In November 2008, the Senator Max Baucus (D-MT) ,chair of the Senate Finance Committee, released a 98 page white paper. This was a crucial precursor to what eventually became the ACA. Some of the white paper made it into the bill. But that was not why this white paper was important. Instead, it was the last major Democratic choke-point holder laying out what he was willing to do and not do with healthcare reform. With this white paper, all the major Democratic Party actors who held explicit or implicit veto positions were at least onboard with a rigorous exploration of passing an individual market, subsidized and standardized and a major expansion of Medicaid eligibility. There was a pathway forward.
Fast forward to this week. Senator Warren released a Medicare for All plan. It is a plan that won’t get sixty votes in the Senate. It is a plan that will need the approval of Senators Manchin and Sinema. It is a plan that will need 218 votes in the House. In addition to the 218 votes it needs in the House, it also needs a floor slot and committee time. That is problematic.
We talk some about how difficult it would be get a maximalist left-wing agenda through a narrowly divided Senate.
We haven’t talked at all about how difficult it would be to get it through the House, especially with a not especially cooperative Speaker. https://t.co/zPLwuFss58
— Bill Scher (@billscher) November 2, 2019
Significant elements of the critical pathway to enactment are screaming that they are not interested in another run up the hill of health finance and delivery system transformation. Senators Manchine and Sinema are veto players. Speaker Pelosi is a veto player. They aren’t onboard with the vision that Senator Warren is outlining. This is a major problem if you support Senator Warren (and/or Senator Sander) and her health care plans. Even if she wins, enactment will be extremely unlikely if the rest of the veto players are indifferent at best to it.
Capri
90% of the things candidates promise have to be passed by the Senate to take effect. It doesn’t seem to stop anybody from pretending otherwise.
David Anderson
@Capri: Yeah, but I think we should make a distinction of plans as a marker of values and priorities and plans that can actually be implemented in something resembling what is being proposed.
zzyzx
This is the main reason I’m not on the Warren train and I wasn’t in Camp Sanders in 2016. Until the Senate is on board, this is like me deciding which mansion I want to move into.
MattF
And, bear in mind that Republicans won’t have the slightest hesitation about lying. Healthcare is a maze of details, even without fending off lies about death panels. It’s a losing game. There are bigger, softer, more appealing targets out there, like the war on women.
Xavier
I’d rather vote for someone who tries and fails than one who doesn’t try.
dr. bloor
Let’s frame this more accurately than Mr. Scher’s lazy take. The Speaker isn’t going to waste the House’s time and swing seats on a quixotic bill that will be squashed like a bug in the Senate.
Jinchi
I look forward to a future when we’re arguing about how exactly we’re going to get affordable healthcare to everyone in the country.
Baud
I don’t think any major overhaul will get through the next Congress. I think the main calculus is how her plans or anyone else’s affects our electoral chances and whether their ultimate failure to be enacted in the next Congress will be something we can build on or will lead to internecine recriminations.
the Conster
@dr. bloor:
Exactly. That’s what she’s telling them. She saw all those seats lost to Republicans after the ACA vote, but deemed it worth it to get it passed WITH A PUBLIC OPTION IN IT.
Upending the entire healthcare system every decade or so seems… crazy, seeing how Democrats were punished in both houses of Congress during the last census year which led to losing 50 years of progress on every other social program front. We have a framework for universal health care, and it’s called the ACA.
cmorenc
The better HC strategy would be to promote improvements and fixes to the Obamacare paradigm, since despite an initial tepid public reception at rollout in 2013, actually grew to become popular outside the hard-core GOP base. I know – Obamacare falls short of the true progressive (TM) vision of universal health care, but with that strategy we have far more stakeholders (both insured and within industry) pulling with us rather than fearfully fighting against us.
A perfect plan that has no chance of being enacted or adequately supported is no perfect plan at all, but a deeply flawed one, no matter how perfect it is on paper or ideology.
j christian mohr
@the Conster:
(My emphasis added to your quote). EXACTLY!
Medicare for all sounds wonderful in progressive talk circles (hey, as a senior I like my Medicare in practice !) – but let’s not let the perfect be the enemy of the good.
Cheryl Rofer
This is why I advocate that all Democratic candidates should stick with generalities on health care. “We are in favor of affordable health care for everyone.”
Or “We agree that no American should be bankrupted because they are sick.”
Many variations. If a candidate wants to toss out a straw plan, that’s great for the discussion.
The support needs to be there to pass a plan. Saying that we will do it and the Repubs want you to die is the way to do that. There is no upside to dividing the Democratic electorate and giving Republicans fodder for “Democrats in disarray.”
Chyron HR
Cue the self-proclaimed Progressives: “We don’t need Pay-As-You-Go, we’ll just cut military spending to pay for it!”
the Conster
@Chyron HR:
I’m no fan of military spending, believe me. It’s insane. But, there are DOD contractors in every Congressional District in the US, making it the biggest jobs program in the world. Even the cosplaying socialist millionaire and hypocritical *progressive* from Vermont loves him some Pentagon boondoggle in the form of the F-35 – a trillion dollar black hole in the budget.
topclimber
Sen. Warren overcame the greater of two problems by showing a defensible way to get to M4A without raising middle/working class taxes. She can’t be accused of evading a direct answer anymore, and she has made her personal preference clear. Her trademark is telling the truth, so she stays on target.
She will overcome the lesser of the two problems when the Democratic platform refuses to abolish private health insurance and employer health insurance. She can pivot from “I have a plan” to “we have a plan” based on public option, strengthening OCare and lowering Medicare age to 55.
In the meantime, she and other Dems debate the broad outlines of that plan. Some educate folks what M4A means. Most people don’t understand that not only does it make Medicare available to all. It also makes Medicare more worth having–it covers ALL health care needs. Might be that a few of my fellow oldsters on the GOP side will find that latter part attractive.
dnfree
YES. I was hoping David would weigh in with facts and I agree with the rest of you. Stick with what has been achieved so far and build on it. Campaign on what has been accomplished and what it’s done for Americans and how Republicans messed with it and how it can be improved. It’s fine to have people advocating bolder steps, but they shouldn’t be our nominee. That’s just presenting a big fat target to be ridiculed, exaggerated, and shot down decisively.
the Conster
@topclimber:
Are you aware that when asked what she meant by middle class, she said it was everything under a billion? At the same time, her funding plan involves immigration reform to get more taxpayers onto the tax rolls. Immigrants are billionaires? She will demand medical professionals’ pay to be crammed down, and said some specialties overcharge. Which ones? Will medical school need to be subsidized too, if every doctor and nurse going forward will depend on Medicare reimbursement rates?
wvng
I just had this conversation with my brother. Warren’s insisting on M4A is an own goal of the highest order. The reality is that you just can’t make balance sheet arguments to sway the American public, because they are so easy to demagogue and as MattF said above republicans will lie like crazy about it. The simple reality that Dems must face is that the Senate is, and will be, heavily biased toward conservative rural America and any Democrats coming from rural America (whgich we need to get a Senate majority) will by necessity be conservative. Those conservatives have a veto point.
dnfree
I’m an oldster on Medicare, and Medicare is not free. It also doesn’t cover dental and vision. Most medical care is free to me because I pay for an expensive supplement plan (F, which is being discontinued). Warren is proposing something much more expensive than Medicare.
Also, I think people should pay at least something for what they get, or it gets overused and abused. My husband was in the public mental health field. Psychiatrist time was the biggest expense, but people with free appointments would just blow them off if something else came up. Paying a fee on a sliding scale, if only a couple of dollars, greatly improved the perceived value and the attendance.
japa21
@topclimber: Except she already said doing anything other than M4A isn’t an option. It’s either keep things as they are or go her plan. No other option exists.
Someday we may get to a single player plan, someday. As of right no, is an electoral liability and could insure defeat.
And yes, the GOP will rip anything and everything, and lie their asses off in the process. But it doesn’t help when Warren (and Sanders) say things and give the GOP ammunition.
Tenar Arha
@Cheryl Rofer: I agree, I would have preferred she remained vague. The problem with generalities is that your primary opponents ding you, & the press really dings you bc IOKIYAR & so Democrats have to map out their legislation in advance. AFAICT Warren really wasn’t interested in making her own plan, plus IIRC she’s said more than a few times her first priority is corruption. I’m fully aware that M4A isn’t even her 1st or 2nd or 3rd priority, those are anti-corruption, free college & childcare.
So I think she put out the specifics to get people to stop hitting her, but she wasn’t going to half-ass it so her plan starts from a serious plausible basis. But the woman who set up the CBP, partially by asking for the maximum up front, knows better than anyone how the legislative & regulatory sausage gets made. And after all, she’s the Senior Senator from Massachusetts, where hospitals & insurance companies are like one of our major industries, she probably knows better than most how big a fight getting M4A passed would be. From watching her as my Senator, if she has to she’ll dicker down to rebooting the ACA with a public option, but she’s the type of person who really will shoot for the idealistic maximum bc that’s not only the right thing to do, it’s the best bargaining position.
CaseyL
Hmph. I like candidates who swing for the fences, because as I’ve said previously, our current systems are rotten to the core. But I really don’t want 45 to still be in office in 2021, and that has to be the highest priority, with the second highest turning the Senate. So far, it’s looking like M4A is not going to get us there.
Pelosi is right about exciting the base and ignoring – or alienating – the great mushy middle. The difference between our base and the GOP’s base is that ours DOES NOT TURN OUT. We can’t rely on them to vote, or to vote for the official nominee rather than a 3rd party spoiler.
This, plus another poll showing Trump polling strongly in the swing states, makes me very depressed.
Miss Bianca
I really like Warren otherwise, but this tethering herself to M4A – to the point of *making a plan* for it! – is a major sticking point for me. Ugh. I think it’s an own goal that could/should have been avoided, for reasons I’ve gone into before and therefore won’t go into again.
Butch
What does focusing on what we can’t do get us? If you’re in an underserved area I’m willing to bet you’re not a fan of the ACA; I’m 67 and still working because it’s the only way we can pay for self-employed spouse’s supposedly “affordable” policy, and that’s with a subsidy. There’s also the problem that the insurers in underserved areas have found all kinds of ways to game the system; we’ve had “preventive and wellness” care denied and the supposed cap on out of pocket is meaningless because the insurer has imposed “tiers” of deductibles.
Kent
This is all true.
However, show me a SINGLE major progressive initiative for which the SAME EXACT argument cannot be made.
Green New Deal (or other major climate legislation)
Major immigration reform
Major labor reforms
Major voting rights act reforms
Major campaign finance reform
Major infrastructure legislation
Major tax reform
etc. etc.
Kay
But supporters could be thinking that if they don’t get M4A they will get what Biden is offering anyway, as the compromise position on M4A.
So it’s not a choice between M4A or nothing- it’s try for M4A, get the Biden plan, or don’t try for M4A, get the Biden plan.
The centrist plan excludes the possibility of the liberal plan. The liberal plan does not exclude the possibility of the centrist plan.
I think opponents of M4A, Warren or Sanders best argument is the political one, in terms of the 2020 election. The argument that it won’t get through Congress isn’t as good because pushing for M4A could include ending up with Biden’s plan, but pushing for Biden’s plan won’t end up at M4A. Warren/Sanders supporters aren’t risking “health care reform”. They’re just risking their preferred version of health care reform.
Princess
Maybe this is 100% correct but it fundamentally misunderstands what a campaign promise is and does. When Trump said he’d build a wall and the Mexicans could pay for it, he was also promising something impossible. But it showed his supporters he understood them and was listening to them and he shared their racist xenophobia. Are his supporters angry that we’re paying for it and it mostly won’t be built? No, because they understood the meaning of his promise, and because he has done enough to show them he still shares that value with them. If Warren comes in and fixes prescription drug pricing and even more if she gets a robust public option, her supporters will also understand she still holds to the values she expressed in her promises.
