Attention, Bernie Sanders: Medicare benefits from Inflation Reduction Act begin in 2023

Subscribe (free) to xpostfactoid

Free in 2023

Senate Democrats' passage of the Inflation Reduction Act yesterday evening was an exercise in the art of the possible, the culmination of a year-long immersion in the reality principle. Senate Democrats as a body probed to the last minute what first Manchin and finally Sinema would allow them to pass, and ultimately maxed out on that allowance. 

The result is powerful legislation that gives us a fighting chance to mitigate the worst effects of climate change and sets up a starter home for Medicare to negotiate prescription drug prices. It also boosts the perhaps still-long odds that Democrats can hold the Senate and House and so stave off the Republican threat to democracy itself.

What is Elizabeth Warren cooking up?

Subscribe to xpostfactoid via box at top right (requires only an email address; you'll get 2-3 emails per week on average)

Quick, what's the difference in the way the Des Moines Register and the New York Times quoted Elizabeth Warren's recent I'll-have-a-plan promise?

Des Moines:

"Right now, the cost estimates on Medicare for All vary by trillions and trillions of dollars. And the different revenue streams for how to fund it — there are a lot of them," she said to a crowd of about 475 at Simpson College. "So this is something I’ve been working on for months and months and it’s got just a little more work until it's finished."

New York:

“I plan over the next few weeks to put out a plan that talks about, specifically, the cost of Medicare for all and, specifically, how we pay for it,” she told the crowd at the event, held at Simpson College.

What's so great about Medicare?

Kaiser Family Foundation polling indicates that when a majority of Americans say they're in favor of Medicare for all, most are thinking of the program as it currently exists, not as Bernie Sanders re-imagines it.*

Which raises the question: Why is Medicare's brand so strong?  I've explored the question over at medicareresources.org, companion site to healthinsurance.org.

Personally I would rate Medicare somewhere along the lines of a review advertised by a Cleveland restaurant long ago: Not great, but more than adequate when you consider the alternatives. For all its gaps and flaws, Americans exhale when they hit age 65. Hope you'll click through for a bit more detail.
--

* Most apparently are also thinking that everyone should be able to opt in, not that everyone should be auto-enrolled with no alternatives.

Subscribe to xpostfactoid via box at top right (requires only an email address; you'll get 2-3 emails per week on average)

Bernie Sanders is the Pied Piper of Healthcare Hamlin

Political battles can be semantic, but important. Such is the case with Democrats wrestling with the meaning of Medicare for all.

This week Kamala Harris came out with a healthcare reform plan that seems designed to resolve her past flip-flops as to whether private insurance should be phased out entirely. In brief, she proposed a 10-year path to "Medicare for all" that includes Medicare Advantage -- private plans reimbursed by the federal government and conforming to strict coverage rules. Employers could also offer "Medicare Advantage" plans.  Lots of question marks, but the intent to preserve the public/private hybrid of Medicare as we know it is clear.

Bernie's camp lit into the plan, claiming in effect that the his bill's title (Medicare for All) is politically trademarked. “Call it anything you want, but you can’t call this plan Medicare for All," Sanders' campaign manager Faiz Shakir said in a statement. Pramila Jayapal, lead sponsor of the House version, tweeted, "as lead sponsor of #MedicareForAll, I find it misleading when my fellow Democrats use the #M4A name to describe proposals that are NOT #MedicareForAll."

That's a straight trademark play: we own the hashtag, we own the name. The subtext is that the One True Path to Medicare for All is Sanders and Jayapal's Big Rock Candy Mountain in which a single government entity provides 100% coverage of everything for everyone, funded entirely by over $3 trillion per year in new taxes ($1.5 trillion according to Bernie).

Elizabeth Warren is faking it on healthcare, part 2

Subscribe to xpostfactoid via box at top right (requires only an email address; you'll get 2-3 emails per week on average)

I was deeply disappointment by Elizabeth Warren's response to a question about Medicare for All in last night's debate. In brief, she went all in for Bernie's bill and Bernie's short path.

Charles Gaba usefully contrasts Warren's response last night to her response to a  question from a union member worried about losing good private insurance in a March Town Hall. There, Warren expressed openness to an incremental path either to Medicare for all (lower case "all," given the multiple paths she name-checked) or to universal coverage with a role for private insurance preserved (temporarily or permanently).

I don't think it's wise for Warren to leave herself no wiggle room to pursue health reform short of Medicare for All.  Last night she didn't:

There are a lot of politicians who say, oh, it's just not possible, we just can't do it, have a lot of political reasons for this. What they're really telling you is they just won't fight for it. Well, health care is a basic human right, and I will fight for basic human rights...

Fight, yes, but pick your battles and their pacing. If Warren fights all-out for Medicare for All -- Bernie's bill, which eliminates all other forms of insurance within four years and would require at least a doubling of federal revenue -- what happens to all those other plans she's got? Is she going to "fight for" universal childcare and free public college and near-total student loan forgiveness and a wealth tax and a sweeping new corporate charter -- all while making an industry that accounts for 1/6 of the country's economy in one fell swoop? And all with a razor-thin Senate majority -- if she's lucky.

Warren is doubtless aware of the extent to a drive to remake healthcare would absorb all political capital -- hence her earlier touting of multiple paths to universal coverage. I doubt Warren would disagree with this well informed liberal realist:

If we enact a voluntary public option, and huge numbers of people end up preferring public coverage, we might someday evolve to a public-dominated system. The chances that we will leap to that from our current system are essentially zero.

— Harold Pollack (@haroldpollack) June 27, 2019

Promising to fight for M4A might be tactically justifiable in a Democratic primary -- particularly for someone promising to fight moneyed special interests on all fronts and fighting Bernie Sanders for the left-end vote. But as in the past, Warren's diagnosis of what's wrong with U.S. healthcare is one-dimensional -- and disingenuous.

WARREN: So, yes. I'm with Bernie on Medicare for all. And let me tell you why. I spent a big chunk of my life studying why families go broke. And one of the number-one reasons is the cost of health care, medical bills. And that's not just for people who don't have insurance. It's for people who have insurance.

Look at the business model of an insurance company. It's to bring in as many dollars as they can in premiums and to pay out as few dollars as possible for your health care. That leaves families with rising premiums, rising copays, and fighting with insurance companies to try to get the health care that their doctors say that they and their children need. Medicare for all solves that problem.

She added in a later interjection:

...the insurance companies last year alone sucked $23 billion in profits out of the health care system, $23 billion. And that doesn't count the money that was paid to executives, the money that was spent lobbying Washington. We have a giant industry that wants our health care system to stay the way it is, because it's not working for families, but it's sure as heck working for them. It’s time for us to make families come first

$23 billion! American payers (federal and state government, employers, individuals) spend $3.5 trillion per year on healthcare. Insurers are certainly part of the systemic problem -- but mainly because they pay too much to providers in our divide-and-conquer payer system.  Medicare for All is as much anathema to hospitals and doctors as it is to insurers, as it would radically cut their payments rates. Warren knows this, but she never mentions providers' role in making healthcare ruinously expensive and a source of constant financial threat in Americans' lives.  As I noted after hearing Warren speak about healthcare in January 2018:

...she also presented the unaffordability of healthcare in the U.S., and the huge out-of-pocket costs that many insured Americans face, as purely a product of insurance industry rapine. Not a word about pricing-gouging by hospitals and doctors; the fine science of upcoding; the loopholes allowing self-dealing; the privileging of expensive procedures; the outsourcing to hedge fund- and private equity-backed price maximizers; the predatory balance billing. Providers got a total pass. I sentence Senator Warren to read Elisabeth Rosenthal's An American Sickness, which meticulously documents all these cost inflators and their evolution

I am a Warren admirer. I have heard her deliver her capsule diagnosis of American economic and social woes -- we sold our birthright for a mass of Reaganite pottage -- and I think all her many plans are designed (many if not all well-designed)  to undo galloping oligarchy. But on her policy piano, healthcare gets her left hand.

Warren is willing to take on banks and the tech giants -- and health insurers -- but healthcare providers are spared from her rhetorical fire. That won't make them any the less anxious to defeat her if she remains all-in on Medicare for All.

Related: Elizabeth Warren is faking it on healthcare

Elizabeth Warren is for single payer, sort of. And against healthcare profiteering...sort of.

Elizabeth Warren sent a letter to supporters last week announcing that she's co-sponsoring Bernie Sanders' Medicare for All bill and asking recipients to sign on as "citizen-co-sponsors."

That's interesting, as Warren herself does not sound exactly all-in.   My emphasis below:

I believe it’s time to take a step back and ask: what is the best way to deliver high quality, low cost health care to all Americans? Everything should be on the table – and that’s why I’m co-sponsoring Bernie Sanders’ Medicare for All bill that will be introduced later this month 

Warren is for putting Bernie's bill on the table -- not necessarily for passing it. There's more hedging near the bottom of the letter:

Nicholas Kristof, meet Nicholas Kristof

Nicholas Kristof, urging Bernie Sanders not to pull a Nader and help elect Trump, invokes the sum of all Democratic fears:

Presidential campaigns are driven in part by surprises: What if there is a new wave of Central American refugees, or a terror attack by a Muslim recently admitted to the U.S.? Either would bolster Trump’s chances.

Quite so.  But that second horror scenario flashes on a blind spot in Kristof's last column -- a truly remarkable one, relating the saga of a 20 year-old Afghan woman who, denied a formal education and shut up in purdah at home, has used online courses to learn advanced mathematics and other subjects, including English, and now, having gained admission to a junior college in Iowa, seeks a visa to study in the U.S. That's a problem:

Unfortunately, the United States isn’t helping. Last month, the U.S. Embassy in Kabul rejected her application for a student visa. That happens all the time: Brilliant young men and women are accepted by American universities and then denied visas because, under U.S. law, they are seen as immigration risks...

Clinton's afterthought is Sanders' lead

Hillary Clinton laid out her economic vision in a speech in Detroit on Friday (March 4). There's a lot to like in it.  She's focused on wage growth, reducing income inequality, shifting back to labor the share of corporate profits it's lost over the last four decades. And of course she has a laundry list of proposals designed.to foster domestic manufacturing, boost wages support unions, and steer investment toward troubled regions.

I find her big picture narrative still a bit unfocused, or mis-focused, though.  Here's the heart of it (my emphasis):

Now, some of the blame for these changes in the economy rest with big, historic forces, like trade and technology.  Wall Street and some of our corporations also, however, bear a lot of responsibility.  Too many in the financial industry forgot that the purpose of banking is to get capital to main street to invest in new businesses or expand successful ones like this of any size, and to increase the opportunity for home ownership and community development.

It is not to create huge riches for a select few at the expense of everyone else.  And meanwhile, too many leaders in corporate America are prioritizing their short-term stock price over their workers and their communities.  And we can’t forget the damage caused by trickle-down economics and right-wing ideologues who believe in weakening government oversight, massive tax cuts for the rich, ripping away the safety net, and breaking the backs of unions.

What you "can't forget" is an afterthought, and it should be the lead. To my mind, Clinton has the optimal emphasis of causes exactly backwards: 1) big historic forces 2) bad corporate behavior, 3) trickle-down economic policy.

Will Clinton feel the Bern on Israel?

Very interesting little trial balloon-and-reaction reported in Haaretz (via Nathan Guttman Forward): 

“Hillary Clinton has been a very strong friend of Israel and that is something that should not be lost on the American Jewish community,” said Paul Hodes, a former New Hampshire congressman who came to rally for Clinton at her post-primary event. Hodes, who is Jewish and from New Hampshire, told the Forward: “Senator Sanders hasn’t showed himself to be the kind of friend of Israel that Secretary Clinton is.”

UPDATE: The Clinton campaign denied that it was considering this strategy. “We have no idea what this report is referring to. The notion that we’re planning to start attacking Sanders’ record on Israel is simply false,” Laura Rosenberger, foreign policy adviser, told the Forward.

Clinton vs. Sanders: It's not really head vs. heart

In an Iowa post-mortem, Greg Sargent spoke to several top Democratic campaign operatives about how Bernie Sanders managed to fight Clinton to a virtual tie. Here's one diagnosis:

Her message has tended to focus on solutions and not really reflect back to people the feelings that they have,” Mark Mellman, a veteran Democratic pollster, tells me. “Bernie is reflecting back to people their feelings. She has to do a better job reflecting back to people what they feel and think. Forging an emotional connection is critically important. She’s not always done that very effectively.”

I think that's true to a point, but it leaves something out. Sanders doesn't appeal purely to emotion. He establishes a better head-to-heart pipeline than Clinton does. His read on our current situation and how we got there may be oversimplified, but it's coherent and easy to grasp. It's political cognitive therapy: you feel good because you feel you understand what's wrong and what to do about it.

As Democrats mull how change works, consider Obama

Bernie Sanders' light sketch of single-payer healthcare Utopia has got Democrats debating their theory of change. Generate mass support for fundamental restructurings -- of healthcare, banking, wage law --or take any step you can, by legislative compromise or executive order, to make current institutions more progressive?

Obama is often held up these days as a proto-Bernie who stoked the thirst for swift transformation in 2007-8 and then disappointed. But if  Hope and Change was the Obama trumpet call, his bass note was always slow, hard, pragmatic step-by-step progress.

Even at his most apparently messianic, Obama has always stressed the incremental nature of change for the better. As I've noted more than once, the key words here, on the night he clinched the Democratic nomination in 2008, are began to:

The opposite of Bernie Sanders

Dressed up like Bernie Sanders, Larry David on SNL looked and sounded almost exactly like Bernie Sanders. But that's not why he was funny. Or rather, that's only half of why he was funny. 

In his public persona at least, Sanders focuses relentlessly on problems that in his telling threaten the future of American democracy and humanity itself: galloping income inequality and climate change. Larry David's humor focuses relentlessly on life's trivialities: tuck or don't tuck your shirt, slip a water bottle into a theater, suffer the consequences of  new pants tenting around the crotch.

The joke was that David looked and sounded like Sanders but acted (or thought) like Larry David's character on Curb Your Enthusiasm. 

David did spoof Sanders on the big picture: We're doomed! But it was funny precisely because he made no distinction between the momentous and the trivial:

Eh, not a fan of the banks. They trample on the middle class. They control Washington. And why do they chain all their pens to the desks? Who's trying to steal a pen from a bank? It makes no sense!

The Senate gets into the swing of bankwhacking

Some months ago, as health care reform languished and the Senate ground nearly to a halt, one read frequent laments that the moment for sweeping financial reform was being wasted -- that by the time the Senate got around to full consideration, memories would have faded, rage against the banks cooled, and lobbyists' hooks sunk ever deeper. 

Reasonable worries, perhaps. But those who despaired of strong reform did not reckon on HCR passage changing the dynamic in Congress; or on the pressure that would be generated by bringing the bill to the floor just as election season heated up; or on the fresh spur to rage afforded by an SEC suit (and criminal investigation) against the nation's most lucrative financial institution.

Just nine days ago, Jonathan Chait was marvelling at the strength of the Dodd ill as it came to the floor. Now, the WSJ reports, a tide of amendments is bidding to restrict financial institutions' activity far more radically:

Sens. Ted Kaufman (D., Del.) and Sherrod Brown (D., Ohio) plan an amendment that would prohibit any bank from ever holding more than 10% of the country's deposits and put strict caps on the debt banks issue.

Sens. Maria Cantwell (D., Wash.) and John McCain (R., Ariz.) have worked on an amendment that would force commercial banks to separate from investment banks—revisiting the Glass-Steagall Act of the 1930s.

Sens. Jeff Merkley (D., Ore.) and Carl Levin (D., Mich.) plan a provision to forbid banks with federally insured deposits from certain trading activities.