We Need to Talk

Mitch McConnell finally confessed to his sins this week in going public with the Senate version of Republican health care. Of course, the bill is a travesty. It does not really have anything to do with healthcare at all, except as an obstacle to its true goal of massive tax cuts for the rich. Amazingly, the bill is not only more dishonest than its House counterpart, but it may actually be worse in the severity of its outcomes. So much for the Senate as the more reasonable body,

But here is truly scary part. In discussing the possibility of this atrocity becoming law, the press talks about a handful of Republican Senators. There is, rightly, no mention of what the Democrats might do. Sure, this partly reflects the fact that no Democrat is expected to vote for the bill. But it also reflects the fact that the Democrats have done nothing to make this bill harder to support. In part, this is because they refuse to acknowledge one truth that Donald Trump has accidentally told: we the people are now worse off with respect to healthcare than we were when the Affordable Care Act first went into effect. This is not for any of the reasons the Republicans or Trump name, but it is true all the same. The Affordable Care Act was not the success that it should have been, but Democrats need to explain that its failure was that it its design was vulnerable both to the trickery of the insurance industry and to outright sabotage by the Republicans. To explain, let me talk about my own situation.

I am the sole breadwinner for a family of four. My job is good enough that I do not qualify for the subsidies provided under the ACA, but I have my company health plan. My family and I have a host of pre-existing conditions, so we are heavy users of healthcare and we need a large menu of medicines each month. Over the past seven years, I have seen a steady increase in the dollar amount that comes out of my check for health care, and my out of pocket expenses have shot up as the insurance companies have gotten better at imposing copays and deductibles. So I am grateful for the fact that I can get insurance at all, given the pre-existing conditions. I am glad that my daughter, who is turning 22, can still be on my plan. And I understand that my health care expenses are still much less than they would be without the ACA. But my family and I are hurting, and Hillary Clinton is not our president in part because she did not sufficiently acknowledge and address this hurt. The situation is worse for my brother-in-law and his family. They do not have jobs that provide them benefits like mine, and they live in a state where a Republican governor and legislature blocked the Medicaid expansion that would have meant so much to them. For the first few years of the ACA, they had to choose whether to use the healthcare they could afford for themselves or their children, and of course they chose their children. Thankfully, they have now reached the point where they no longer have to make that devil’s bargain, but we were really worried about them for quite some time. Again, the provision regarding pre-existing conditions in the ACA meant that they could get healthcare for themselves once their job situations improved enough that they could afford it.

I am sure this country is full of families like mine, and like my brother-in-law’s. The Democrats are simply not talking to us. They are not acknowledging our hurt. Instead, they are reacting to what the Republicans are doing, and thereby letting Donald Trump and his allies control the conversation. Hillary Clinton spoke vaguely on the campaign trail of improving the ACA, but I regard myself is more politically aware than most Americans, and I don’t know what improvements she thought were needed. Only Bernie Sanders offered a solution, but he got bogged down in the question of how to pay for it in a way that suggested he was unable to master the details needed to make universal healthcare the law of the land. His approach also would have failed to persuade most Americans to support him in the face of Republican fearmongering. I have explained before how universal healthcare can be sold to the American people, but I have yet to hear any Democrat make this pitch. Barring that, the Democrats must explain all of the ways the ACA has made lives better, and all the ways it could be made to do so much more. They must help the American people to see how much better the ACA could be if the Republicans were not so intent on its destruction. One way or another, they must take back the conversation, and make the Republicans react to them for a change. The results of the midterm elections next year will depend on whether or not they can get it done.

I believe Americans are ready to hear the truth. Here is Sheryl Crow with the alternative we have now:

A Plan for the Democrats

The Republicans who now control the White House and both houses of Congress have a problem, and it is the job of progressives in particular, and the Democratic Party as well, if they will only accept the challenge, to make that problem worse for them. The Republican Party as now constituted is dedicated to the proposition that government can only do harm, and never do anything good. The Affordable Care Act, or Obamacare, flies in the face of that proposition, which is why from the beginning the Republicans set out to sabotage the ACA once they understood that they could not stop it. It was also necessary to amplify every problem that occurred during the rollout of the ACA, to promote the idea that the ACA overall was bad. One defense the Democrats pursued was to challenge the Republicans by asking what their alternative was. Now we know: it is the monstrosity known as the American Health Care Act, which I prefer to call Ryancare. At this point, it is not Trumpcare, because Trump had no apparent hand in shaping it, but he has said that he will try to sell it.

In trying to “repeal and replace” the ACA, Republicans ran into sharp opposition from their own constituents at emotional town halls. It turns out that people are discovering, when faced with the prospect of losing the ACA, that they really like and need it. Oddly, Ryancare is also opposed by the most extreme members of the Republican Party, who object to the fact that it fails to completely repeal the ACA. So it would seem that progressives would have nothing to worry about, because the Republicans will not be able to find the votes to pass Ryancare. This assumption, however, fails to take into account the extraordinary sales skills of Donald Trump. This is a man who could sell sand in the Sahara Desert. The last time we underestimated him, he became president. The Democratic Party is being too complacent at the moment, and not listening to their own advice. It is not enough to defend the status quo, to insist that the ACA must remain in place. Despite the exaggerations and outright lies of the right wing, there are real problems with the ACA that created the opening for Trump’s victory in the first place. For many, lack of insurance has been replaced by insurance that people can not afford to use. So, in order to make sure that Ryancare fails, The Democrats need to offer up their own plan, just as they insisted the Republicans do. Let me offer my idea of what that plan should be, and how to sell it.

The purpose here is to offer up a plan that highlights the inadequacies of Ryancare and the harm it will do. We also need to undercut Trump’s efforts to get it passed. So we need a plan that really does deliver on a promise that Donald Trump made, that he would deliver a plan that would save money and deliver better care than the ACA. That plan is universal health care. I have talked before about how and why Democrats have failed to sell it to the American people, but I want to go into more detail now about how to win this battle. Hillary Clinton tried to get universal healthcare in 1993, but her instincts are always to find a consensus solution to any problem. There is no consensus solution here, because there is no way around the fact that you are destroying a vital part of the insurance industry, taking them out of the very lucrative health care business entirely. Done properly, universal health care also hurts the pharmaceutical industry, because you should insist that the government has the right to negotiate for the best prices. So you need to stand up to some powerful lobbies to pass universal health care. That is why the best time to do it is during a severe economic crisis. Barack Obama had that opportunity in 2009, but he too was intent on government by consensus, so we got the ACA instead. Last year, Bernie Sanders tried a different approach, insisting that universal health care was a right, a moral imperative. It is, but Hillary Clinton was able to get him bogged down in the details of how to pay for it. She made him lose the same battle she had lost thirteen years earlier, and also managed to make him look unprepared to govern while she was at it. I believe this was a major reason why Sanders lost the primaries. Ironically, the answer to how to sell universal healthcare was at Sanders’ fingertips the whole time, but he never effectively put the whole package together for the voters.

Universal health care would give the American people cash to spend on other things, so it would provide a major boost to consumer spending. Money that now gets deducted from paychecks for premiums, or spent on copays and deductibles, would instead go directly into the economy, leading to a major boost in job creation. It would also make American companies more competitive, by reducing the cost of hiring, and freeing companies from the expense of providing retiree health benefits. To pay for it, we must first recognize that the current cost of the ACA and other government health programs would no longer be needed, so those funds would go here instead. On top of that, companies currently deduct $260 billion for employee health benefits. Add in increased revenue from all of those new jobs I mentioned. And then there is the kicker. Pair universal healthcare with a measure that costs the government nothing, and you suddenly need very little in the way of new taxes to pay for it all. That measure is an immediate increase in the minimum wage to $15, indexed to inflation. Right wingers like to make the disputed claim that increasing the minimum wage is a job killer, but pair it with the job creating aspects of universal healthcare and that problem disappears. Over time, the minimum wage increase promotes consumer spending, which also means more jobs, and more revenue to pay for healthcare. Bernie Sanders erred in failing to realize the powerful synergy between his two proposals. It even gets better. All those new jobs, plus increased pay for existing jobs, means a sharp reduction in the number of the working poor, meaning funds that had been spent on public assistance programs such as food stamps can be used to pay for universal healthcare instead. I am not an economist, but I think it is possible that this proposal could be sold as being revenue neutral. At the worst, it should be possible to claim convincingly that the only new taxes needed would be on the wealthy.

I am a realist. I understand that there is no chance that a Republican-controlled Congress would ever pass this. Even if they did, you can be sure that Donald Trump would veto the measure. But that is not the point. By offering up this proposal and selling it properly, the Democrats would guarantee the failure of Ryancare, and expose the callousness of the Republican Party for all to see. If anything, the fact that this proposal would not pass should help reluctant Democrats to rally around it, knowing that they would have to answer to their constituents in redder states only for an idea, but not a law that would be vilified in the right wing media. The minimum wage increase is a popular idea, and so is universal healthcare if the public can be made to accept that their taxes do not need to rise to pay for it. The Democrats need to show that they are better than the Republicans who could not come up with an alternative to the ACA for eight years, and this is how to do it.

OK, I admit the song this time is a stretch, but I couldn’t resist: