#anyway sorry to that last pollster

[rimalaw]

Why this Non-Trump Voter Thinks Trump Could Win 2020

I am a registered independent and both parties have ideals I agree with, and sadly those I don’t. Therefore, I am always left out and just looking for who will better support some of the more important values that I believe in. I did not vote for Trump, and because I need healthcare (among other things), I cannot support a man who wants to destroy the healthcare plan that I am on, without a real plan in place that will protect people with pre-existing conditions.  Trump says ObamaCare is a horrible program! But what the heck has he offered??? Nothing!  I can't take small talk to the doctor or hospital if and when you take away my health plan, and have to wait for small business enrollment in Florida (1x a year) to kick in and charge me tons of money to cover my pre-existing condition! 

When Bush was President, health insurance was costing me over $1,200/month, and now under the Affordable Care Act (a/k/a Obama Care which is really why Trump hates it... it doesn’t have his NAME!!), I am paying approximately $600.00 a month for a really good plan. Make no mistake, by now my plan would cost AT LEAST $1400.00-$1500.00, since I am 16-20 years older than when Bush was President.  Let me not forget how Obamacare saved the life of my best friend, who would otherwise NOT have gone to the doctor, and not have discovered a life threatening illness, which but for the Grace of God, she did. Because of her health plan, she received the best care and treatment, and thank God survived one of the worst diagnosis one could get.   She got the plan two (2) weeks before she went to the doctor!  This is what Trump wants to take away! Trump wants to take away lifesaving care without a REAL PLAN in place to help millions of Americans.

And make no mistake; sadly, I think people who are on that plan, who rely on this plan, who have family or friends who need that plan, etc. etc. will still NAIVELY and IGNORANTLY vote for Trump. 

Why do I think that enough people would vote for Trump and that he can win?  Well... Let’s think about it:

1-He is campaigning like a high energy Super Bowl Team in all the swing states, bringing with him his own type of electrifying energy, electrifying his base, and those who are still on the fence and can feel some of that electricity as the attendees and media blare their excitement of his visit.  Make no mistake, these visits matter.  When I ran for Judge 14 years ago, I was an unknown an the youngest in my race.  I didn’t have the type of ethnic or Anglo name needed to win in my County.  However, every area that I was able to heavily campaign in, make speeches, meet people, I WON. I didn’t win that election, but I won those areas.  So I realized that meeting people matters, and in this race, make no mistake, these super spreader events excite people.  They don’t care about COVID while they are there, and for the most part have learned to live with it.  They just care that the biggest Super Bowl team came to their town and made them feel GOOD!  I know Biden has toured, but I’m sorry it doesn’t come close. I know he was doing social distancing etc, but the car thing isn’t exciting nor generating the amount of crowds and energy that it needs. 

2-COVID- yes believe it or not, without COVID, Trump might have been up in the polls without issue.  Then COVID happened which threw him down in the polls, and then his apparent lack of handling it, threw him even further down.  Then he got COVID, and believe it or not, even though he didn’t seize the opportunity to come out more contrite, which would have assured him a win, he still earned a lot of points. How: A) because America saw him as human and actually felt scared for their President (even some of the ones that didn’t vote for him); B) America got to see that he BEAT IT!  Yes, he has the best doctors and treatment etc, but America saw that this 74 year old overweight man, who got sick enough to need treatment, still BEAT IT!  So now America sees COVID (foolishly or not) not to be so feared, which deep down everyone wants to believe. These two results of Trump getting COVID actually earned him voters as people felt scared for him and then happy at his beating COVID, signaling the Country and they could too could slay this dragon; and finally C) people are seeing the country economically recover and attributing this to his lack of fear of COVID, and the desire to keep the country out of lockdown which most Americans are fed up with.  

3-Fracking- For the love of God Joe, you don’t denounce fracking like that when you need the swing states in the way that you do.  Instead you CONFIDENTLY say, “don’t worry, our plan is to slowly bring in safe alternate sources of energy while we freely train current workers and so many more (as we will have so many jobs created) to transition into great and even BETTER paying safer jobs. NO ONE WILL LOSE ONE JOB, and I can guarantee even BETTER Jobs for you all.”  But instead, you have Trump in Pennsylvania, and other swing states scaring people that they will lose their jobs.

4-Law and Order-Make no mistake, I believe the police have systemic racism and needs serious training and overhauling.  But Biden and Democrats need to COMPLETELY distance themselves from the anarchist propaganda of defunding the police. That was NEVER a train to ride.  From the first use of those words, BIDEN should have never bitten, not even a nibble. Now with the visual of businesses boarding up, Trump is touting about these rioters and giving the illusion to those voters less capable to comprehend the difference, that this is what the Democrats, i.e. Joe are doing and allowing. From the get go, Dems and Joe should have aggressively, I mean hot tooting crazy like attacked and distances themselves from it. 

5-COVID AGAIN-I wear masks (2), I barely go out, etc, but like most Americans, we are tired of hearing about COVID.  When that is all that you hear, gloom and doom, and Biden talks about dark days, it just doesn’t sit so well.  Strangely enough, to people on the fence now, Trump seems like the guy that wants to give you freedom and a cheery positive outlook of life, while the Democrats, CNN, MSNBC, etc., are painting this bleak picture and more lockdowns, that no one wants to keep hearing about. 

6-The Darn Polls- So many polls tooting a Biden victory whether true or not, are only making on the fence people, the lazy, the unmotivated, the unenergized Democratic voters say, “they don’t need me, ... I’m not so excited.. or Biden will win anyway.” Meanwhile, the Trump supporters are freaking out and making sure they show up in massive droves to help their Super Bowl Team, I mean their guy. Plus, any poll should really discount a lot of points away from Biden, because really, there are a lot of paranoid secretive, conspiracy believing, or seemingly ashamed Trump voters who will not participate.  Remember, a bleeding hard liberal is more likely to be kind to a pollster and answer a poll; and a right winger will say, “I have nothing to say, leave me alone,” hang up, etc...

7-Socialism-Kill this socialism crap- The Dems should have killed this idea long ago, and Biden should have been VERY ASSERTIVE and vocal about how he is for middle of the road values (yes I know this might alienate the Bernie people, but that’s what Bernie is for. And if this party is so crazy to sit out and let Trump win because Biden isn’t left enough, well then the party has bigger issues which no amount of therapy can fix). 

8-The last Debate- Trump basically showed people he is not so crazy, he can have restraint, he wasn’t rude. People who were running away from him after the first debate or on the fence, came back after he showed America and the world that he isn’t so bad. 

9-Strength and POWER- Basically, aside from the fact that Trump often appears to be a bully, lately, more than anything he has shown stamina and strength.  People like that, and want to join the stronger looking team, and the man that never ever seems to stop, and confidently never takes NO for an answer. People, like to support the one that appears to never back down, never accept defeat, never look weak, and never quit!

10-Too many people believe his lies, those of the crazies on Facebook, and the alt right that disseminate the worst of the fake news. Sadly THE DEMS DON'T STRONGLY and DEFINITIVELY ATTACK THEM!! Every talking point should have been hit with a barrage of targeted commercials and aggressive stump speeches. People need to be told for example, “TRUMP brags about the economy, he hopes you have amnesia and forget that OBAMA left him with a booming economy, and only an untrained monkey could ruin it.  All Trump did was NOT destroy it YET, but his tax cuts to the MILLIONAIRES (not you AMERICA making under 400k) will cause us a depression if he is in office four more years because you can only pay so much to help the country without having income we used to rely on coming in.” 

Well, that’s all folks. I hope I am wrong, but if it doesn’t go as the untrustworthy polls show, these are some of the main reasons why. These points are for that small percentage that pick the winner in most Presidential elections, not for the firmly committed of either party. Also, if Biden doesn’t win, then those who protested this summer did not all come out to vote, and that’s shameful! 

#trump2020 #election2020 #2020 presidential election #stoptrump #Trumpcanwin

[snkpolls]

SnK S3E15 Poll Results (Anime Only Viewer Version)

The poll closed with 84 responses. Thank you to everyone who participated!

Please note this is the anime only viewer version of the poll. Manga readers, please click here for the results of the manga reader poll!

RATE THE EPISODE 65 Responses

This episode got overall positive responses from the fandom, with nearly all votes at a 4-5 rating. Can WIT keep up this momentum?

Another fantastic episode.

intense

Stressful

Rude

WHICH OF THE FOLLOWING WAS YOUR FAVORITE MOMENT? 64 Responses

The favorite moment of the episode inarguably goes to Bertolt activating his Bertl Bomb™! Closely behind is the short Mikasa vs. Bertolt conflict, and in third place is Annie’s hesitance to assist in killing Marco.

Reiner was right, Bertholdt really was the strongest warrior of their so-called "hometown", able to fend himself off from an Ackermann.

Wow Bertholdt is really strong, he completely dominated Mikasa in their fight.

WHAT DO YOU THINK OF THE APETITAN AND YOUSEEBIGGIRL REARRANGES? 61 Responses

72% of respondents were thrilled to hear new versions of familiar songs from Sawano, feeling that the new versions were totally epic. Nearly 20% still prefer the originals, although they agree the new versions sounded cool.

WHAT’S YOUR OPINION ABOUT THE RECENT EARLY EPISODE LEAKS? 63 Responses

54% of respondents weren’t even aware that leaks of the episode had happened. 23% aren’t happy about the leaks happening, while 15% don’t really care.

Great. I hate sunday releases

WHO WON THE SHOUTING MATCH? 63 Responses

With nearly ¾ of the vote, Bertolt is deemed the winner of the shouting match on the rooftops!

Armin should have asked Bombholdt why they wanted to kill all humans.

HOW DID YOU FEEL ABOUT BERTOLT’S DEVELOPMENT AT THIS POINT? 64 Responses

40% of respondents are glad to see how far he’s developed as a character. 26% are just happy to have his thoughts and more lines from him, and narrowly behind at 25% people are curious to see what will become of his character.

He’s progressed but in the way of the warriors. The more he’s with beasty and Reiner the more cold hearted he becomes.

i still hate him with all my heart

Bertholdt with conviction is really badass. He’s actually interesting now.

HOW DID YOU FEEL ABOUT ARMIN BLUFFING ABOUT ANNIE A SECOND TIME? 64 Responses

A whopping 60% of respondents believe that Armin should have known better than to try manipulating Bertolt’s feelings for Annie to his benefit again, while the remaining 37% feel that it was worth another shot.

I think in Armin’s scenario he couldn’t think of another bluff that quickly so he resorted back to Annie, knowing that there was a chance it wouldn’t pay off.

WHAT DID YOU THINK ABOUT CGI COLOSSAL TITAN? 63 Responses

With a surprising divide between positive and negative reactions, 42% of viewers are pleased with the CGI render of the Colossal Titan, labeling it as “awesome.” Closely behind, 30% feel that it’s very “meh.”

WHAT DO YOU THINK ABOUT THE 104TH RIDING ON TITAN EREN? 64Responses

Fanart becomes a reality as the 104th take a ride on Eren’s titan form! 42% of viewers found this detail adorable, 29% think it’s pretty neat, and 20% don’t think much of it either way.

WHAT WAS YOUR REACTION WHEN IT WAS REVEALED THAT ALL OF THE WARRIOR TRIO WERE INVOLVED IN MARCO’S DEATH? 64 Responses

Much to the pollster’s delight, it seems that Reiner’s brief flashback from season 2 didn’t spoil it for everyone! A solid 25% of viewers had expected that each of them played a part in Marco’s death. 20% of viewers were genuinely surprised by the reveal. 18% picked up on the clue from season 2.

FUCK. REINER. BERTOLT. AND ANNIE.

I excepted all 3 to be involved but I DIDN’T expect them to care about killing Marco.

I loved seeing that Annie actually cared and didn’t want to take Marco’s ODM gear.

DO YOU THINK THE WARRIOR TRIO COULD HAVE NEGOTIATED WITH MARCO WITHOUT KILLING HIM? 63 Responses

The overwhelming majority believe that Reiner and Bertolt were right to believe that negotiation with Marco wasn’t possible. 14% of respondents aren’t sure either way, and 12% feel they could have come to an understanding.

THE WARRIORS TALK ABOUT AN “EVIL RACE” AND JUST WANTING TO “END IT.” WHAT DO YOU MAKE OF THIS? 63 Responses

Nearly half of respondents believe that there’s someone above the warriors who wants humanity to perish. 20% believe that shifters are a different race than the rest of humanity in the walls, and 19% believe everyone in the walls are of a certain race, and that is why the warriors are trying to kill them. In retrospect, we should have left an option for write in answers. :P

WHAT DO YOU THINK THE SIGNIFICANCE OF REINER’S WORDS ABOUT HIS PROMISE TO YMIR ARE, IF ANY? 63 Responses

42% of respondents feel that Reiner’s desire to fulfill his promise to Ymir stem from mixed motivations. 20% believe that he genuinely just wants to save Historia, and 19% believe that he’s doing it as a way to repay her for saving them.

I feel like he’s honoring her last wish. (My theory is the Quadruped Titan night have eaten her)

REINER SURVIVED THE THUNDER SPEAR ATTACK BY TRANSFERRING HIS CONSCIOUSNESS AGAIN - THOUGHTS? 64 Responses

Over half of the fandom feel that Reiner’s abilities are simply born from plot armor. At much smaller percentages, 15% of respondents feel that it’s a reasonable explanation for his survival, 12% think it’s a super cool feature of his titan, and 10% aren’t really bothered about it.

Again, I think this is how shifting works. If your consciousness is transferred to your body then you transform, but if your mind and body are disconnected (by cutting off the nape) you die.

whatever, i just hate him with all my heart

WHAT IS THE FATE OF HANGE’S SQUAD? 63 Responses

44% of respondents are certain that most of the soldiers with Hange were killed in the blast, with maybe a couple of survivors. 30% are slightly more optimistic about the survival numbers, but ultimately feel most of them didn’t escape the blast. 15% are certain that all of them have perished, and a small 9% are optimistic about their fates.

I hate that I have to wait  until Sunday to see what happened to Hange’s squad.

DO YOU THINK THE 104TH WILL BE ABLE TO DEFEAT BERTOLT? 62 Responses

43% of respondents have faith that the 104th will be able to outdo Bertolt somehow and defeat him. 29% don’t want to say confidently either way, and 17% already know what happens.

HOW HAVE YOU OPINIONS ON THE FOLLOWING CHARACTERS CHANGED?

After this episode, Marco, Bertolt, Annie and Armin got large boost in regards to how well liked they are among respondents. Meanwhile, Reiner took the biggest hit, with more people finding him less favorable than more favorable, although most opinions remained unchanged. The Beast Titan, now known as Zeke, got a boost in terms of favorability. Mikasa remained mainly unchanged, but also received a good boost in favorability this episode.

BARREL BOY BEST (problematic) BOY

Jean and Mikasa are the only ones with resolve. Reiner and Bert are from the past

It feels like each character is acting realistically. They are on opposite sides of a war that they don't understand but were thrust into

ADDITIONAL THOUGHTS ON THE EPISODE?

It’s nice. Bertolt’s tranformation scene was really epic... but Hange squad might be dead... T.T

I think they could of done a better job in going into more depth about the plan? And i wish they didn't leave us hanging with what happened to Hange's squad

This may be a long one so buckle up. (im sorry)

Okay, so first off I didn’t know that quadrupedal titan could speak so that totally caught me off guard. Secondly, having seen the Lost Girls OVA, I expected Annie and at least someone else to be involved with Marco’s death. I feel really bad for Annie (and Bertolt, but mostly Annie) because it was obvious she didn’t want to kill Marco. Also Reiner’s split personality thing??? Anyways, I’m happy we finally got to see the beadt titan shifter, he kinda looks like Grisha though. The thing with Bert and Reiner was great. The Bert vs Armin yelling battle was great as well. I’m super excited for the next episode! This one was so good.

WHERE DO YOU PRIMARILY DISCUSS THE SERIES? 60 Responses

Thank you to everyone who participated! We’ll see you again in a few days!

#snk spoilers #snk s3 #snk poll #snk polls #poll results

[theliberaltony]

via Politics – FiveThirtyEight

Welcome to a special weekend-edition of FiveThirtyEight’s weekly politics chat. The transcript below has been lightly edited.

micah (Micah Cohen, managing editor): Hey, everyone! We’ve convened here on a weekend(!) to talk about President Trump’s address to the nation on Saturday. Trump called the country together to make an offer to Democrats to try to end the partial government shutdown, now more than 28 days old.

Here’s Trump’s offer, summarized by Bloomberg News reporter Sahil Kapur:

President Trump outlines his offer:

• $800 million for “urgent humanitarian assistance”

• $805 million for drug detection technology

• 2,750 new border agents

• 75 new immigration judge teams

• $5.7 billion for a wall

• 3-year DACA protection for 700k

• 3-year TPS

— Sahil Kapur (@sahilkapur) January 19, 2019

So, the question in front of us: Is this offer likely to end the shutdown? And, more generally, is this a smart move politically by Trump, who’s seen his job approval rating erode as the shutdown has dragged on?

Let’s briefly start with that first question. What do you make of Trump’s offer? Will it bring about the end of the shutdown?

sarahf (Sarah Frostenson, politics editor): No.

micah: lol.

natesilver (Nate Silver, editor in chief): Nyet.

perry (Perry Bacon Jr., senior writer): It’s not at all likely to end the shutdown. House Speaker Nancy Pelosi bashed the proposal before the speech started (once reports came out with Trump’s offer). He didn’t consult Democrats before the proposal was released. It’s not clear he was even really trying to get Democrats to sign onto this.

sarahf: Yeah, what I don’t understand about the proposal is that it was negotiated without any Democratic input. It was just Vice President Mike Pence, Senior Adviser Jared Kushner and Senate Majority Leader Mitch McConnell talking with fellow Republicans.

natesilver: I mean, there are some permutations where this is the beginning of the end of the shutdown, I suppose.

Those have to involve some combination of (i) Trump offering a better deal than what he’s offering right now, and (ii) public opinion shifting to put more pressure on Democrats.

micah: So is the best way to look at this address as basically a political ploy — an attempt to change the politics of the shutdown? (I don’t mean “ploy” in a negative sense.)

perry: I think that’s the only way to look at this.

natesilver: The real audience for the speech is likely the media. Because we’re the only people sick enough to actually waste our Saturdays watching this thing.

slackbot: I’m sorry you aren’t feeling well. There is Advil, Aleve and Tylenol in the cabinet in front of Nate’s office/Vanessa’s desk.

micah: lol

natesilver: lol, slackbot

Anyway, in theory, “we’re willing to compromise and Democrats” aren’t is a perfectly decent message. It’s BS in various ways (mostly because the compromise Trump is offering isn’t too good). But it’s a fairly conventional message — to sell a not-very-great compromise as being a good deal.

sarahf: Right now, Americans overwhelmingly continue to blame Trump and congressional Republicans for the shutdown. Saturday’s speech seemed like an attempt on his part to try and shift some of that narrative by outlining a proposal that definitely seemed like a compromise.

perry: And I think it has as few potential good effects for Trump. First, it may help keep Republicans on Capitol Hill aligned with him. They were getting leery of his wall-only strategy. This makes it easier for the party to unify around him.

Second, Trump’s proposal allows McConnell to hold a vote and suggest he and his chamber are trying to resolve the shutdown too, just like the House is doing.

Finally, I assume, when pollsters ask people about this proposal, it will be more popular than the wall itself. My guess is it will be near 50 percent support and perhaps higher. Most people I assume aren’t totally against any money for the wall and feel like Dreamers must have a path to citizenship or else.

sarahf: And I don’t know if it’s a good look for Democratic leaders like Pelosi to immediately come out the gate saying, “nope this doesn’t work.” Then again, they weren’t consulted in the making of the deal it sounds like, so maybe she’d be better off highlighting that.

natesilver: I did think it was weird that Trump opened the address with a sort of uncharacteristically gentle paean to the virtues of legal immigration, but then careened to talking about drugs and gangs and violence and some of the other stuff that doesn’t usually pass a fact check. If you actually wanted to portray an image of bipartisanship, you could skip most of that stuff. Or you could talk about how there were extremists on both sides — call out Republicans for X and Y reason.

micah: Well …

I do wonder if this could change the politics of the shutdown in more than one way, as Perry was getting at.

It could make Democrats look like the intransigent side, as you were all saying.

But, it could also shift the narrative towards more “border crisis” and less “wall.” And that’s better political ground for Trump. Polls show more people believe there is a crisis at the border than support a wall.

sarahf: Right, last week we looked at different pollsters who asked Americans what they thought of the situation at the U.S.-Mexico border. I was surprised by the number of Americans who thought it was a serious problem or a crisis. Fifty-four percent of respondents in a Quinnipiac poll said they believed there was a security crisis along the border with Mexico. And in a CBS News/YouGov poll, 55 percent said the situation was “a problem, but not a crisis.”

natesilver: It could shift things — although, again, it’s worth mentioning that the deal Trump offered isn’t really much of a deal at all.

In fact, it offers a bit less than what they floated last night.

That was my read too -& this is a crucial distinction Democrats are already seizing upon. WH officials last night said it was the Bridge Act-& confirmed that to other reporters today-but what Trump announced just now is NOT the Bridge Act, it's a more limited twist on it. https://t.co/CxX154n9As

— Jonathan Swan (@jonathanvswan) January 19, 2019

The DACA part itself is a compromise, but to get that compromise, Democrats have to give up something (wall funding) that they’re firmly opposed to.

Although, it probably is fair to say that the wall is also a compromise of sorts. As Trump actually emphasized. It’s not all that much wall. It’s certainly not a big concrete wall stretching the length of the border.

sarahf: I know! OMG, what a 180 from him on that!

And, as Democrats will be quick to point out, they were already working on their own legislation that would give $1 billion in funding for border security (but not a wall – to be clear).

natesilver: Right, and Trump hasn’t really made the case as to why a wall is necessary to stop the humanitarian crisis at the border.

The other thing is that … none of this is really new. This compromise, if you want to call it that, has been around for a long time. Democrats have rejected it because it doesn’t give them enough. They rejected better versions of this compromise before the shutdown began, in fact.

And Democrats have more leverage now than then because Trump needs the shutdown to end a lot more than they do — it’s hurting him politically.

micah: I guess my point is more that the convo may change.

perry: To put this bluntly, I think this speech had two audiences the media (so they will do “both sides” coverage) and Republicans (so they will stay loyal to Trump on this issue). I assume this speech will buy him at least of few days of that. And both of those, as Micah suggests, will help with the public opinion.

sarahf: I was kind of surprised that he made no mention of the thousands of furloughed government workers.

Like some kind of nod to their hardship. But nada.

perry: They’re all Democrats.

I’m joking, but that is what he thinks.

natesilver: The question is partly: will the press run with Trump’s frame?

micah: Nate, I don’t know if the media will run with it.

Probably?

The headline in the lower-third on CNN right now is “Pelosi rejects Trump’s proposal to end shutdown.”

perry: Trump may have bought himself at least another week to sustain this shutdown. Next week will be 1. Pelosi rejected Trump’s idea before he spoke, and 2. Senate holds vote and Democrats filibuster.

You all disagree?

micah: I think that’s right, Perry.

As we’re chatting, here’s Politico’s headline: “Trump’s bid to negotiate on wall met by Democratic rejection”

The Washington Post: “Trump offers to protect ‘dreamers’ temporarily in exchange for wall funds”

Dallas Morning News: “Trump seeks border wall funding in exchange for DACA protections to end shutdown”

natesilver: There’s at least some semi-intelligent understanding on the White House’s part of how media dynamics work.

At least parts of the speech play well into the media’s “both sides-ism.”

micah: NBC News: “Trump offers new shutdown deal, Democrats expected to reject it”

Los Angeles Times: “President Trump proposes to extend protections for ‘Dreamers’ in exchange for border wall funding”

ABC News: “Trump will extend ‘Dreamers,’ TPS protection in exchange for full border wall funding”

CBS News: “Trump proposes deal on immigration, Pelosi calls shutdown offer a ‘non-starter’”

natesilver: But the thing about that NBC headline is that the “new” part is pretty misleading.

perry: Those are great headlines for Trump. Considering the reality is closer to this:

Isn't this a kind of hostage-taking squared? First end the programs. Then shut the government. Then promise to temporarily restore the programs you've ended & reopen the govt you have closed, in return for the ransom of $ for a wall that 55-60% of country consistent opposes? https://t.co/PhsMABh6VC

— Ronald Brownstein (@RonBrownstein) January 19, 2019

micah: Yeah, at least in the very very early going, this seems like a good move by Trump.

natesilver: Keep in mind that media might feel a little chastened this week by the mess that’s become of the BuzzFeed story.

micah: Yeah, I was thinking that.

perry: I also think that keeping the Lindsey Graham’s of the world happy is something Trump cares about. The Republicans on the Sunday shows now have something to say. So do the Will Hurd’s.

micah: Very good point.

perry: Pelosi and Democrats, I would argue, were more unified than Republicans before this speech. But I wonder if some moderate Democrats start getting nervous now.

natesilver: The path here is like:

1. Trump and Republicans maintain some degree of message discipline for a week or so; 1b. Trump and Republicans don’t face too many defections from their own base; 2. Polling and other indications show that blame for the shutdown is shifting away from Trump and toward Democrats; 2b. There aren’t any strikes or planes falling from the sky that create a crisis and force an immediate end to the shutdown; 3. Trump offers Democrats a little bit — maybe quite a bit — more.

If all of that happens, maybe he gets a deal!

And no one of those steps is *that* crazy.

perry: So the fundamentals of this issue have not changed, you are saying, Nate?

natesilver: I don’t really think it changed anything.

perry: I agree.

natesilver: Except Trump made a chess move to advance the game instead of just sitting there petulantly staring at his opponent and watching his clock run down.

micah: “It gives him some more time” is a good read, I think.

natesilver: It was an extremely standard chess move, but at least it was a move!

sarahf: Well, I mean leading up to this speech there had been some speculation he’d declare a national emergency. And he didn’t do that.

So all things considered, I think this was a much smarter political move to make.

natesilver: Oh yeah, this is definitely better than that.

sarahf: Because I do think at this point Democrats have to say something other than, “we won’t support this.”

natesilver: It was, like, almost what a normal president with a competent group of advisors would do!

sarahf: Hahaha yeah

natesilver: But it will require a lot of follow through.

perry: I think Trump is aware that declaring a national emergency is a “loss.” He doesn’t want a “loss.” I don’t know how he gets a win. I actually think, this proposal, if it was passed, would very much irritate the right.

I will be curious how the right receives this idea.

perry: Ann Coulter attacked it hard.

natesilver: Coulter attacked it … although… you could almost say that’s helpful for Trump.

perry: Good point.

It makes it seem like more of a compromise if the right hates it.

natesilver: Now, if he loses the votes from several conservative Republicans in the Senate, then he’s screwed.

Or if he himself has second thoughts because Sean Hannity calls him tonight, he could screw himself.

perry: That’s an interesting question: Can Sen. Ted Cruz vote for this?

Can it actually pass the Senate?

micah: That is interesting!

perry: Because I assume part of the play here is for Republicans in the Senate to be seen doing something about the shutdown.

Would Sens. Susan Collins and Cory Gardner support this from the left-wing of the GOP? I think yes. But would Cruz, and some of the more hard-core immigration members on the more conservative wing of the party?

I assume yes, but I’m not sure.

micah: Wouldn’t you assume he cleared this with the Cruz’s of the world before unveiling it?

perry: I would not at all assume that.

micah: LOL.

That was a soft-ball.

perry: McConnell maybe.

sarahf: Yeah, I’m not picturing mass Republican defections here in the Senate … I guess just because McConnell seems to have been so heavily involved in negotiating this.

natesilver: Right, yeah

perry: Do we think any Democrats vote for it?

Doug Jones? Joe Manchin?

I assume no, right?

natesilver: Manchin maybe.

He voted to confirm Supreme Court Justice Brett Kavanaugh, so it’s not exactly like he’s worried about stoking the ire of the Democratic base.

sarahf: But it does make you wonder why Trump ever listened to Mark Meadows and the Freedom Caucus in the first place getting into this mess.

Wouldn’t have $1.7 billion or whatever it was and no extension for DACA, TPS, etc. have been more popular for them?

I guess none of it went to the wall. So maybe not. No way to appease anyone!

natesilver: Right, the $1.7 billion didn’t specifically include border wall funding though.

perry: Another question: I think I’m a believer in the distraction theory, so would Trump have scheduled this speech if he knew Buzzfeed’s Michael Cohen story would be so heavily criticized?

micah: He sorta stepped on a pretty good news cycle for him.

Though Buzzfeed is standing by its reporting.

natesilver: Hmm. But the fact that he had a good news cycle probably means that today will be portrayed more favorably by the press.

So that gave him more incentive to do it.

perry: So you think the media, cowed by the coverage of the Cohen story, will cover this announcement more favorably than otherwise?

natesilver: The headlines we’re seeing are not “Embattled Trump desperately proposes already-rejected compromise in meandering speech,” but rather “Trump proposes new compromise and Pelosi rejects.”

micah: And you think the former is more accurate than the latter?

natesilver: I think “Trump again proposes already-rejected compromise in competent speech; Pelosi reiterates that she won’t agree” is roughly correct.

micah: The other thing maybe worth keeping in mind: The politics of the shutdown right now are really bad for Trump. Trump is unpopular, and the wall is even more unpopular. This is from our friends at The Upshot:

micah: And this is from us:

I guess what I’m saying is that it wouldn’t be too surprising if the politics of this improved for Trump after his speech, given where they are now. There’s plenty of room to improve.

Anyway … final thoughts?

perry: We know that presidential addresses generally don’t work. But Trump is making those political scientists look really smart.

sarahf: I think the fact that Trump didn’t consult Democratic leadership is a big ding against this proposal. But the fact that Trump did put forward some kind of compromise is something. It has the potential to change the politics around the shutdown.

It’ll be interesting to see what congressional Republicans actually put forward and what Democrats choose to counter with.

natesilver: I thought it was a bit weird at the end when Trump said this was just the start of negotiations on a much bigger immigration solution.

If this is just small potatoes stuff, Pelosi might ask, why do we need to keep the government shut down, when we’re going to have a much bigger discussion about immigration anyway?

That’s ultimately the question that Trump doesn’t really have a good answer for. Why do we need to keep the government shut down to have this negotiation?

Senate Minority Leader Chuck Schumer and Pelosi will need to be clear about that in their own messaging.

At the same … I wonder if they also want to float, maybe on background because it does sort of contradict the message of “no negotiations at all while there’s a shutdown,” some notion of what a real compromise would look like. e.g. the full DREAM Act.

Or my idea: Offer HR1, the Democrats’ election reform/voting rights bill, in exchange for the border wall.

perry: The one reason I have a hard time seeing any deal being cut: “the wall is a monument to racism” is a real view on the left and has real influence. That makes it much harder Democrats to sign off on any money for the wall.

natesilver: Also, Republicans would presumably never agree to HR 1. But it moves the Overton Window (sorry if that’s become an overused concept now) and frames the idea that Republicans are nowhere near offering a fair compromise.

If the wall is so important to Trump — and he’s often talked about it as his signature priority — a fair offer now that we have bipartisan control of government would be to give Democrats what’s literally their No. 1 priority (given that they named the bill HR1) as well.

(That’s Pelosi’s hypothetical argument, not me necessarily endorsing the deal as fair to Republicans.)

micah: Yeah, that kind of deal seems a looooooong ways off.

#IFTTT #Politics – FiveThirtyEight #politics #538 #A FiveThirtyEight Chat

[lorajackson]

‘Slipping and Sliding down the Polls’

This is an excerpt from episode 233 of The Editors.Rich: So Jim Geraghty, I have the RealClearPolitics Biden versus Trump polling page up right here. I’m just going to read you some numbers going back to … This is a CNBC poll from the 10th and 12th of June. And I’m just going to run through to the latest poll. Biden plus ten. Biden plus eight. Biden plus twelve. Biden plus nine. Biden plus twelve. Biden plus 14. Biden plus nine. Biden plus eight. Biden plus four. Biden plus eight. Let’s look at Wisconsin, Jim. Wisconsin. Biden plus twelve. Biden plus 14. Biden plus nine. Biden plus eight. Biden plus four. Biden plus eight. Sorry, that was the general election again. Florida, Biden eleven. Biden plus seven. Biden plus six. Biden plus nine. These are the real Wisconsin numbers. Whoops, now I’m on Florida. I’m back on Florida 2016 for some reason. Wisconsin, here it is. Biden plus nine. Biden plus eleven. Biden plus four. Biden plus eight. Trump plus one. Let’s do Pennsylvania just for fun. Pennsylvania, Biden plus ten. Biden plus three. Biden plus five. Jim Geraghty, what do you make of it?Jim: Well, for all the listeners who lost track of all those numbers in there, let me summarize what Rich just laid out over the last couple of minutes. Everything is bad. The polls are bad.Rich: There was a Trump plus one in one of these states. Florida maybe. Was it Florida or Wisconsin?Charlie: Wisconsin. It was the Trafalgar poll in Wisconsin.Rich: Trafalgar. I think Trafalgar has him up in one of these other states, too. I won’t bore our listeners by trying to find where it is.Jim: Broadly speaking, the big three swing states up in the upper Midwest, Michigan, Pennsylvania, Wisconsin, they all look pretty bad. Florida, maybe not looking bad but still not looking great. Every now and then Arizona, which everybody kind of thinks of as a Trump state, not looking that great. Iowa and Ohio, two states that Trump won by pretty sizable margins last time, not looking great. Well actually, there’s a fairly consistent movement across all the polls, across all the country of anywhere I would say from two to five to ten points against Trump towards Biden. Now, when you have this discussion with Trump supporters, they’ll jump up, and they’ll say, “Hey, there are some people out there who don’t want to tell a pollster that they’re voting for Donald Trump, but they’re going to vote for him anyway.” I think that’s true. I think that’s probably … I don’t know what percentage of the population that is. I don’t know what percentage of the electorate that is. I think it’s probably worth one or two points easily. Five points? Not so sure. The idea that it’s going to overcome a ten-point deficit we’re seeing in these polls, I’m rather skeptical of it. And I certainly would not want the Trump campaign to walk around saying, “Oh don’t worry; we’re totally doing fine.”And I think probably what might have been a particularly useful canary in the coal mine, for weeks and months we’ve been hearing, “Oh, don’t worry; don’t worry about these polls. Polls were wrong in 2016.” Brad Parscale is building the Death Star. By the way, if you’re going to compare your campaign to some sort of science fiction device or instrument, please don’t pick one that blew up twice when a small underfunded band decided to go after it. Probably what I think was the steam coming out of the engine for the Trump campaign was the Tulsa rally last week. The turnout was nowhere near what the Trump campaign expected. Parscale himself was saying a million tickets had been requested. And yeah, maybe some people were afraid of the protesters. No doubt I think some people were understandably worried about catching coronavirus at a large indoor event with crowds. Maybe some of the factor was people who ordered tickets who had no intention of showing up. But let’s face it; it’s Tulsa, Okla. It’s Trump, it’s a Saturday. There’s really no good reason for him to not be able to put a decent crowd together. And the fact that this was so much lower than they expected, I think that convinced even the skeptics on the Trump campaign that no, they’re not winning this race. Everything is not fine.The interesting thing is, I actually think one of the most encouraging headlines I saw, even articles that I saw in the past week was by Politico, June 27th, “Trump Knows He’s Losing.” Trump admits that he’s losing and the story begins, “The president has privately come to a grim realization in recent days. People told Politico, amid a mountain of bad polling and warnings from some of his staunchest allies that he’s on course to be a one-term president.” You can’t solve a problem unless you see a problem and unless you recognize it’s a problem. And I think the worst possible thing for the Trump campaign between now and November would be to walk around saying, “We don’t have to worry about any of these polls. These polls are meaningless. We’re still doing fine. We’re still doing great.” Look, there’s a very simple way to explain why Trump would be in lousy shape up against Joe Biden at this point. When in fact, at the beginning of the year, he was not in that rough shape.For a long time the idea is: Okay, these Democrats have taken over the suburbs. There’re a whole bunch of white soccer moms and minivan-driving dads out there who abhor what the president does. They just don’t like what they see. They can’t stand what he’s saying on his Twitter feed. But that’s okay because we’re going to make up for it amongst blue-collar whites in those key swing states. Well, that works when unemployment is between 3 percent and 4 percent. That doesn’t work when unemployment is in double digits, and it’s easy to see some white blue-collar workers saying, oh, you know what, I’m pretty disappointed with this presidency; maybe I should give this guy Biden a try. I don’t think the cake is fully baked yet. I don’t think that Trump is actually defeated yet. He just needs to run a very different campaign from here on out. And I thought your observation on the Corner the other day, Rich, where you know, asked by Sean Hannity this ultimate softball, what do you want to do in your second term? And Trump gives this meandering Mississippi River of an answer that talks about how experience is good and I didn’t think experience was good before. John Bolton’s a real SOB.If I had the chance to talk to the president, I would say, “Mr. President, you need to start talking to people about what will happen in your second term and what you can deliver. People need a sense of what will happen. You need to lay out an extensive second-term agenda.” I think this argument you’ve seen from … I don’t often agree with Sohrab Ahmari about all these other guys who are saying, you got to put up a forthright defense of the American Founding, the American principles. You need to say, this is a good country. We have laws, and we’re not perfect, but we are seeing this violent anarchist movement that wants to tear down everything we have, and I will not stand for it. That’s a message that can win. But you can’t wake up every morning, watch the TV and complain on what you see on cable news. And you’ve got to get rid of … Anyway, so I’ll stop for my usual … I think the polls are that bad. I think he is on course to lose. I think there’s time to fix it, but he’s got to get focused, and time is ticking away right now.Rich: It’s kind of funny. Some of Trump’s worst moments have been on Hannity. And they’re so bad exactly because Hannity has zero intention of making them bad. It involves whiffing on a softball. But Charlie, what do you make of the general terrain?Charlie: I really like that the impression that Jim did of Trump was actually of Chris Mathews. They have similar hair maybe. That’s such a good Chris Mathews impression, Jim. What do I think? I think Biden is winning and is likely to win. I don’t think that Biden will win by ten points when it comes to Election Day. There’s a small part of me that wonders if we’ve been here before, but that’s not based on any intelligent analysis. It’s just the lizard part of my brain remembering how sure I was that Hillary Clinton was going to win and also remembering seeing some similar—Rich: You weren’t 100 percent. In your defense, you weren’t 100 percent sure. There’s that moment I starkly remember we were sitting in your office. We might have been recording a podcast. We were recording a podcast. You had the sizable office back in the old NR world headquarters, and you were playing around with 270 to win or the RealClear electoral map. And I remember you pointing to 270 on the Trump side. And it involved those blue wall states. Playing around with those blue wall states.Charlie: Yeah, so I should probably separate out the year because at this point in the summer of 2016 I was absolutely convinced that Hillary was going to win. And we were seeing similar polling at the state and the national level, and we were also being told that Republicans were going to lose the House and the Senate. I would need to look up the numbers, but I distinctly remember them being down by about seven on the generic ballot in the House. As it got closer to it, yeah, I started to play around with the map and to wonder. And then there was one incident which I think I texted you about, Rich, where I went to get a haircut in Connecticut, and all of the people who worked in this old-fashioned barber shop were either second- or third-generation Hispanic immigrants or Italian Americans. And all of them were for Trump. Every single one. And it made me wonder. Not that he won Connecticut, but there’s just something about the way they were talking about Trump and Hillary that made me wonder. But I didn’t think that Trump was going to win even on Election Day.And I’m not saying that this is the same. I don’t think it is. But there’s a part of my brain that’s just been humbled by that experience. I also remember Romney being up seven points in the Gallup poll a lot in 2012. And I look at these Florida polls and sure, maybe Biden’s up eight. Entirely possible. It’s also true that Andrew Gillum was up over Ron DeSantis by seven points on Election Day in 2018. And that’s partly because of who votes in Florida. So there’s a part of me that is of the view that this is a bit early and that we don’t know. And the other contrarian view that I have is that Donald Trump is losing the people he is best suited to win back. If Biden were 80 to 15 or 80 to 20 with Hispanic voters, I would think, game over. But he’s not. Trump’s actually not doing as badly with Hispanic voters as you would assume. He seems to have kept about the same amount of black support, which is very low. But he hasn’t gone to a 1 or 2 percent. He’s at 8 or 9, and enthusiasm for Biden seems to be lower than usual. Where he’s really suffering is with seniors. Especially white seniors and white working-class women.Now, I don’t think he’s going to, but if the election becomes an actual election, those are the people you would assume he would be best placed to win back. My problem in seeing him winning and the reason I think Biden is winning and will win, is that as Jim says, I’m not really sure what he can do. The economy’s not going to go back to where it was by the end of the year. He’s not going to gain a reputation for having guided us through the coronavirus storm by the end of the year. He is unable to articulate why he wants to be president for four more years. He’s very easily distracted. And although I understand why he’s criticizing the Supreme Court for its decisions over the last two weeks, “vote for me and I’ll appoint different justices than the ones I already appointed” is less likely than not to be a winning message. So I can’t quite see how he gets on track. I am nonetheless a little bit hesitant at this stage, both because of what happened last time but also because of who it is that he seems to be losing.Rich: Yeah, so Jim, my problem is given what happened in 2016, I just don’t think I could ever count Trump out again. If these were the polls a week out, yeah. I guess I’d count him out. But we’ve got four months to go. The difference though is the nature of the opponent. Biden is not as hateable as Hillary Clinton. There was a stark number I believe in the last New York Times/Siena poll that had Trump down 14, which kind of seems like a lot. But just had Biden’s very unfavorable number. And it’s 20 something. I don’t know, 23 something. And Hillary’s at this point, I believe it said it was like at 46. And Trump is about 46 very unfavorable. So he’s where Hillary was. Now he was also where Hillary was in 2016 with a very a … But still managed to win. And the other thing that’s going on now is Trump’s a known quantity. He’s not the change candidate anymore. And he’s had these two crises that people have a really negative view of his handling of them. And absent having some other crisis that he handles in an unquestionably confident and deft manner that people really approve of, it’s hard to see how he can unring the bell of his numbers on the coronavirus and on police/race relations.Jim: Yeah. Look, you’re not running on potential and promise anymore. You are a known quantity. I have a suspicion that a key ingredient of that unexpected 2016 victory came from the sense of, people who were not thrilled about the course of the country under the two terms of Obama, including quite a few Obama voters. People forget, the year heading into Election Day 2016, we had the San Bernardino shootings, we had the Orlando shootings. We had the shooting of the cops in Dallas right before the convention in Cleveland. I remember heading out to that Republican convention in Cleveland and being really afraid there’s going to be some mass shooting or some sort of terrible terror attack. There was a sense … If you look in the right places, there was a sense that the country was coming apart at the seams in 2016. Of course now it looks like the good old days. This is where the president has to govern where he is, and he cannot keep running this sort outsider insurgent campaign because you’re the president now. You’re in charge. You are the status quo whether you like it or not.You need to make the case either that things are going well, which is going to be very, very tough considering the circumstances or probably the better argument is, I had things going really, really well and then this terrible virus came over here from China. And it’s a challenge like we’ve never seen before and haven’t seen in 100 years. And it forced us to shut down the economy that was the goose that was laying the golden egg. If you keep me in charge, once we get this virus under control, I can keep government policy in a direction to restore the golden goose. I can get us back, and you know the Democrats don’t do that. You know the Democrats are going to want to raise taxes. You know they’re going to want to do the crazy New Deal. Sooner or later, Joe Biden will succumb to the Bernie Sanders side. Joe Biden was not put on this earth to stand up to the left wing of the Democratic Party. Joe Biden is a back slapper. Joe Biden wants everybody to get along. Joe Biden will not stand up for you. He couldn’t even stand up for the businesses that were being trashed by rioters.There’s an argument to be made. Except the president needs to focus and do that, and he can’t run on his own personal grievances. I think it was Ramesh who made this very good point. The Trump campaign of 2016 was about doing things. Building the wall, immigration security. We’re going to bring back U.S. domestic production. Just on the issue of China alone there was an enormous potential for the president to get on this. But he’s got to stop thinking about like, China is merely a—Rich: I can’t believe you did this, Jim. I was just about to steal Ramesh’s point, and you stole it before I could get to it. I would express Ramesh’s point a little differently, or maybe this is a different point. Some of my best punditry is based on stealing Ramesh’s points, Jim.Jim: Here you go.Rich: Don’t hone in on my territory here.Jim: I’ll spike the volleyball over to you.Rich: I don’t know whether Ramesh has written this or just said it. But the thing about the 2016 campaign is Trump was hitting on issues that were under-discussed in our politics, underappreciated among the political elite. Fears of terrorism, concerns about illegal immigration, concerns about de-industrialization. Whereas this time around, very often his obsessions are just totally his obsessions or the obsessions of a very small group of people that might include us on this podcast. Probably includes a lot of our listeners. But Obamagate and Section 230 and these are not things that hit people where they live, and what I wonder about, Charlie, going back to Jim’s point in his first answer, that’d be great if Trump gave a speech about how this is a good country. You know, we have this wonderful Constitution. We need to defend our heritage. I certainly think he should give that speech. Any president should give that speech at any given point in time. But I just wonder if the toppling of the statues and all the rest of it infuriating and appalling to us, whether the average voter cares about it so much.I’ve basically been on board Jim’s theory. There’s going to be some sort of backlash to what’s been going on. But I wonder if it’s just not top of mind enough for the average voter.Charlie: So we have the opinion of the cause delivered by a Ponnuru, R. and joined in concurrence with Geraghty, J. and Lowry, R. I feel I should dissent just to make it a proper case. I think Ramesh is right, and I think that there is something to what you just said, Rich, but I think that that is only the case if you look at this narrowly. One of Trump’s problems is that he’s not eloquent. He is incapable of developing an argument, and he is incapable of nuance. And this is a moment that requires both. Now, four years ago just by talking about, just by mentioning topics that had been swept under the rug for so long, he had people sitting at home for better or for worse and saying, “I think that. I want to talk about that.” You could distill the entire immigration question, which is a complicated topic, down to “build the wall.” And people would hear, he cares about this. You could distill the question of China into a few soundbites. You can’t do that when you’ve been in charge for four years. Because you have to defend your record and explain why it’s different than the aspirant’s. But also this is a moment which calls for Trump to thread needles. The coronavirus question is complicated. You can’t just say, open up our businesses. You have to acknowledge this is a real threat. People have died.And the same is true of these protests. You have to acknowledge that what happened to George Floyd was terrible, and historically African Americans have been persecuted legally, systematically. But also to defend some of America’s great figures and to defend America’s virtue. And Trump’s contributions thus far are to tweet three- or four-word sentences in all caps. LAW AND ORDER. KEEP THE STATUES. I think that there is a real appetite out there for a defense of America. But he hasn’t made it. He’s been oddly silent. For all of the worry about Tom Cotton, and for all the, in many cases, correct anger at what happened in the park outside the White House, Trump’s been fairly hands-off. There’s been no real moment where he has become the avatar of a movement that doesn’t think America is rotten to the core. At least not beyond his usual platitudes. And one of the problems with being so effusive as he is, is it loses its currency. If you say all the time, this is the best, this is the greatest, this is the most influential, this is the … People say, “all right, whatever."You look back to presidents that have capitalized on this, you look back to Ronald Reagan when he first ran for governor of California, and he ran against the students at Berkeley and indeed the faculty at Berkeley. Find the video on YouTube of him telling them that they were in charge of spoiled children. If you look at Richard Nixon in 1968. They were pretty clear. They weren’t battering rams, and they weren’t just mouthing platitudes or shouting three-word slogans. They were clear about what it is that they thought. I do think maybe the statues per se aren’t American’s No. 1 concern. But I do think that the sort of sentiment that was expressed by Drew Brees about the importance of the flag, what it meant to him, what he thought about when he looked at it. The generational argument. The Burkean argument for America. I think that is extremely poignant and extremely poignant for a majority and extremely poignant for what it’s worth, for an awful lot of minorities. I don’t like this narrative that we’re seeing. The white person’s country. That’s absolute nonsense.It’s very important that we acknowledge disparities and historical persecution. But let’s not pretend that there aren’t lots and lots and lots of non-white people in this country who love it very dearly and who are glad to be here. Trump has an opportunity to be that guy. Joe Biden is not going to be a caricature. He’s not going to be a stereotype. He’s not going to burn the flag. So Trump if anything has to do it more than he would otherwise. But he’s not. He hasn’t sent in the authorities to shut down what’s happened to these statues. He hasn’t made a big speech about it. He hasn’t had a great sister–soldier moment where he just says no. He’s absent. And for all the talk about Joe Biden being in his basement, so is the president. And without that sort of action there’s just really no rationale for him beyond people saying, well we need him as a bulwark against Joe Biden. But that just doesn’t sell in the way that it did against, say, a Hillary Clinton.Rich: Yeah Jim, there are, I’m going to say it, things that I don’t understand about Trump’s view of the presidency. But I think I do understand them. But rhetorically I don’t understand why given the opportunity to give a national speech about American history and our heritage and our heroes, I’d love to do that. I wouldn’t want to do any other presidential duty, but I want to do that. And by the way, our listeners are wondering, we’re going to talk about the Russian intelligence thing probably later in the week when we have a firmer bead on it. But I’d love to read the presidential daily brief every day. The best gossip basically around the world gathered by the most adept spies in world history and surveillance techniques served up in a binder on your desk every morning. Who wouldn’t want to read that? And the president of the United States, you can have dinner with anyone you want, you can reach out to anyone you want. Any historian. Any issue expert at your beck and call. And instead of sitting and watching Fox News, which I can do as an ordinary American every night not being president of the United States.But these things don’t appeal to him because what he’s really … He’s in the job for the show. He wants to be the center of attention every day and to vent and say whatever he’s feeling at any given moment, no matter how reckless or heedless like that villages thing he retweeted. And be the center of attention and watch people talk about him every morning and every night and during a lot of the day on cable TV.Jim: Yeah. Maybe we’ll talk about this a bit later in the podcast when we start talking about the coronavirus stuff, but there’s considerable evidence that Donald Trump doesn’t actually enjoy the job part of being president. He likes all the pomp and circumstance. He likes the title. He likes being the center of attention. But it’s not like you see him spending a lot of time hashing things out with legislators and trying to put together some sort of majority to pass a bill. He clearly has very little interest in the details of policy. At one point you had said something about all the different things he could talk about, and Charlie mentioned the tweets of three or four words all in caps that he does. Do you know what’d probably be helpful, guys? If he’d stop retweeting videos of his supporters shouting “white power.” That’s probably not helpful at a point of a national conversation about racial inequities and stuff like that. That’s probably not helping. Yeah, I know the other guy said you’re not supporting him, you’re not black. Somehow we’ve managed to pick the two least self-aware, sensitive, erudite septuagenarians to run for president this cycle. But there is a …At the end when Trump couldn’t articulate that second-term agenda … Basically what is the cause? What does America get if it reelects Trump? More Trump. Him. Him being in the White House is the victory. So you’ve had some very interesting arguments of what does Trump really want to do in a second term? I think the first attack against Barack Obama from the John McCain campaign that drew blood was the celebrity ad. And Barack Obama was not merely a celebrity president, but he definitely leaned into it. Doing the picks on ESPN and doing the wacky videos with BuzzFeed and all the appearances on late-night talk shows and slow-jamming the news with Jimmy Fallon. Barack Obama was a full-spectrum celebrity for a good portion of his eight years. And I have a suspicion that’s part of the job. That may have been how Trump thought the job was. And guess what? Being president involves a heck of a lot more than that. Particularly when you’re facing major crises of urban unrest and this terrible pandemic going around.And if Trump doesn’t win reelection, I think a big chunk of the reason will be, he never really understood the job and never really wanted to do the parts of the job that are necessary to succeed in the job.Charlie: I have never wanted to be president, which is good because I can’t be. But watching Trump gives me that strange instinct. You know when you’re watching sports and you just sort of kick your leg out to try and kick the ball in soccer or if you’re watching baseball and you see they’re just going to miss catching it, you sort of put your arm out? I just sit there watching Trump so often and sort of just wish I could substitute myself—Rich: Yeah. I can do that better.Jim: You just got this yearning for mind control. Just for a short period of time.Charlie: I never felt like that before.Rich: I can see as Charlie’s striding boldly in a black and white picture from the White House to St. John’s Church after the protesters had been tear-gassed. You’re like, I could have done that better.Charlie: Yeah. I mean for a start, I think I would have said, if anyone is liable to get hurt or moved in order for me to do this, let’s not do it. It is a different feeling because with Barack Obama, I opposed almost everything he did. He was built in a laboratory to annoy me politically. But I never thought, “well I would do it better.” I thought, you have an ideology that I don’t share and I really wish you weren’t there. But with Trump it’s like watching someone drop the ball all the time. You just want to stand up and say, oh no, don’t say that. Oh no, don’t do that. Here’s … It’s just genuinely frustrating.Rich: Jim Geraghty exit question to you. At this juncture, which is more likely in November, a Joe Biden landslide or another Donald Trump narrow Electoral College victory without winning the popular vote?Jim: Joe Biden landslide. Didn’t take me very long to make that decision.Charlie: Yeah. I think it’s more likely that there’ll be a Joe Biden landslide.Rich: I’m going to say more likely narrow Trump victory because I think the race will close up, and I don’t see the landslide happening at this juncture. But I don’t totally discount the possibility that ten days out this race could really flip and could be an utter catastrophe for Republicans. But at the moment I’m more likely a Trump narrow victory, but obviously the most likely scenario is just a solid, non-landslide Joe Biden victory.

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[kristinsimmons]

Why Hillarycare failed…and what we need to learn from that failure

By MATTHEW HOLT

In July 2005 George W Bush had relatively recently won a Presidential election in which the Republican won the popular vote (something that will likely never happen again) & the Republicans controlled all three branches of Government. Those of us liberals at the bottom of a dark trench were wondering if and how we’d get to health reform. So in another reprint to celebrate THCB’s 15th birthday, here was my then take on what went wrong in 1994 and what would happen next–Matthew Holt     

There are lots of versions about what killed the 1993-4 health care reform effort.  Hillary Clinton has now decided that the problem was the lack of incrementalism in her plan.  Last week the New York Times said that since becoming a Senator:

“She has deliberately avoided the major mistake she made as first lady, namely trying to sell an ambitious plan to a public with no appetite for radical change. <SNIP>. She summed up her approach in the first floor speech she delivered in the Senate about four years ago, when she unveiled a series of relatively modest health care initiatives. “I learned some valuable lessons about the legislative process, the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done,” she said, referring to the 1994 defeat of her health care plan.”

On the other hand, some people are still claiming victory for the plan’s defeat even if they were at most modest bit players.  Here’s what one fawning bio says about former New York Lt Governor Betsy McCaughey

“A 35-year-old senior fellow named Elizabeth McCaughey…wrote an article for The New Republic on what she discovered in a close reading of the 1,431-page document containing the Clinton Health Care Plan: Namely, that it would put every citizen in a single government-operated HMO. That one article shot down the entire blimp, and Betsy McCaughey became a 35-year-old Cinderella. One of the richest men in America chose her as his wife, and George Pataki made her lieutenant governor of New York.”

Ignoring the fact that McCaughey spent her time thereafter putting poor New Yorkers into those HMOs she so despised, and then went off the deep end en route to divorce from Pataki, the rich guy, and reality (not necessarily in that order), it’s not really true that one article in The New Republic can be quite that influential. (Sorry Jon!).  Even if the overly geeky Clintonistas in the White House did feel that they had to come out with a point by point rebuttal. And anyway, the article only came out in January 1994 by which time the die was more or less cast the other way. Again we have to look elsewhere for the explanation.

If you want to go back and spend a few minutes wallowing in the era of trial balloons and secret task forces, there’s a very interesting time line of the whole process on the NPR website, as well as a briefer information over at the Clinton Health Plan Wikipedia site. It seems like there was a moment when it could have succeeded, and indeed there may well have been. What has been missing from the whole discussion over multiple blogs over the last couple of months has been the understanding that there’s a real world outside Washington and that sometimes (but not too often) what’s going on there has an impact inside the beltway.

The debate over health care had been building for quite a while by the time of the 1992 election even though it wasn’t a big factor in the Clinton victory. Harris Wofford had won a Senate seat in 1991 in Pennsylvania with some slogan about the right of every American to go to a doctor. And the debate was being picked up amongst the SCLM elite, with the NY times having several articles about it. In fact my only ever mention on the front (or any other page) of the NY Times (as the third banana author of a piece on Japanese health care) came in very late 1992. That was one of many tiny indications that the discussion about what was wrong with American health care which had been brewing in academia for some time, was starting to come to the notice of the politicos.

So why was that debate becoming politically important? The answer was recession and middle-class insecurity. The recession of 1991-2 was brief but deep and somewhat local (centered around Los Angeles — remember “Falling Down“?)….and it was the first time that a significant number of white collar workers were asked to pay towards their health benefits. It was also the second time that heath care costs rapidly went up much faster than economic growth (the first time was in the Reagan recession of the early 1980s) which woke up employers, and it was the first time that Americans were being put into managed care plans by their employers. But by far the most important factor was the fear that no job meant no health insurance.  And even though the recession in fact was over by the end of the election season, the carry-over effect of the “no job = no health care” fear went on into 1993.

Clinton was not elected to change the health care system — the slogan was “It’s the economy, stupid!”. But rational wonk that he was, when he started to look at the economy and the rate of growth of the health care sector, he realized that he had found the biggest problem, and he set out to fix it. But he wasn’t really a wonk about health care, and neither was Hillary. So after the election they decided that they had to study the problem first and then come up with a solution. As a more recent opportunist politician would say, Beeg mistake!

Instead what was important was the opportunity given to the reformer crowd by the recession. Harris has asked questions about Americans’ attitude to the health care system since 1982. They published a historical retrospective a couple of years back which I urge you to read if you only click on one link in this post. The proportion saying that the system needed to be completely rebuilt (the most negative of 3 choices) went from 19% in 1987 to 24% in 1989 (via a weirdly high 29% in 1988) to 42% in 1991. There’s always a big group in the middle looking for “fundamental change”, but the fact that 42% were looking for a complete rebuilding meant that there was an appetite for something real to be done.  But of course there was only so much of a window, and as the economy picked up by 1993 the number was down to the mid-30%s where it basically stayed until the boom of the 1990s took health care off the radar and it fell to hover around 30% and below.  (Note of course the 30% is still a pretty high number and a much higher “base of dissatisfaction” to start from when we have the next debate).

While they should have been petrified about the gradual reduction in concern around the “no job = no health care” issue, Hillary and Ira Magaziner basically ignored 15 years worth of study about what was wrong with the health care system and spent 4-6 months fact-finding. Clinton’s address to Congress about health care, the most important issue of his Presidency not involving interns and blue dresses, was not until  September 23, 1993–Nine full months after he came to office . (That was the speech when the wrong one was loaded into the teleprompter, but he aced it anyway)

While there was some optimism in the immediate aftermath of the speech, nothing got done and politically everything was going to pot. Paul Starr, the Princeton professor who ended up being the ideological parent of the Clinton plan published his version of reality in an article called called What Happened to Health Care Reform?. In the middle of that article he got somewhere near to the truth:

“With unemployment down, Americans were worrying less about their jobs and health coverage and more about crime. As health care inflation eased primarily because inflation was generally under control, businesses worried less about health care cost containment and more about the political implications of an expansion of government authority. Under these conditions, the ideological and interest-group opponents of reform were able to change the subject. Instead of health care, the focus of debate became government, which was a debate we were sure to lose.”

It didn’t help that the Clinton’s taskforce had mystified and excluded even potential allies.  For example the whole thing was supposed to be an employer mandate based on managed competition a la Enthoven. Sara Singer in Enthoven’s office told me that by putting Medicaid into the Regional Health Alliances, the Clinton plan would kill the employer risk pool and become de facto single payer. I didn’t see too much wrong with that as a policy but it was enough for Enthoven to declare that all 1400 plus pages of the plan should be ripped up. So without the ideological father of managed competition, it’s not surprising the the Jackson Hole Group and the employers they carried with them wouldn’t sign on. And, of course, because of the employer mandate the small employers (including the doctors) and smaller insurers were always going to be opposed, hence the Harry and Louise campaign of late 1993. When it came out around that time that they were going to pay for the plan by cutting Medicare and Medicaid reimbursements, they lost the doctors and providers, and it was all over bar the shouting.

By December 1993 Harvard pollster Bob Blendon was telling the corporate clients we worked with that the only way to save the plan was for Bill to sack Hillary and Ira, and like the Palestinian-Israeli peace process (remember that?) he should take a few trusted Senators to a Norwegian hotel and let them come up with a whole new bill. Magaziner and Hillary continued to press forward, but the meeting in the Norwegian Hotel never came about.

Of course the delays and all the other scandals like Whitewater, Vince Foster, and the various fluffed appointments and nannygates — not to mention the stress of getting the budget passed in 1993, took away attention from the health care reform initiative. But the key point was that a plan as detailed as that coming out of the task force was never going to be more than a first offer, and that it never needed all that time in preparation, or all that detail. Clinton’s six simple principles for health reform, that he announced in the September speech, would have sufficed in February 1, 2003. By the time he tried to bargain away universal coverage in mid-2004 it was too little too late.

Compare and contrast with how a real political operative got stuff done. Here’s a description of the Medicare Act passage, also passed with a Democratic President, House and Senate.

“This act was signed into law by President Lyndon Johnson on July 30, 1965, in Independence, MO. It established Medicare, a health insurance program for the elderly, and Medicaid, a health insurance program for the poor.”

In 1965, the passage of the Social Security Act Amendments, popularly known as Medicare, resulted in a basic program of hospital insurance for persons aged 65 and older, and a supplementary medical insurance program to aid the elderly in paying doctor bills and other health care bills. It was funded by a tax on the earnings of employees, matched by contributions by employers, and was well received. In the first three years of the program, nearly 20 million beneficiaries enrolled in it.

Debate over the program actually began two decades earlier when President Harry S. Truman sent a message to Congress asking for legislation establishing a national health insurance plan. At that time, vocal opponents warned of the dangers of “socialized medicine.” By the end of the Truman’s administration, he had backed off from a plan of universal coverage, but administrators in the Social Security system and others began to focus on the idea of a program aimed at insuring Social Security beneficiaries whose numbers and needs were growing.

Between 1960 and 1965, the health coverage debate was a front burner issue in Congress, with dozens of proposals introduced and testimonies given by representatives of major organizations, including the American Hospital Association, the American Medical Association, and the AFL-CIO. After Congress passed the legislation in the summer of 1965, President Lyndon Johnson decided to sign the bill with former President Truman at the Truman Presidential Library in Independence, MO, in order to recognize Truman’s early effort to establish a national health insurance program. What that doesn’t tell you is the three key aspects of the Medicare and Medicaid Act; 1) It explicitly bought off the AMA by telling them that Doctors could keep billing at UCR rates and would not be interfered with by the government. 2) It explicitly gave the Blues plans a role in processing Medicare claims, one which they still by and large have, and 3) most important, look at the date. The whole bill was done and dusted less than 6 months after the new Congress was sworn in. So the potential opponents were bought off, and then it was pushed through fast before they realized what was hitting them.

Now Johnson had advantages. He had won a landslide; he had more Democratic Senators on his side (although many were very conservative); he didn’t have to worry about the deficit and thus could afford to buy off his industry opponents, who of course were much weaker than they were 30 years later, and he wasn’t going for universal insurance for everyone (just the most expensive ones). And of course he lied about the cost (Note that that worked for Bush in 2003 too!). But one lesson at least is, if you want to get something done, make it simple and get it done fast before opponents can get it together to stop you. So don’t be too fussed about the details so long as it works for your overall principles.

I remember going to the American Association of Health Services Researchers meeting in DC in 1993, and I, like everyone else, thought that the Clintons were going to get something passed. How naive. But I do remember one speaker saying that he remembered when it failed last time (1973), because everyone’s second best option then was to “do nothing”. He hoped that we had a better second option. We didn’t.

Instead the option was to trust the market. If I had a nickel for every health executive who told me that market reform was happening and that meant we didn’t need government reform, then I’d probably have had two bucks by the end of 1994. But as soon as the “market” (i.e. doctors and hospitals) realized what “market reform” meant they started squealing for government protection. That put the Republicans in a bind that they’ve yet to get out of. We used to call it “The market is working but managed care sucks”,  as exemplified by Republican M. Stanton Evans in The National Review in this 1998 article. Of course nothing that came out of the period of market “reform” was that different to the mechanisms for cost control in the Clinton plan — aggressive managed care plan pricing and Medicare cuts.

The memory of this foul-up may not be enough to matter. Even if employers and the public can’t afford the bill for health care, and even if providers fear that no reform may be worse that reform they have a stake in, it still may be impossible to do. In an article called The Great Health Care Debate of 1993-4 Derek Bok essentially argued that health care reform can’t be done. as it’s just too damn political. He also intriguingly noted that the Clinton plan was very popular in 1994 until it was associated with that name. So politics trumped policy in a triumph of Limbaugh over logic. And if you remember the vitriol over the very moderate Clintons from the newly loud right in the early 1990s maybe nothing would ever have worked. And we are no less polarized today.

But there are some positive points.  If you look at Harris polls taken nearly more than a decade apart, philosophically as a nation we are still in favor of universal health care access. (Below are the 2003 results)

“By 75% to 21% (including a 66% to 30% majority of Republicans), most people agree that “people who are unemployed or poor should be able to get the same amount and quality of medical services as people who have good jobs and are paying substantial taxes”.

By 69% to 27% (including a 63% to 32% majority of Republicans), most people disagree that “it’s fair that people who pay more in taxes (or in health insurance premiums) should be able to get better medical care than those who pay little or nothing.” In fact despite 15 years of arrant egotism and conservatism this whole series also shows that we’ve only become slightly meaner since 1991. And in principle we as a nation want to move to universal health care. So I think that at some point reform can and probably will be done, particularly as all the pressures of 1991-3 are worse now.

But we unquestionably need to take advantage of the opportunity that the failure of the system is presenting us with. Especially the new equation that “a job doesn’t not equal health care access”. We need to get the debate into gear about how the system isn’t working for most Americans, and how “that means YOU!” for what’s left of the middle class. Particularly the white, male, southern, middle class.

The main lesson of HillaryCare is that when the right moment comes along politically we need to get whatever form of universal reform can be agreed on shoved quickly through the Congress. Make no mistake, universal insurance is a big bang and a necessary big bang.  Getting it through will be a hell of a confluence of opportunity and tactics.  Once we get it done, then we have a while to worry about sorting out the system to the purists’ satisfaction later.

So will you all still please stop arguing about what it should look like!

Why Hillarycare failed…and what we need to learn from that failure published first on https://wittooth.tumblr.com/

[isaacscrawford]

Why Hillarycare failed…and what we need to learn from that failure

By MATTHEW HOLT

In July 2005 George W Bush had relatively recently won a Presidential election in which the Republican won the popular vote (something that will likely never happen again) & the Republicans controlled all three branches of Government. Those of us liberals at the bottom of a dark trench were wondering if and how we’d get to health reform. So in another reprint to celebrate THCB’s 15th birthday, here was my then take on what went wrong in 1994 and what would happen next–Matthew Holt     

There are lots of versions about what killed the 1993-4 health care reform effort.  Hillary Clinton has now decided that the problem was the lack of incrementalism in her plan.  Last week the New York Times said that since becoming a Senator:

“She has deliberately avoided the major mistake she made as first lady, namely trying to sell an ambitious plan to a public with no appetite for radical change. <SNIP>. She summed up her approach in the first floor speech she delivered in the Senate about four years ago, when she unveiled a series of relatively modest health care initiatives. “I learned some valuable lessons about the legislative process, the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done,” she said, referring to the 1994 defeat of her health care plan.”

On the other hand, some people are still claiming victory for the plan’s defeat even if they were at most modest bit players.  Here’s what one fawning bio says about former New York Lt Governor Betsy McCaughey

“A 35-year-old senior fellow named Elizabeth McCaughey…wrote an article for The New Republic on what she discovered in a close reading of the 1,431-page document containing the Clinton Health Care Plan: Namely, that it would put every citizen in a single government-operated HMO. That one article shot down the entire blimp, and Betsy McCaughey became a 35-year-old Cinderella. One of the richest men in America chose her as his wife, and George Pataki made her lieutenant governor of New York.”

Ignoring the fact that McCaughey spent her time thereafter putting poor New Yorkers into those HMOs she so despised, and then went off the deep end en route to divorce from Pataki, the rich guy, and reality (not necessarily in that order), it’s not really true that one article in The New Republic can be quite that influential. (Sorry Jon!).  Even if the overly geeky Clintonistas in the White House did feel that they had to come out with a point by point rebuttal. And anyway, the article only came out in January 1994 by which time the die was more or less cast the other way. Again we have to look elsewhere for the explanation.

If you want to go back and spend a few minutes wallowing in the era of trial balloons and secret task forces, there’s a very interesting time line of the whole process on the NPR website, as well as a briefer information over at the Clinton Health Plan Wikipedia site. It seems like there was a moment when it could have succeeded, and indeed there may well have been. What has been missing from the whole discussion over multiple blogs over the last couple of months has been the understanding that there’s a real world outside Washington and that sometimes (but not too often) what’s going on there has an impact inside the beltway.

The debate over health care had been building for quite a while by the time of the 1992 election even though it wasn’t a big factor in the Clinton victory. Harris Wofford had won a Senate seat in 1991 in Pennsylvania with some slogan about the right of every American to go to a doctor. And the debate was being picked up amongst the SCLM elite, with the NY times having several articles about it. In fact my only ever mention on the front (or any other page) of the NY Times (as the third banana author of a piece on Japanese health care) came in very late 1992. That was one of many tiny indications that the discussion about what was wrong with American health care which had been brewing in academia for some time, was starting to come to the notice of the politicos.

So why was that debate becoming politically important? The answer was recession and middle-class insecurity. The recession of 1991-2 was brief but deep and somewhat local (centered around Los Angeles — remember “Falling Down“?)….and it was the first time that a significant number of white collar workers were asked to pay towards their health benefits. It was also the second time that heath care costs rapidly went up much faster than economic growth (the first time was in the Reagan recession of the early 1980s) which woke up employers, and it was the first time that Americans were being put into managed care plans by their employers. But by far the most important factor was the fear that no job meant no health insurance.  And even though the recession in fact was over by the end of the election season, the carry-over effect of the “no job = no health care” fear went on into 1993.

Clinton was not elected to change the health care system — the slogan was “It’s the economy, stupid!”. But rational wonk that he was, when he started to look at the economy and the rate of growth of the health care sector, he realized that he had found the biggest problem, and he set out to fix it. But he wasn’t really a wonk about health care, and neither was Hillary. So after the election they decided that they had to study the problem first and then come up with a solution. As a more recent opportunist politician would say, Beeg mistake!

Instead what was important was the opportunity given to the reformer crowd by the recession. Harris has asked questions about Americans’ attitude to the health care system since 1982. They published a historical retrospective a couple of years back which I urge you to read if you only click on one link in this post. The proportion saying that the system needed to be completely rebuilt (the most negative of 3 choices) went from 19% in 1987 to 24% in 1989 (via a weirdly high 29% in 1988) to 42% in 1991. There’s always a big group in the middle looking for “fundamental change”, but the fact that 42% were looking for a complete rebuilding meant that there was an appetite for something real to be done.  But of course there was only so much of a window, and as the economy picked up by 1993 the number was down to the mid-30%s where it basically stayed until the boom of the 1990s took health care off the radar and it fell to hover around 30% and below.  (Note of course the 30% is still a pretty high number and a much higher “base of dissatisfaction” to start from when we have the next debate).

While they should have been petrified about the gradual reduction in concern around the “no job = no health care” issue, Hillary and Ira Magaziner basically ignored 15 years worth of study about what was wrong with the health care system and spent 4-6 months fact-finding. Clinton’s address to Congress about health care, the most important issue of his Presidency not involving interns and blue dresses, was not until  September 23, 1993–Nine full months after he came to office . (That was the speech when the wrong one was loaded into the teleprompter, but he aced it anyway)

While there was some optimism in the immediate aftermath of the speech, nothing got done and politically everything was going to pot. Paul Starr, the Princeton professor who ended up being the ideological parent of the Clinton plan published his version of reality in an article called called What Happened to Health Care Reform?. In the middle of that article he got somewhere near to the truth:

“With unemployment down, Americans were worrying less about their jobs and health coverage and more about crime. As health care inflation eased primarily because inflation was generally under control, businesses worried less about health care cost containment and more about the political implications of an expansion of government authority. Under these conditions, the ideological and interest-group opponents of reform were able to change the subject. Instead of health care, the focus of debate became government, which was a debate we were sure to lose.”

It didn’t help that the Clinton’s taskforce had mystified and excluded even potential allies.  For example the whole thing was supposed to be an employer mandate based on managed competition a la Enthoven. Sara Singer in Enthoven’s office told me that by putting Medicaid into the Regional Health Alliances, the Clinton plan would kill the employer risk pool and become de facto single payer. I didn’t see too much wrong with that as a policy but it was enough for Enthoven to declare that all 1400 plus pages of the plan should be ripped up. So without the ideological father of managed competition, it’s not surprising the the Jackson Hole Group and the employers they carried with them wouldn’t sign on. And, of course, because of the employer mandate the small employers (including the doctors) and smaller insurers were always going to be opposed, hence the Harry and Louise campaign of late 1993. When it came out around that time that they were going to pay for the plan by cutting Medicare and Medicaid reimbursements, they lost the doctors and providers, and it was all over bar the shouting.

By December 1993 Harvard pollster Bob Blendon was telling the corporate clients we worked with that the only way to save the plan was for Bill to sack Hillary and Ira, and like the Palestinian-Israeli peace process (remember that?) he should take a few trusted Senators to a Norwegian hotel and let them come up with a whole new bill. Magaziner and Hillary continued to press forward, but the meeting in the Norwegian Hotel never came about.

Of course the delays and all the other scandals like Whitewater, Vince Foster, and the various fluffed appointments and nannygates — not to mention the stress of getting the budget passed in 1993, took away attention from the health care reform initiative. But the key point was that a plan as detailed as that coming out of the task force was never going to be more than a first offer, and that it never needed all that time in preparation, or all that detail. Clinton’s six simple principles for health reform, that he announced in the September speech, would have sufficed in February 1, 2003. By the time he tried to bargain away universal coverage in mid-2004 it was too little too late.

Compare and contrast with how a real political operative got stuff done. Here’s a description of the Medicare Act passage, also passed with a Democratic President, House and Senate.

“This act was signed into law by President Lyndon Johnson on July 30, 1965, in Independence, MO. It established Medicare, a health insurance program for the elderly, and Medicaid, a health insurance program for the poor.”

In 1965, the passage of the Social Security Act Amendments, popularly known as Medicare, resulted in a basic program of hospital insurance for persons aged 65 and older, and a supplementary medical insurance program to aid the elderly in paying doctor bills and other health care bills. It was funded by a tax on the earnings of employees, matched by contributions by employers, and was well received. In the first three years of the program, nearly 20 million beneficiaries enrolled in it.

Debate over the program actually began two decades earlier when President Harry S. Truman sent a message to Congress asking for legislation establishing a national health insurance plan. At that time, vocal opponents warned of the dangers of “socialized medicine.” By the end of the Truman’s administration, he had backed off from a plan of universal coverage, but administrators in the Social Security system and others began to focus on the idea of a program aimed at insuring Social Security beneficiaries whose numbers and needs were growing.

Between 1960 and 1965, the health coverage debate was a front burner issue in Congress, with dozens of proposals introduced and testimonies given by representatives of major organizations, including the American Hospital Association, the American Medical Association, and the AFL-CIO. After Congress passed the legislation in the summer of 1965, President Lyndon Johnson decided to sign the bill with former President Truman at the Truman Presidential Library in Independence, MO, in order to recognize Truman’s early effort to establish a national health insurance program. What that doesn’t tell you is the three key aspects of the Medicare and Medicaid Act; 1) It explicitly bought off the AMA by telling them that Doctors could keep billing at UCR rates and would not be interfered with by the government. 2) It explicitly gave the Blues plans a role in processing Medicare claims, one which they still by and large have, and 3) most important, look at the date. The whole bill was done and dusted less than 6 months after the new Congress was sworn in. So the potential opponents were bought off, and then it was pushed through fast before they realized what was hitting them.

Now Johnson had advantages. He had won a landslide; he had more Democratic Senators on his side (although many were very conservative); he didn’t have to worry about the deficit and thus could afford to buy off his industry opponents, who of course were much weaker than they were 30 years later, and he wasn’t going for universal insurance for everyone (just the most expensive ones). And of course he lied about the cost (Note that that worked for Bush in 2003 too!). But one lesson at least is, if you want to get something done, make it simple and get it done fast before opponents can get it together to stop you. So don’t be too fussed about the details so long as it works for your overall principles.

I remember going to the American Association of Health Services Researchers meeting in DC in 1993, and I, like everyone else, thought that the Clintons were going to get something passed. How naive. But I do remember one speaker saying that he remembered when it failed last time (1973), because everyone’s second best option then was to “do nothing”. He hoped that we had a better second option. We didn’t.

Instead the option was to trust the market. If I had a nickel for every health executive who told me that market reform was happening and that meant we didn’t need government reform, then I’d probably have had two bucks by the end of 1994. But as soon as the “market” (i.e. doctors and hospitals) realized what “market reform” meant they started squealing for government protection. That put the Republicans in a bind that they’ve yet to get out of. We used to call it “The market is working but managed care sucks”,  as exemplified by Republican M. Stanton Evans in The National Review in this 1998 article. Of course nothing that came out of the period of market “reform” was that different to the mechanisms for cost control in the Clinton plan — aggressive managed care plan pricing and Medicare cuts.

The memory of this foul-up may not be enough to matter. Even if employers and the public can’t afford the bill for health care, and even if providers fear that no reform may be worse that reform they have a stake in, it still may be impossible to do. In an article called The Great Health Care Debate of 1993-4 Derek Bok essentially argued that health care reform can’t be done. as it’s just too damn political. He also intriguingly noted that the Clinton plan was very popular in 1994 until it was associated with that name. So politics trumped policy in a triumph of Limbaugh over logic. And if you remember the vitriol over the very moderate Clintons from the newly loud right in the early 1990s maybe nothing would ever have worked. And we are no less polarized today.

But there are some positive points.  If you look at Harris polls taken nearly more than a decade apart, philosophically as a nation we are still in favor of universal health care access. (Below are the 2003 results)

“By 75% to 21% (including a 66% to 30% majority of Republicans), most people agree that “people who are unemployed or poor should be able to get the same amount and quality of medical services as people who have good jobs and are paying substantial taxes”.

By 69% to 27% (including a 63% to 32% majority of Republicans), most people disagree that “it’s fair that people who pay more in taxes (or in health insurance premiums) should be able to get better medical care than those who pay little or nothing.” In fact despite 15 years of arrant egotism and conservatism this whole series also shows that we’ve only become slightly meaner since 1991. And in principle we as a nation want to move to universal health care. So I think that at some point reform can and probably will be done, particularly as all the pressures of 1991-3 are worse now.

But we unquestionably need to take advantage of the opportunity that the failure of the system is presenting us with. Especially the new equation that “a job doesn’t not equal health care access”. We need to get the debate into gear about how the system isn’t working for most Americans, and how “that means YOU!” for what’s left of the middle class. Particularly the white, male, southern, middle class.

The main lesson of HillaryCare is that when the right moment comes along politically we need to get whatever form of universal reform can be agreed on shoved quickly through the Congress. Make no mistake, universal insurance is a big bang and a necessary big bang.  Getting it through will be a hell of a confluence of opportunity and tactics.  Once we get it done, then we have a while to worry about sorting out the system to the purists’ satisfaction later.

So will you all still please stop arguing about what it should look like!

Article source:The Health Care Blog

[mightbedamian]

#TMIishTuesday #56 - The Social Democrats are a lie! - On the discussion of same-sex marriage in Germany

Hey, No pre-things to say - enjoy this week's #TMIishTuesday. Well… "Enjoy" is probably not the right expression with this topic in mind. But nonetheless: I hope you like the post. Hey there mighty people of the internet! And welcome to issue #56 of #TMIishTuesday - my weekly Tumblr post about what goes through my weird mind and on what you guys want to know more about. It can be something very personal, it can be something political, it can be completely pointless - but in 99.9 % of the cases, it involves opinions. And mine as well. // Last week I told you how I felt growing up thin and rather small. The post focuses on how my peers reacted to that - and how they made me feel. Click the link above, if you haven't read it, yet. // A couple walks up to the civil registry office. The marriage registrar says: "Excuse me, you are men." and… No punch line. Reality. This translation of a tweet by @politischernate is a pretty accurate description of a situation that could arise any given day in any given German registry office. Sad reality. I already addressed the topic of same-sex marriage in Germany in previous posts (e. g. the Letter to Society and - shortly in my comparison between the Dutch and German cultures). But nothing has changed. So why should I bring it up again? Because f*ing nothing has changed! And that feels just surreal! Absolutely ridiculous! It's nothing short of a political disgrace! How can a country as progressive as Germany be behind so much on an equal rights issue? HOW ON EARTH can some ignorant little a*holes in parliament play god? Think that is exaggerated? Let me show you what happens and has been happening! 1. The German population wants marriage equality - for years and years For years and years there have been polls by many different pollsters. The outcome has always been the same: The vast majority of Germans are in favour of same-sex marriage and equal rights, e.g. adoption rights. The most recent survey I found sees 75 % of respondents pro same-sex marriage. 2. Parliament is pro marriage equality With the rather-left parties (the Left, the Greens and the Social Democrats) more than half of parliament are in favour. Most of the Christian Democratic Union and the Christian Social Union (the two parties form one grouping in parliament, hence I will refer to them as the "Union" from here on) are still opposing, but that shouldn't matter. You got your 50 %. That's what counts. 3. Party discipline But if you thought this would do the trick, you're wrong. Cause why should a democracy be bound by democratic principles, right? Why should parliament take a decision that the majority of MPs appreciate? That would be… That would… No! That would be democratic! We certainly can't do that!! Instead let's pretend we are the f*ing rulers of the world! Oh and let's make our country less progressive than South Africa, Brasil, Uruguay, Mexico, and the like. That makes so much sense, right!? Okay, party discipline. A very simple concept: If the majority of the party in parliament holds a certain opinion, the rest of that party will vote for this opinion as well. Prohibited by constitution in Germany - as in most democratic countries. Still it widely exists and is carried out. How?! 4. Dealing The coalition of the Union and the Social Democrats are governing. And how this coalition works - given the two rather different approaches of both parties (with the Union being rather "right" and the Social Democrats being rather "left") - is by dealing. “You get this, if we get this, okay?” Remember when you and your childhood friend were 4 and he would let you borrow his cool toy truck, if you gave him your toy dinosaur? But the deal was only valid until one of you had enough of that toy and handed it back? That's exactly how this coalition works! The Social Democrats got their minimum wage, the Union got their child care subsidy. Both parties were very happy with one of these - and took the other one cause it was part of the deal. With same-sex marriage, however, there's a problem. Well… It's not a problem to the coalition it seems. But to the 75 % of Germans mentioned above. The Social Democrats told us they were pro marriage equality. And they really wanted to fight to implement it. That was back in 2013. When they were campaigning. But since it apparently was not too important of a topic for them, they dropped it when agreeing on goals with the Union when fixing their coalition. Instead we got a mere sentence in the agreement. It says: "We will eliminate legal hurdles discriminating same-sex civil partnerships", but, quite frankly: That's vague af! Also, (not so) fun fact: We're approaching the end of this election period and there are still hundreds of laws in place that discriminate against same-sex couples. 5. The incredible farce of the Social Democrats Yepp, you guessed it: I'm not happy with what the Social Democrats are doing with their political power. I used to be quite a supporter of them. I gave one of my two votes to them in the last elections of parliament. But I feel let down. Running the 2013 campaign saying "100 % equality only with us!" is a strong promise, yes. And I was aware that it might not be possible to achieve that 100 %. I totally get that, when you are in a coalition with the Union, it's not exactly the easiest topic to address. But: If you make such a strong statement - and if you decide to make it one of your core principles your campaign is about - I expect that you at least fight for it over the next election period! It might be a little harsh of me, but I'll say it like I feel it anyway: What the Social Democrats did regarding same-sex marriage is fraud! During their campaign they pinky-promised that they would fight for equal rights and marriage equality. Not even a month later, the coalition agreement was signed. And they had completely given in to the Union's request. The Social Democrats opted to live the Stone Age-like life instead of being the paving stone to what might have been historic. And this is where things get really hypocritical: The Social Democrats realised they messed up just now. Five months before the election. They had 4 years to make the change. And they didn't. They left the Union in peace. Instead of insisting to put the topic on the agenda, they - jointly with the Union - voted to not discuss it. Not 1 parliamentary week. Not 2 parliamentary weeks. Not 5 parliamentary weeks. Not 10 parliamentary weeks. Not 30 parliamentary weeks. 49 !!! parliamentary weeks! And bear in mind that parliament only has meetings in one of two weeks every time! And that there is such a thing as the summer break as well. All in all the oh-so-social Democrats voted to push the topic off the agenda f*ing 11 times! And now? Now all of a sudden they tell the Union: "Let's hurry! We need to make it happen!" Or… Well… They told them a month ago. By now - after the Union was like: "Why now? We don't have enough time left before the elections? Oh, and we need the constitution to change [which is total bullshit! Marriage is not defined in the constitution. It only says: “Marriage and family” are under special protection of the state (GG, Art. 6 (1))]. That's gonna take some time. Let's just… wait?" …by now the Social Democrats have changed their mind. Again. Now they say: "If we don't achieve same-sex marriage in this election period, we'll definitely make it happen in the next one."

Like… WOW! Thanks for nothing! Also: You are aware that not mentioning a strict deadline means you're gonna end up in March/April of 2021, trying to push the topic over the finish line once again? If - and that's IF - there's still a majority in favour then. It looks like the AfD will be featured in parliament quite prominently after the election. They are even more opposing of same-sex marriage than the Union. You don't want that to happen when pushing for same-sex marriage. Also: Sorry? But it was one of your core principles of your past campaign. And you committed fraud to that promise 11 times! YOU had the change to make it happen for FOUR years! YOU chose not to do it! If you were not completely OUT OF YOUR MIND, you would not declare marriage equality your goal for the next election period. DON'T YOU SEE? That just makes you look STUPID as FUCK! The chance to change was there. It was served to you on a silver platter. The opposition parties - the Greens and the Left - did ALL the work for you! They prepared a very detailed, very well-thought of proposal to change the law. All you had to do was NOD YOUR HEAD. That would have made it pass and become law. The Bundesrat didn't even have to approve anymore - after all that was the chamber in which the Greens and the Left proposed the law change. And the majority of the Bundesrat had already approved of the changes. But you did NOT nod your head. And to be honest, you denied yourself the chance. Simply by following the bad example of the oh-so-mighty Union - and putting it off the agenda, and putting it off, and putting it off, and putting it off… 11 f*ing times! But, okay. At least you realised you missed something over the last few years. But WHAT THE FUCK are you doing now!?? If I realise I did something bad, I apologise and do everything I can to change things. As quickly as possible. But not the Social Democrats! They proposed their OWN law change last week. Why? No one knows! Probably so they can say "Haha! It was US who brought to you same-sex marriage!". In ten years time this might actually be very handy. However… talking of 10 years ahead: If you ask me, the Social Democrats might be redundant in 10 years time, if they proceed to do politics the way they do at the moment. Schulz might be a good candidate. And tbh, I quite like him as a person. But that won't make me vote for them. They really disappointed me over the last couple years. And I feel that, if they don't change their "oh, the Union is so powerful, we are so helpless" policy, a lot of others will feel the same. For me this story just shows one thing: They do not deserve my vote! Full stop. If you really want to work towards equal rights, why don't you sign this petition for same-sex marriage in Germany? If you do, tweet me, or tell me on another social media. I wanna know who are with me! Before I go, tell me your thoughts on same-sex marriage (in Germany and elsewhere) and your opinion on the behaviour of the Social Democrats. I wanna know! Place a comment, tweet me, dm me, or do anything else you can think of to get to me. Queer Shoutout you say? You know that I adore Troye Sivan and his music. Now it has been announced that he'll be rewarded with the GLAAD award for his promotion of equality and acceptance. He'll be the youngest recipient ever. Well deserved, if you ask me! He speaks up so much for equal rights and knows how to use his platform. Well done, Troye! Keep going! As always: Next #TMIishTuesday next Tuesday. If you have any questions in the meantime, just ask away. Whatever you’re curious about - I don’t bite. :) Until then: Stay mighty! Linkage: - Link by politischernate: https://twitter.com/politischernate/status/832622707254534146 - Zeit: Umfrage: Mehrheit der Deutschen für "Ehe für alle":http://www.zeit.de/news/2017-04/02/gesellschaft-umfrage-mehrheit-der-deutschen-fuer-ehe-fuer-alle-02023803 - