a conservative voter to fear where that would lead us.
If Vermont’s audacious senator has a plan for overcoming an ultraconservative GOP caucus in Congress, a right-leaning U.S. Supreme Court, and millions of voters who still flinch from the word “socialist,” he ought to lay it out. It would be quite a revolutionary plan, indeed.
By: Cynthia Tucker Haynes, Pulitzer Prize Winner for commentary in 2007: The National Memo, February 13, 2016
“A Perfect Storm Of Indecisiveness”: There Are Only Two Paths Left For The GOP: Chaos Or Catastrophe
Coming out of New Hampshire, the Republican Party faces two possible scenarios: chaos or catastrophe.
Right now, either looks equally possible.
Let’s start with the chaos.
Perhaps the biggest question going into the New Hampshire primary was whether Donald Trump would match, fall short of, or surpass his polling numbers. He fell several points short in Iowa, leading many analysts to conclude that his support could be soft, with voters willing to express enthusiasm for Trump to pollsters, but balking at the prospect of actually voting for him.
New Hampshire failed to make it a trend. Trump finished with about 35 percent of the vote — which is pretty much at or slightly above where he’d been polling over the past week. And that might indicate that his considerable support in upcoming states is solid. If so, Tuesday’s victory will be followed by several more over the coming weeks.
But that’s exactly what most analysts and pundits have been predicting for quite a while — even many of those who have remained broadly bearish on Trump’s chances. So what else is new?
This: complete disarray among the other candidates. Had Cruz come in a strong second — say, around 30 percent to Trump’s 35 — that would have combined with his victory in Iowa to make him the clear alternative to Trump. Likewise, had Rubio given Trump a run for his money, that would have built on his surprisingly strong third-place showing in Iowa to make him, if not the definitive non-Trump option, then at least a strong contender to battle Cruz for that distinction in the upcoming Nevada caucus, South Carolina primary, and beyond.
Instead, the GOP ended up with a perfect storm of indecisiveness. Besides Trump, no candidate inspires as much derision among rock-ribbed conservatives as John Kasich, who came in a wan second place with 16 percent, fewer than half as many votes as Trump. Then came last week’s wunderkind, Ted Cruz, who barely managed to come in ahead of Jeb “Please Clap” Bush and everyone’s favorite robot, Marco Rubio.
It already looks like Chris Christie’s sixth-place showing is going to drive him from the race. The same will soon likely be true of Carly Fiorina and Ben Carson, who brought up the rear. But the top five finishers? It’s hard to see why any of them would quit on the basis of their performances so far.
Cruz can pin his hopes on the South, and especially his delegate-rich home state of Texas, which votes on March 1. Rubio can continue to believe that despite the scorching humiliations of the last week, he’s the frontrunner-in-waiting that so many establishment Republicans desperately want him to be and thought they saw emerging on the night of the Iowa caucuses.
Kasich, meanwhile, certainly won’t quit after ending up the runner-up. And that leaves Bush, who won’t quit either — not after besting Rubio, his one-time protégé and present-moment bête noir. Bush still has money and a flush super PAC on his side. Had he finished in the basement in New Hampshire, he would have quit in abject embarrassment. But now he’ll have a chance, if not to win, then at least to bow out later on with a smidgen of his honor intact.
And that, my friends, is a perfect storm of chaos: Trump riding high, but not high enough to best the non-Trump vote, while the non-Trump vote remains badly splintered, with no movement at all toward clarifying which single candidate might emerge to challenge him, and the various options training their fire (and tidal waves of negative ads) on each other.
For the past several months, the smartest of the Trump doubters have based their case on Trump’s relatively low ceiling of support. Yes, he’s leading the polls in a very crowded field, but that ceiling (never higher than the mid-30s) is unlikely to go much higher, and certainly not past a majority in any state. As soon as the non-Trump vote falls in behind an establishment candidate, he’ll be beaten.
But what if that doesn’t happen before the GOP primaries become winner-take-all in mid-March? In that case, Trump is going to start piling up an awful lot of delegates, even if his share of the popular vote never rises above 40 percent. That might not be enough to clinch the nomination, but it would be enough to give us the most riveting political convention in a very long time.
Who would emerge from the chaos in Cleveland? Trump? Cruz? Rubio? Bush? Paul Ryan? Mitt Romney? It could be any of them. Or someone else not currently on anyone’s radar screen.
But there is, of course, another possibility: the catastrophe of Donald Trump winning the nomination outright and competing head-to-head with the Democratic nominee to become president of the United States.
For that to happen, he’d probably need several of the non-Trump options to remain in the race through March, a significant number of their supporters to pull the lever for him when their first choice does drop out, and (most ominously) substantial numbers of Democrats to vote for him in those states that have open primaries (including South Carolina, Alabama, Georgia, Tennessee, Texas, Vermont, Virginia, Michigan, Illinois, Missouri, Wisconsin, and Indiana).
The first scenario looks likely. The second and third somewhat less so. But we just don’t know.
Just as we don’t know the outcome of a general election contest that pitted a demagogic megalomaniac against Hillary Clinton or Bernie Sanders.
Or what he would do once elected to the most powerful job in the world.
By: Damon Linker, The Week, February 10, 2016
“Hillary Unleashes The Kraken On Bernie”: ‘If You’ve Got Something To Say, Say It Directly’
It was almost as if a switch went off in Hillary Clinton’s brain.
Moments into the first Democratic debate not beleaguered by the presence of Martin O’Malley, Clinton laid into her remaining opponent, Bernie Sanders.
Sanders has tried to paint Clinton, the former secretary of state and first lady, as a representative of the “establishment” he rails against. He often notes, sometimes without using Clinton’s name that she has taken millions in contributions from Wall Street and pocketed hundreds of thousands of dollars in speaking fees from banks.
But tonight, after weeks of semi-veiled attacks, Clinton announced she had enough.
“People support me because they know me, they know my life’s work, they have worked with me, and many have also worked with Senator Sanders—and at the end of the day, they endorse me because they know I can get things done,” Clinton said, redefining her “establishment” credentials as an asset.
“Being part of the establishment is in the last quarter having a super PAC that raised $15m from a whole lot of money from drug companies and other special interests,” Sanders quickly retorted.
As soon as the dreaded “e” word was used again, Clinton was ready to pounce, directly pushing Sanders to attack directly if he was going to attack at all.
“It’s fair to really ask what’s behind that comment. Senator Sanders has said that he wants to run a positive campaign, and I’ve tried to keep my disagreements over issues,” she said. “But time and time again by innuendo and by insinuation, there is this attack that he is putting forth, which really comes down to ‘anybody who ever took donations or speaking fees from any interest group has to be bought,’ and I just absolutely disagree with that, senator.”
Clinton went on to insist that she would never be influenced by the vast sums of money she’s received from Wall Street.
“If you’ve got something to say, say it directly,” Clinton said, her voice raised. “You will not find that I have ever changed a view or a vote because of any donation I have received. I have stood up and I have represented my constituents to the best of my abilities, and I’m very proud of that.”
Semantics about the definition of “establishment” and “progressive” aside, this seemed to mark the beginning of a new stage in the contest between Sanders and Clinton. And it’s not going to be pretty.
By: Gideon Resnick. The Daily Beast, February 4, 2016
“The Choice Is Between Two Theories Of Change”: The Questions At Stake In The Democratic Presidential Primary
Democrats are in the midst of a tough presidential primary and there are times when that battle puts out more heat than light. But Bryce Covert provides some much-needed perspective.
But the largest difference between Mrs. Clinton and Mr. Sanders is not over policy…There is scant daylight between them on most issues and certainly almost all of the causes near and dear to Democrats’ and progressives’ hearts.
If your reaction is to dismiss that as untrue, take a look at this:
Here is a partial list of the policies that Mrs. Clinton and Mr. Sanders largely agree on: The country should have paid family leave; the minimum wage should be substantially increased; college students shouldn’t have to take on so much debt; parents need more affordable, quality child care and preschool options; Wall Street needs further reforms; health care should be universal; the wealthy should pay substantially more in taxes. Many of these are new policies even for Democratic presidential candidates. Despite using the socialist label, Mr. Sanders sounds a lot like many prominent Democrats. Mrs. Clinton is a tried and true liberal.
Covert’s point is that what separates Clinton and Sanders is not those goals, but the issue that is taking up a lot of ink from liberal pundits lately: their different theories of change.
The largest difference, and therefore what the Democratic Party is truly grappling with, is not about two different visions of the party. The choice is between two theories of change. It’s the difference between working the system and smashing it.
Much of the discussion about these different theories has focused on which one is more likely to be successful against Republican extremism and intransigence. The truth is that no one has seriously cracked that nut yet. But underneath it are other questions. For Clinton pragmatists, the idea of “smashing the system” is reckless and the outcomes are too unpredictable. For Sanders idealists, “working the system” is insufficient for the level of change that is needed. So the issue is at least as much about how to get there as it is about efficacy.
Those are the issues Democrats should be debating in this presidential primary. Accusations of complicity with corporate interests, dishonesty and lack of integrity are distractions that are divisive and could hurt liberals in the general election against Republicans. As then-Senator Barack Obama said back in 2005, here is what is at stake:
I firmly believe that whenever we exaggerate or demonize, or oversimplify or overstate our case, we lose. Whenever we dumb down the political debate, we lose. A polarized electorate that is turned off of politics, and easily dismisses both parties because of the nasty, dishonest tone of the debate, works perfectly well for those who seek to chip away at the very idea of government because, in the end, a cynical electorate is a selfish electorate.
Republicans are doing all they can to “dumb down the political debate” in search of a cynical, selfish electorate. Democrats can (and should) do better than that.
By: Nancy LeTourneau, Political Animal BLog, The Washington Monthly, February 2, 2016
“Bernie Sanders Isn’t Electable, And Here’s Why”: Revolution On Hold, Politicians Think Of Their Own Necks First
The blunt truth: I just can’t see Bernie Sanders winning a general election. Three months ago, I thought it might be possible, maybe. But watching the campaign unfold as it has, and given some time to ponder how circumstances might play themselves out, I’ve become less convinced that he could beat any of the Republicans. He’d probably have the best shot against Ted Cruz. But in that case, as we now know, Mike Bloomberg would get in, and I think he’d be formidable, but I don’t want to get into why here. That’s another column, if indeed it ever needs to be written.
This column is about Sanders’s chances, which I think are virtually nil for two reasons.
Reason one: He’s not an enrolled Democrat. Understand that I say this not as a judgment on him, but as a description of what would surely become, were he the nominee, a deep, practical liability. Let me explain.
That he’s not an enrolled Democrat doesn’t matter, obviously, to his fans. I’m sure it doesn’t matter to most rank-and-file Democrats. It doesn’t matter to me. But you’d better believe it matters to Democratic office holders and party officials—members of Congress, state legislators, governors, mayors, national committee members, and state committee members across the country. These people are Democrats, and they’re Democrats for a reason. It’s important to them.
A party’s nominee, to these people, needs to lead the party—he or she needs to be the country’s No. 1 Democrat. Sanders has never been a Democrat, which is fine, it’s served him well. But even as he made the decision to seek the presidency as a Democrat, he doesn’t seem to have made any effort to act like he cares about the party he wants to lead.
Politico in early January published an interesting news story comparing Clinton’s and Sanders’s fundraising operations. Clinton raised more than $100 million in 2015, and Sanders $73 million. But here was the key thing: In addition to that $100 million Clinton bagged for herself, she raised an additional $18 million for Democrats around the country.
The Sanders figure? Zero.
There’s a lot I don’t know about life. But I know this: Democratic office holders keep tabs on that sort of thing. Now maybe some of them didn’t want Bernie Sanders at their fundraisers, but that wouldn’t have prevented the Sanders operation from writing checks to progressive Democrats all over the country as a kind of down payment, which apparently did not happen. Also, Sanders could just say at any time, “You know what? I’m a Democrat now.” He cannot, technically, enroll as one, because Vermont has open, non-party registration. He could however simply say it, but he hasn’t. He caucuses with the Democrats in the Senate, but that’s just because any senator has to choose one side or the other.
Partly as a result of this, and for other reasons, Sanders has very little Democratic support. He has one Democratic member of Congress, Keith Ellison of Minnesota (out of 232); and, according to the relevant Wikipedia page, just 115 Democratic state legislators across the country. Actually, that’s not across 50 states; it’s across only 14 states. Of the 115, 94 are from New England: Maine 37, Vermont 29, New Hampshire 19, Connecticut five, Massachusetts four. The Vermont number of 29 is particularly interesting, because the Vermont General Assembly (which includes both houses) has 103 Democrats, meaning that Sanders doesn’t have even one-third of the Democrats in his own state.
Maybe 115 sounds like a quasi-respectable figure to you. But there are 3,175 Democratic state legislators in America (.pdf). So 115 is nothing. And again, the vast majority come from states right in his neighborhood. Where are the others from? According to this list, to take stock of some large states and key swing states, there’s one from Ohio; zero from Florida; zero from Virginia; zero from Colorado; zero from New Mexico; one from Nevada; two from New York; one from Illinois; and from California, Pennsylvania, and Michigan, zero, zero, and zero.
Now, my argument is not that endorsements matter that much. Rather, the important part is the likely consequence of this lack of support. Say it’s late spring, and somehow or another, Sanders is charging toward the nomination. He’ll pick up some more Democratic endorsers, in safe liberal districts in states that he won. But here’s what’s going to happen. Every one of those roughly 3,200 elected officials is going to conduct a poll of his or her district to ascertain whether association with Sanders helps or hurts. It’s my guess that for a lot of them—and I would say the substantial majority of them—the answer is going to be “hurts.”
And even if that’s not the case, these legislators will sound out, as they inevitably do, their top donors, and their districts’ major employers. How many Sanders enthusiasts are going to be found among those two groups? These legislators will keep their distance from Sanders. They won’t do the things that party people normally do for their nominee—go out and make speeches, share voter information, give tips about the district that only they know, and so on.
This will vary from district to district and state to state, but the sum and substance will likely be, if I’m right, that in a number of important jurisdictions, the message of the state and local Democratic candidates and party infrastructures to Sanders will be: You’re on your own, pal. Politicians think of their own necks first, and they’re fearful of the unknown and are overly cautious on matters like this anyway.
So that’s the first reason: Having never been a Democrat, and having even not given them any of his money in this past year, Sanders just isn’t going to get much help from Democrats. The Democratic Party hasn’t nominated someone who wasn’t an enrolled member of the party since, I believe, 1872, when it chose newspaperman Horace Greeley (I’m still checking on Gen. Winfield Scott, 1880, but even if it was he, that’s a long time ago).
Now, the second reason. I think Sanders is uniquely vulnerable to scorching foreign-policy attacks. Scorching. He’d be subject to stinging attacks on domestic policy, too, but on domestic policy, I’d imagine he can hold his own. On economics and health policy and monetary policy, whatever you think of his proposals, he clearly knows the nuts and bolts.
On foreign policy, that’s not so clear at all. It’s not his lefty past here that I’m mainly talking about, although you’d better believe that Republicans would make sure every voter in America knew about that, and they’d lie about its extent to boot. But even putting that to the side, the issue is his apparent lack of interest over all these years in foreign policy. The world is in a pretty parlous state right now, so I’d bet foreign policy will matter more in this election than it usually does, even without a Big Event in October. One factor that greatly benefited Bill Clinton in 1992 is that the Cold War had ended and foreign policy was low on voters’ radar screens. Sanders won’t be so lucky. I could write the ad myself, and it would be crushing, but I don’t want to give them ideas. Rest assured, they’ll think of them on their own.
And now, here’s where my first and second reasons relate to each other. If a nominee has strong backing from his party, when those attacks come, the other folks will have his back. If he doesn’t, they won’t. Mind you it is not my intent here to scold Sanders, even though many readers will take it that way. My intent is just to describe what I think would be the reality. When the right started savaging Sanders over foreign policy (and over socialism too, of course), the bulk of the support systems that are usually there for a candidate under attack won’t be.
Now, since I know this column is going to face plenty of rebuttal, let me spend two paragraphs pre-butting myself. It’s possible that if Sanders won the nomination, local Democrats would by and large just say “OK, he’s our guy,” and they’d get behind him. I don’t think so, for reasons stated above, but I concede that it’s possible, with so much at stake. And he still would have the support of the unions, who these days do most of the get-out-the-vote legwork. So it’s possible that a lack of support from Democratic candidates in swing (and other) states won’t be that severe and won’t mean as much as I suspect it will mean.
On foreign policy, we see from his debates with Clinton what Sanders’s reply will be: I opposed the Iraq War, and I was right. And second, I support Barack Obama’s foreign policy, so I’ll just do more of that. Who knows, that might be enough. My suspicion is that it will not be. It certainly won’t be against Donald Trump, who also opposed the war in Iraq, making that issue a wash between the two of them. But I suspect that as a general election campaign progresses, Sanders will have a harder and harder time leaning on a decision he made 14 years ago, even though it was the right one.
So that leads to my first stipulation. I could be wrong. I’ve been wrong before, and I’ll be wrong again. Despite what some of you are going to say on Twitter and elsewhere, I don’t presume to know everything.
Stipulation No. 2: Though I admire Hillary Clinton, my argument doesn’t have anything to do with her. It’s not a brief for Clinton. She has a number of flaws. She lacks the natural pol’s exuberant charisma, she has made errors of strategic judgment in her career that make me wonder how effective she’d be at negotiating with Republicans (or Israelis and Palestinians), and though I don’t think she’s corrupt, this stonewalling reflex of hers is just terrible, and it’s kind of shocking after all these years that she can’t see how poorly it has served her.
And she comes with risk. As I wrote Monday, I doubt she’ll be indicted over the email business. But something short of that could still prove politically problematic: an FBI report that gives Republicans enough grist to grind through the attack-ad mill this fall, say.
So what I’ve written here doesn’t have to do with her. Joe Biden could be the mainstream candidate, or John Kerry, or Joe Manchin, or Claire McCaskill, or a Democratic governor, or anybody, and I’m certain I’d still think the same thing.
My feeling that Sanders could win a general election was never strong, based on the usual stuff, i.e., 74-year-old socialist from Vermont. But recently I’ve been reflecting on these two matters, his lack of affiliation with the party whose standard he wants to bear, and his unique vulnerability to attack on foreign policy at a time when those issues are much more in the forefront of voters’ minds than usual. As I’ve written before, current general election head-to-head polling is meaningless, since conservatives haven’t yet spent a dollar attacking him. If he’s the nominee, they’re going to spend at least five hundred million of them doing that. And some Democrats, more likely a lot of Democrats, are going to run away from him. I can’t see how that ends well.
UPDATE: A first reader reminds me that Rep. Raul Grijalva of Arizona has also endorsed Sanders. A second reader corrects that the Democratic nominee of 1880 was Gen. Winfield Hancock. Winfield Scott was the Whig Party nominee of 1852.
By: Michael Tomasky, The Daily Beast, January 27, 2016
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