The Democrats ran on healthcare in 2018 and won, and I don’t careif they don’t have the stomach for another fight about it, if they win the presidency and don’t move on it, they will be shellacked and they will deserve it. And I don’t see a candidate who comes out and says, sorry, the ACA is as good as it is going to get for you at the moment, winning the presidency.
the Conster
@j christian mohr:
I’ve learned that there’s a lot of mention of Medicare 4 All by folks who have no idea that Medicare is pretty complicated, doesn’t cover everything, needs supplemental private insurance and isn’t identical in meaning to universal health care or single payer. IOW, there’s a lot of virtue signaling in the use of the word by a certain segment of the left that tends to be ideological rather than pragmatic and learned a lot of wrong talking points about what happened politically in the run up to the vote on Obamacare. That certain segment of the left also have no recollection, or willfully overlook the fact of the racist vitriol and the fueling of the ugliest of the ugliest underbelly of the white majority of this country directed at President Obama, which led to Democrats who supported him – and only Democrats did – losing their seats. Pelosi deemed it to be worth it however, and she was right – hanging on to their health care and coverage for pre-existing conditions fueled the blue wave and flipped red seats blue. I can’t believe how stupid it would be to cede health care talking points to Republicans at this juncture. Mind bogglingly stupid.
Frankensteinbeck
A) Every time someone quotes Nancy saying she supports pay-as-you-go rules, remember she’s saying she wants taxes raised on the rich.
B) Didn’t Warren say she’s going to release a sheet of how she wants to get to M4A? I strongly suspect it will be highly incremental and start with strengthening Obamacare, then moving through a public option until everyone has been weaned off of insurance.
Kay
I’d like to see Warren’s or Bernie’s supporters polled on that. Do they see this as M4A or nothing, or M4A might fail, very sad, but they still get the less ambitious centrist plan. That’s a big difference in risk. Maybe they look at it as win big or win small, but it’s all win. That’s rational.
gvg
We have spent the last decade defending the ACA from all kinds of attacks, full frontal and stealth poison pills. We barely kept it and we needed McCain, who is dead now. I don’t even want to think about trying something ambitious that will fail. Now we have a corrupt would be dictator and a ton of loony toady’s all though our government, plus our foreign allies have been seriously alienated and have their own domestic problems very like ours. This isn’t the time IMO. Now health care is always actually life and death to many people. I notice though ACA attacks have died out. I think Trump got bored with it, but I also think in a way the public got bored with that. IMO what we need to do is undo Republican sabotage as quietly as possible while still getting credit. I really want to hear a way to get around the BS supreme court rulings that allowed states to opt out of medicare expansion. Require all the country to have basics not just depend on common sense and “self interest” that haven’t worked yet.
Then improve based on experience.
Getting the corruption cleaned up should distract the howler monkeys from putting much into demonizing ACA improvements.
I don’t actually like our system, but I don’t like the constant threat that the poor will lose healthcare. It made us blackmailable too.
Butter emails!!!
Cute. Apparently, there’s two sides to the purity pony coin.
Side 1: Any policy proposal that’s not 100% in line with the most progressivy of progressive policies is evil.
Side 2: Any policy that can’t get 10+ Republican votes in the Senate is the devil.
Princess
Basically, I agree with Kay (as usual).
the Conster
@Princess:
No one ran on Medicare for All in 2018. They ran on preserving the ACA and its benefits.
Cheryl Rofer
@Kay: Also known as pushing the Overton Window.
Kay
@Princess:
Good, but if M4A is unpopular and thereby causes them to lose the election, I think that’s a good argument.
I think Bernie would lose under any set of circumstances because he stupidly alienated Clinton voters – who he needs- so really for me it’s just about Warren. Is M4A so unpopular she would lose? That’s a good question IMO.
Kay
@Cheryl Rofer:
Right and I should preface this with my change of heart on that. I didn’t believe in The Overton Window to the extent that I made fun of it. Now I do believe. I was wrong. I’m literally watching it happen in the Democratic Party, so it would be silly to deny it at this point.
It’s shifted. Democrats are bragging about raising taxes and it gets 60% support. Amazing. Trump’s tax cut is unpopular. That’s a big change!
Cheryl Rofer
Jamelle Bouie takes on this question today.
The garbage about healthcare, which the moderators love, should just be set aside. Kamala Harris is very good at this sort of thing. I hope she’ll lead.
rikyrah
Thanks for this post, Mayhew.
206inKY
Thank you for this post. I think Warren has done an amazing job pushing the goalposts leftward, but the $21T tax plan seems like a suicide pact. I have been pounding the pavement on GOTV for Beshear (side note: can we have a Kentucky gubernatorial post?), and it’s just so clear that there would be a backlash. There’s no need to risk so much for something unworkable.
I have come to believe that Klobuchar is our best option; she has been extraordinarily productive in the Senate and ran 20 points ahead of Clinton in many Wisconsin-adjacent districts. She’s no Manchin or Sinema and is a smarter, more effective version of Shertod Brown. Klobuchar is credible when she advocates for smart revisions to the ACA since she has the legislative track record.
Beyond Klobuchar, I think Harris or Booker would actually have a better chance than Pete in conservative Dem districts. It’s so revolting that we have to consider sexuality, but people underestimate the extent to which the culture of the Bible belt cuts across racial lines. I also think the shameless hypocrisy of Republicans will reach its logical conclusion by attacking Pete over his work history for McKinsey.
topclimber
@the Conster: Your immigration point hinges on whether what they pay in CURRENT taxes (the ones all we non-billionaires pay) will offset the cost of paying their health benefits. My hunch is immigrants skew younger and so need less expensive care, but I am always open to where the facts lead.
If you think that the only reason we pay twice per capita what other industrialized companies pay for health care is those greedy health care companies, then sure–don’t go after overcompensated doctors, administrators, et.al. If I were Baud 2020!, I would send some of their fat pay to those who will be taking those nursing care personal aide jobs–the ones MY kids aren’t taking. (I am strawmanning you because you probably agree with the aim, just not the vehicle. But frankly, sometimes you ask for it).
You have a good idea about paying medical school tuition. I would open it up to include creating federally chartered medical schools to break the AMA’s monopoly. Since like Warren I admire a good work ethic, I would provide a tax credit for those professionals who paid if off all by themselves.
Of course, I am not the candidate. Warren is. Her plan is no doubt full of holes. I just said it was defensible, not fool-proof. And not to repeat myself (an unknown tendency on BJ), nothing stops what might be a brokered convention from adopting a platform that has more acceptable healthcare improvements. I do believe she is humble enough to pivot from “my plan”to “our plan.” Smart enough too. Think voters might go for someone who can admit that others might have a better idea, or one more likely to succeed, after 4 years of Orange omniscience?
Princess
@Kay: It is a good question. I don’t know the answer to it and I don’t think that anyone does. My own view is that the primary is going to answer that for us. If Warren becomes the nominee it is because she’ll have been able to persuade people that her version of M4A is desirable. She’ll be able to then soften her approach against Trump. FWIW I’m one of those Warren voters who is with her despite thinking M4A is not the best way to get to universal and affordable healthcare. But I think demanding M4A gets us closer to something that will work in the States.
Cheryl Rofer
@Kay: This is why I sometimes sound annoyed with the “centrists” in my posts about politics. Their argument is “Let’s not even think about pushing things and just stay in the safe space defined by the Republicans. Or maybe stretch it just a little.” Whereas if you go outside the window, you can still come back to the centrist position. I hate shrinking down the possibility space until it’s absolutely necessary.
Barbara
@Kay: I think this is the correct position. I just hope she can maintain sufficient control of the narrative to make it work out for her.
My substantive position is that Medicare is a messed up benefit structure because the FFS part of the program is stuck in time — specifically, 1965, when its structure was enacted to reflect how BCBS plans worked at the time. That’s why there was no drug coverage as well. So fast forward, and you have this incredibly clumsy benefit structure with a yet clumsier Part D “add on” for FFS beneficiaries, that is paid for separately, along with supplemental coverage. Medicare Advantage plans overcome some of the inherent weaknesses in the benefit structure by at least integrating all of the constituent parts in a single plan, but they introduce other weaknesses. There is definitely a case to be made for moving toward an exchange type approach, with a Medicare option as a backstop.
There is also no shame in forcing insurers and others to justify the current structure or to propose a universal plan that builds on the exchanges without continuing to burden individuals with hardship level cost sharing. Criticizing M4All doesn’t do that.
Also, this point about people losing their jobs is really kind of bogus. Medicare has always relied on outside parties to administer benefits and would have to keep doing so. For those who think coding jobs would go away, for instance, Medicare created the concept of “correct coding” and you have to code claims for Medicare just the way you code them for private insurance. What I read in the popular press just reinforces that most people have no clue how Medicare or insurance works in any way shape or form.
Jinchi
Maybe our base doesn’t turn out because we don’t promise to do anything for them?
Kay
I’m a Warren supporter and I’m fine with the rest of the field attacking her, it’s a race, she’s fair game, but I do think Biden’s campaign in particular risks coming off as exclusively negative and he’s not that good at “negative”. It isn’t what people like about him and he sounds whiny and entitled when he does it. Why doesn’t he just sell his own plan more? People think of him as positive and upbeat and that’s a strength. Play to that.
topclimber
@japa21: Has she really said she would veto any health care improvement than M4A? Then she really is dumb. Who knew?
Cacti
@Kay:
Indeed. Speculating how it does or doesn’t make it through Congress seems almost beside the point, when the most immediate concern is that it gets us clobbered at the ballot box in 2020. Before you can craft world changing legislation, you have to win elections.
Kay
@Cheryl Rofer:
I was there with them because I’m temperamentally kind of risk averse but I have to hand it to Lefties- they moved the Party.
Have you seen Biden’s labor plan? It’s good! I feel like I died and went to heaven. It’s not Warrens or Bernies plan but it’s more robust than anything Democrats have put forth in 30 years. They moved. It’s undeniable at this point.
??? Goku (aka Amerikan Baka) ??
@Cacti:
You ignored the rest of Kay’s comment and the point she was trying to make
topclimber
@Miss Bianca: Ah, the rare non-repeating commentator. You deserve a new point.
Remember how Obama was against an individual mandate until that’s what it took to make ACA work? Keep an idea, steal an idea, drop an idea. Doesn’t really matter if people believe in you.
Betty Cracker
As a senator herself, Warren knows Congress as currently configured (or even under the more optimistic scenarios modeled for 2020 so far) isn’t going to pass her plan. She’s offering a vision. Democrats who don’t share that vision and/or who believe including M4A as an aspirational goal in the 2020 campaign would doom us to four more years of Trump should vote for someone else in the primary. That’s what primaries are for.
japa21
@Cheryl Rofer: Cheryl, I disagree with you here. It isn’t a question of let’s not push the envelope, let’s stay in a safe space. I actually think most “centrists” here would be thrilled with a working single payor system. However, before we can move in that direction, we have to win an election. Not just the WH, but also the Senate, retain the House and win in the state legislatures. SO yes, let’s talk about the need for health care financing reform but keep it vague. Avoid specifics. Talk about how that can be worked out later. Save all that talk for once the elections have been won.
And don’t use the term Medicare for All when what you are talking about is nothing like Medicare.
Mike in DC
Do the votes even exist for ACA reform(i.e., adding a public option and making some tweaks to improve the system)? As far as I can tell, not unless we can do it under reconciliation.
Ditto for virtually every one of the “centrist” policy proposals advanced by Biden(and to a lesser extent, Mayor Pete).
Warren running on abolishing the filibuster is the most exciting proposal I’ve heard from any major candidate, precisely for this reason–because we can’t get a @#*!ing thing done otherwise.
japa21
@topclimber: Never used the word veto. But she specifically stated there are only two options, her plan and the current system. And that is stupid.
Kay
@Barbara:
Her campaign takes risks and that has (mostly) gone their way so far so we’ll see. She may have stalled now that the centrists have apparently wakened from their inexplicable slumber :)
The centrists were complacent (and perhaps a tad arrogant) so the Lefties took the opening. The centrist candidates shouldn’t bitch about that- it’s their fault. Biden can’t just squat up there – he has to work.
Kay
@Betty Cracker:
Too, right, if it’s about “risk” Biden would have an easier argument to make if he were stronger. If he were 60 and the rest were a combined 40 he’s low risk. If he’s at 30 and they’re at 25 he’s not low risk at all. They’re being told to jettison something they care about for not much risk reduction. No wonder it’s not appealing. To be the safe choice he has to actually be safe.
Baud
@Kay:
I agree. Although Pete’s rise might be because of that. An attempt by centrists to reassert influence.
Cacti
@206inKY:
I hope she’s able to catch on once the votes start being counted.
She’s all steak, in contrast to Pete’s sizzle.
Miss Bianca
@206inKY:
I’m a Democrat, and *I* am prepared to attack Pete over working for McKinsey. Because, you see, I also worked for McKinsey (briefly, very briefly) – and I still have PTSD-like flashbacks to how horrible that corporate culture was, and what horrible things they did.
Capri
@Cheryl Rofer: Warren has a plan for that too, as do other candidates. She would eliminate the filibuster. Bernie would pass this as part of a reconciliation bill so no need for more than 50 votes. Candidates do talk about how they will get things through the Senate, but I don’t think reporters repeat or or dwell on it because it is seen as too “inside baseball” for their viewers and readers.
One of my pet peeves is folks claiming that the press isn’t covering something that they absolutely are. Just because something doesn’t go viral or catch the imagination of the public doesn’t mean it hasn’t been reported. Case in point- there was a ton out there about the fact that Trump was a crook and a grifter before the election. His voters didn’t care, but it wasn’t exactly being covered up.
Kay
@Baud:
Pete has his own risks, though. Mayor of South Bend to President is a very inspiring story but the bottom line is he has no experience. I think the mavericky appeal of “no experience” has probably dimmed a little after Trump. Donald Trump doesn’t know what he’s doing. It’s a problem.
To me, Klobachur is so much the obvious choice for the centrist wing that I can’t even believe they aren’t promoting her. Her (admittedly big) hurdle would be AA voters but Biden tanks with young people, so he’s got big problems too.
I’ll support the nominee but I think she’s a stronger candidate than Biden so I hope centrists think this thru and perhaps consider a little risk.
Steeplejack
I haven’t read the comments yet, and I make no judgment on Warren’s plan, but I bridle at Bill Scher’s characterization of it as “a maximalist left-wing agenda.” Many countries have universal health care plans, including most of South America and “We can do fascism right this time!” Hungary, without being radical socialist hellholes. Unless Scher’s point is that universal health care automatically makes you a radical socialist hellhole.
Probably can’t rule that out. Scher’s Twitter page shows him to be a Politico and Real Clear Politics contributor who loads up on “Dems are doing it wrong” themes. He proudly notes that Democracy for America called out his “unique brand of bloodless, ideologically inert liberalism.” But I digress.
A less politically charged way to refer to Warren’s plan might have been to call it “epochal,” “far-reaching,” “monumental” or even just “radical” without a “left-wing” stinger at the end. In our current politics, apparently everything is left-wing outside of oligarchy and crony capitalism. But by all means let’s taint the discussion from the get-go. Don’t oppose Warren’s plan on the merits or the logistics, just rule it out of bounds as a “maximalist left-wing agenda.” Saves a lot of heavy lifting.
And Scher doesn’t address that anyway. His tweet thread devolves into an inside-baseball discussion of what Nancy Pelosi and various Democraatic factions might or might not want.
Barbara
@Kay: I think Harris, in particular, has failed to take any risks. Maybe that’s a skewed perception, but I have been supporting both Warren and Harris, and I think I am going to start supporting Klobuchar and Booker as well. I really wish Biden and Sanders had called it a day. It would be so great to see those four debating each other. Buttigieg never impressed me much but pining for more justices like Kennedy is his death chant as far as I am concerned. Yeah, let’s keep appointing overly politicized corrupt justices who somehow never see an argument for women’s freedom in the same light they do for men, gay or straight.
topclimber
@japa21: Point taken. Even smart people are stupid once in a while. I speak from personal experience.
Miss Bianca
@Kay: I’m with you, here. I cannot understand all my older white lady liberal friends who are squeeing over “Mayor Pete”! It’s another thing I blame Trump and white male supremacy for – what the hell is the mayor of South Bend, IN doing, thinking that he’s qualified for the WH? That’s some fucking hubris, there. I’d say, “Get back, honky cat” – except for the ineluctable fact that the GOP nominated and voted for the least qualified candidate for POTUS ever, over the most qualified candidate for POTUS ever, simply because he was a white man. Period. That was all the qualification he had, and it was enough. So why the hell *wouldn’t* every white guy in America look at that and say, “well, shit, if Donald *Trump* can do it, with no brains, no heart, and no courage, then why, oh why, can’t I?” And unfortunately, they have a point, damn it!
Chyron HR
@Cheryl Rofer:
Or maybe our argument is “Voluntarily letting nazis burn down human civilization so that single-payer health care can inevitably rise from the ashes is a stupid, stupid plan.”
topclimber
@japa21: M4A means Medicare for everyone and Medicare for everything. Universal healthcare with a kill-for brand name. Or am I missing something?
If it has not been clear let me make it so now: M4A is an election loser because it is too early. But we need to talk about it now because it is a winner in the end. It = universal health care.
Baud
@Kay:
I don’t think anyone is risk free. Maybe Michelle Obama, but she doesn’t seem interested (or is too smart to be interested).
Kraux Pas
Honestly, Warren’s best answer on healthcare was in an interview I saw after one of the debates.
She was very clear that she knows she’ll have to bring in all the stakeholders and build consensus. I wish she’d focus on that angle somewhat more often.
Still, I’m not going to fault her for having lofty goals.
Betty Cracker
@Steeplejack: Well said. I find it odd that it’s not considered “radical” to advocate keeping a rent seeker-infested system that costs 40% more than the rest of the developed world pays, leaves tens of millions uninsured and tens of millions more afraid to access needed care, has resulted in people dying for lack of insulin, etc., but shruggies!
Matt Yglesias seems a little panicky:
LOL! God, I hate this fucking primary with the white hot heat of 10K exploding supernovas. I didn’t think anything could be worse than 2008 until 2016 came along. I didn’t think anything could be worse than 2016, but whoopsie-doodles! Wake me up when it’s over so we can get to work ejecting Trump from the White House, okay, comrades? :)
Jim, Foolish Literalist
@Miss Bianca:
That’s how I feel. I think Warren was on her way to be in the strongest candidate in the wake of Biden’s floundering, but she had a lot of challenges even if she is/was the strongest candidate, and now she’s decided to hug an anvil.
Kay
@Miss Bianca:
I admit I like him less since the jokes about him competing for the Rotary Scholarship came out after the last debate.
That’s dead on. In so many ways.
VincentN
Warren couldn’t keep talking in generalities because her brand is the one with the plans and everyone kept harping on her to explain herself. So she did. She can always moderate herself later on. Nobody believes that she’s stupid or doesn’t know that the Senate is where bills go to die so why are people so bent out of shape about how her plan is going to work? It doesn’t matter if it works because it will never become law. It just has to be plausible enough to take the heat off her on this issue.
Now, there’s some merit to worrying that laying down this aspirational marker could scare voters away but the same could be said of many of her other lefty positions. I appreciate that she’s not constantly worrying about going too afar afield. If she flames out and burns by getting too close to the sun we have plenty of other good candidates to step in.
Kay
@Barbara:
Me too. I want to move on but these ancient old men will not let me :)
I admit I want a woman. Sick of this shit with them. But, I’ll back either of them if they win – I would back either just for the judges.
Miss Bianca
@Betty Cracker:
Gotta admit I’m getting to that point myself.
I did manage to fill out my ballot today. I had to keep reminding myself to do it, and falling into a slight panic lest I forget, because I’ve been feeling so overwhelmed and disgusted by politics in general. That’s a bad feeling. : (
@Kay:
Yeah, I’m there with you on that stance, too!
Kay
@Betty Cracker:
She’d be fine though Betty. She’s mean and will be vicious re:Trump, she has lots of experience, and she’s a very popular politician in her state. No one notices this about her because (she’s female) but she attacks Trump constantly in the debates.
narya
@Barbara:
Exactly. If she didn’t come out with a plan, everyone–the rest of the dems + the repubs–would have said she didn’t have a plan. She proposed a plan, and I’m hoping she basically makes the argument above: Okay, you hate M4A, how are YOU proposing to cover everyone? Because if you don’t have an answer, then you’re saying that you’re willing for some to sicken/die so you can keep what you have exactly the way it is. And good luck with THAT, anyway–because I don’t know about you, but I pay for 37% of my health insurance costs, and the cost goes up every year. And plans change. And so on.
Jim, Foolish Literalist
@Betty Cracker:
seems like a reasonable response to the current political landscape
topclimber
@Kay: You might be able to break through to the Incels with this. Have to split the woman-wanters from the woman-haters. Or are they the same?
Matt McIrvin
I see this in “Overton window” terms. Ask for 100%, you might get 10%. Ask for 10% and you’ll probably get nothing.
Cacti
@VincentN:
Stupid has nothing to do with it. Quite the opposite. I think she has the same blind spot that trips up a lot of very smart people who enter politics: That you can always win the day with an appeal to reason.
Jim, Foolish Literalist
@Matt McIrvin: I see that as a legislative strategy, post-election.
Matt McIrvin
@Betty Cracker: Remember 2004, when polls like these convinced the Democrats that the path to a win was to nominate someone who’d been for the Iraq War?
Barbara
@Matt McIrvin: Although Mayor Pete annoys me for the reasons discussed above, I do think he is one of the candidates who gave a reasonable, substantive response to Warren: Medicare for all who want it, which is to say, a public option. The failure to engage with Warren other than throwing potshots and making vague promises is why others aren’t doing better (like Biden’s promise to “build on the exchanges” — what does that even mean?).
Kay
@topclimber:
I reject your comparison.
Betty Cracker
@Kay: If we must have a centrist, Klobuchar would be a fine choice, IMO. I like her just fine and could enthusiastically back her, even though she doesn’t exactly represent the major course correction I believe this country needs. She’s tough and smart, and she has swing-state appeal.
Kay
So strange that the Trump Family refuse to release any information on their finances. You’d think such wildly successful people would want to brag.
Cheryl Rofer
@japa21:
Totally agree. This is what I said upthread.
Steeplejack
@Kay:
They are modest to a fault.
Mary G
@dnfree: I also have Medicare with Plan F, and between that and my separate drug policy I pay $600 in premiums a month. Medicare is a million times better than the feeble coverage I had before, but it isn’t free for everything. The drug copays in particular can be brutal.
I appreciate Bernie etc moving the window to the left, but the overpromising that can’t possibly be fulfilled could lead to the 2022 midterms replaying the 63 seat shellacking of 2010.
topclimber
@Kay: Please elucidate. Being droll or being pissed? Or something else because I would not presume on your options.
the Conster
Can someone please define *centrist*? Is it being a political pragmatist and not believing in pie in the sky while we’re living through every nightmare the system of white male supremacy can conjure, aided and abetted by our hideous media?
Brachiator
@narya:
Okay, you hate M4A, how are YOU proposing to cover everyone? Because if you don’t have an answer, then you’re saying that you’re willing for some to sicken/die so you can keep what you have exactly the way it is.
Big Mango
She should respond with Mexico will pay for it….and economic success will make it doubly cost effective….
Barbara
@Brachiator: Obviously, anyone can improve it right away by reversing all the policies that Trump and company have used to try to kill it with a thousand cuts. A lot of other improvements would be more technical (for instance, requiring Medicaid eligibility to last for a specific period of time — at least six months — regardless of income, so that people are not flitting in and out of the system, which is very destabilizing for them, their care providers and insurers), but the biggest thing to improve it would be a sliding scale on subsidies, so that there is not a cliff once your income reaches a certain point. I thought of those three things in less than a minute. Surely a sitting senator with an employed staff can figure out how to come up with even more.
the Conster
And by the way, Warren as president would have no say in getting rid of the filibuster, so anyone who buys that line of hers is having smoke blown up their ass. And she’d be replaced by a Republican, so there goes the Senate. If being a *centrist* means accepting political reality, then I guess I am, even though I’m probably the leftest person I know. I’ve just learned about the country I live in since Reagan.
And here’s some real talk about Sanders and Warren:
“DeParle said she was gobsmacked that anyone would follow Sanders on this issue. “I’m just shocked that a number of them let themselves get out there behind Bernie. Because he was there, but does he know how hard it is to get 60? No! Because he never tried.” DeParle recounted numerous meetings sitting on a green Naugahyde couch in Sanders’ Senate office while he lectured her about how Obama should be trying to pass a single payer bill instead of the ACA. “What are you doing to advance that?” she would ask, “because I’m not seeing you out here. I’m not seeing the coalitions forming.””
Warren tying herself to Bernie was a HUGE mistake.
Jim, Foolish Literalist
thread
glory b
@Mary G: In 2010, I remember listening to an npr panel of young people who voted for Obama. Most of them said they weren’t voting that year because he promised to close Guantanamo and he didn’t. At least one or two of the other panelists tried to explain the opposition in the House, but they would not be moved. Obama didn’t do what he promised, and that was that, it seemed.
I haven’t been “enthusiastic” about younger voters since.
the Conster
@Jim, Foolish Literalist:
Hoarse is right. Republicans are cynical enough to run on protecting healthcare from Socialism, and they will win if we nominate a Berniecrat. I’m gobsmacked that anyone would follow the Independent Party of One finger wagging fraud who never accomplished anything in his 35 years in Congress down this rat hole before another census year election, when we need to keep the House and get the Senate, at least. Liz Warren has terrible instincts.
Brachiator
@glory b:
There were probably a lot of older voters with equally lame excuses. But consider: Obama won fairly easily in 2012. And Democratic voters made a big difference in the 2018 mid-terms.
A lot of people, young and old, know that a lot is on the line in 2020. We have to build on that knowledge.
jonas
@Princess:
This isn’t the right analogy. If Warren went around vowing to “lock up those insurance executives” that deny claims, or that “everyone will get affordable healthcare and those Wall Street fat cats *will* pay for it” without really explaining how that would work, it would be more like Trump’s wall rhetoric. It would signal her rage at wealth inequality and lack of affordable HC access for millions. Unfortunately, she unveiled a painfully detailed M4A plan that costs tens of trillions, paid for with a wealth tax that is unlikely to come close to covering it, and that does away with most private insurance. Lots of people lack adequate health care coverage or are furious with the companies that do provide their coverage, but just as the Obama administration fatally underestimated how how many people would be royally pissed when they were involuntarily rolled into ACA-compliant policies that cost them more (and how the MSM, trying to keep up with the RW noise machine, would amplify that outrage), Warren’s team has underestimated the number of people who will freak out if you tell them that their private insurance is going to be replaced with a Medicare-style government program, even one that promises to be largely free. They won’t believe it. As other folks here have pointed out, it would have been far better to have gone with a plan to improve the ACA (e.g. better subsidies for those making over 400% FPL) and a Medicare or Medicaid buy-in option. She’ll be hoist by her own petard on this, unfortunately.
Percysowner
The thing is I don’t think M4A is something Warren is completely in love with. Bernie started the drumbeat in 2016, progressives in the House and Senate continued it. Warren looked at a completely public system (M4A) and one with private input and decided M4A was what would eventually be the best answer for the most people. Certainly it wasn’t an issue she came out of the gate with a plan for. She was willing to support M4A and and let Bernie’s handwave of how to pay for it be enough. But the other Democrats (Hi, Mayor Pete) insisted that she HAD to have a plan NOW, ELIZABETH! So she did her thing and came up with a viable plan that didn’t involve taxes on the Middle Class.
I do think that this plan allows her to negotiate a better deal than say Biden. She can eventually admit that M4A wont pass the House or Senate, but the Public Option will. She can also call for the enactment of the high income taxes and demand that Medicare be beefed up to pay doctors more, add dental and vision, cover drugs without going through private insurance companies, negotiate prescription prices and make it a more appealing choice.
I’m of the view that this moves the Overton Window and that is about as good as we are going to get right now. We do get more if the person setting the bar sets it high so that negotiation is more than just adding the public option without adding value to that option
Brachiator
@Jim, Foolish Literalist:
Yep. This lays it out really well.
glory b
@Brachiator: From your mouth to FSM’s ears…
Jim, Foolish Literalist
@Percysowner: if her proposal scares off suburbanites in WI and PA, then all this “Overton Window” horseshit is a binkie we can suck on while we watch Ruth Bader Ginsberg’s funeral on MSNBC
artem1s
I suppose no matter how you feel about M4all, it’s better to get the debate out in the open sooner rather than later. If the public prefers to incrementally move ACA toward universal coverage, then the polling will show it. If EW can get the MSM to drop GOP talking points and actually have a conversation – great. Then she deserves the nomination and has a chance to win the WH. If she can make the Sanders or some other third party campaign a dead end for voters, even better. But better to find out now than a year from now, I guess.
someone
“I’m of the view that this moves the Overton Window and that is about as good as we are going to get right now. We do get more if the person setting the bar sets it high so that negotiation is more than just adding the public option without adding value to that option.”
This. M4A is a much better place to begin negotiations.
Cacti
@the Conster:
Protecting the ACA is a winning issue for the Dems, and one they paid a steep price for in the beginning. Ceding that position to the Rs, who have fought tooth and claw for a decade to destroy it is unconscionable.
Jim, Foolish Literalist
Barbara
@Percysowner: I am not sold. However, I think she should pivot to some extent to a message like the following: “We need to get better value at all levels of our health care system. We pay more — nearly twice as much — as anyone else to cover fewer people, spend more on administrative services and health care services to do it, and people with coverage still go bankrupt and can’t afford many things, like needed drugs! I think M4A is worth debating and I laid out a plan, but we need consensus that our entire system needs to move in the direction of getting better value. Ask all these people standing around wringing their hands about expenses where they were when Trump’s tax cuts for millionaires and billionaires were blowing a hole through our budget.”
Raoul
Late to chime in but I am very much in favor of setting a vision of comprehensive, effective health care for all permanent residents in the US of A. If we can’t get there by 2023, that’s tolerable. It is useful to be reminded that we may be disappointed during the struggle towards universal access. We need to be strategizing how to get there by the mid-2020s, though, if at all possible.
All the brake tapping and off ramping towards centrist compromises is to be expected. Massive systemic change rarely happens fast. But the ACA kludge is only gonna be workable up to a point, and tinkering around the edges is incredibly uninspiring. But there is no need to accept these constraints this early in the expectations-setting.
Worrywarts like Jen Rubin or Ezra Klein are in this to be professional worrywarts. Whatevs.
narya
@Brachiator: And I’m good with that–as long as the plans are equally detailed. I don’t really know what people mean when they say they want to “improve” ACA (I’m not saying they’re being disingenuous–i think people mean a lot of different things). I think some folks mean that everyone can get affordable coverage. Some folks are focused on pre-existing conditions. I think a coverage mandate would improve the ACA, but that’s probably a heavier lift. I think a public option in the mix would be a fabulous idea, but I’d want to see what that would look like, too. i think it was Barbara above who had multiple good suggestions. Warren’s pretty smart; I don’t think she thought she was going to drop the plan and then expect it to be enacted exactly as she outlined it, and i do think there’s value in saying, well, if we were to do it, this is what it would take. I love HoarseWisperer, and see the points he’s making, but I guess I think it’s too early to be eliminating Warren because she put these cards on the table, and I’m not as certain that this was a mistake.
Steeplejack
@Barbara:
Excellent point. All of our issues—but especially health care and health insurance—tend to get discussed in a vacuum, without reference to anything else. And particularly with regard to costs. Our obscene military budget hardly gets discussed at all, in any context, except when Trump occasionally mentions that he (personally, all by himself) has raised it.
Mnemosyne
Honestly, guys, I’m not freaking out that we’re definitely going to lose an election that’s a year away for which we don’t even have an actual candidate.
This is when we battle out the details and see who rises to the top. We’re not locked in to ANY candidate yet. At this point in 2007, Barack Obama was still polling in single digits.
Please chill.
Mnemosyne
It’s exactly 365 days to Election Day 2020 and the Democrats have already lost.
That must be a new record. ?
And in case it’s not obvious: YES, I’M BEING SARCASTIC.
PJ
@Mnemosyne: The Democrats lost when they didn’t run a Republican for President. Why isn’t there a campaign to draft Manchin for 2020?!! That would bring those Midwestern swing states over to our side!
206inKY
@the Conster: This is how it’s being defined right now, which I guess makes me a centrist for supporting Klobuchar. And yet, during the 2010 endgame of the ACA, I don’t recall any stress about her vote in the way we had to worry about Lieberman or Baucus. I don’t recall her playing anything like Biden’s role in protecting credit card companies. She’s a centrist only by the standards of 2019.
Either way, I don’t want to bet the future of our democracy on the proposition that the suburban voters who flipped blue in 2018 did so because they have become economic liberals who will support a massive expansion of the welfare state, $16 trillion in new taxes, $800 billion in cuts to the military, and the elimination of the private insurance industry, where many of them work as actuaries, sales reps, etc. I think the unifying force holding the 2019 coalition together is disgust with Trump, and Klobuchar has the stones to throw a binder straight into his face.
Ascap_scab
@zzyzx:
I’m totally with you. I’d rather dream of which crumbling bridge I’d want to live under and which brand of cat food I’ll be eating when the Trump tax cuts bankrupt America.
Raven Onthill
It may or may not be done, depending on things like retaining the filibuster, but I’ll tell you for certain that the ACA cannot go on as it has – people are finding out that ACA plans have all the problems of employer health care plus a few of their own.
Meantime, Warren has exploded the “We can’t afford it” argument, which makes the positions of the opposition to an improved plan of some sort a whole lot more difficult.
Ksmiami
@the Conster: Warren is done she just doesn’t know it yet
Jim, Foolish Literalist
@Raven Onthill:
I don’t think any Dem candidate is suggesting that.
Right. All we have to do is win the Senate, an already heavy lift that this plan makes heavier, cut military spending (always popular) and pass the wealth tax, which won’t pass the Senate and wouldn’t stand up to a Roberts-Kavanugh Supreme Court challenge even if it did. Oh yeah, Hickenlooper, Manchin, Jones and Sinema have already announced their opposition to single payer.
But by all means, let’s lose Wisconsin to trump because saying “Single Payer” makes us feel good.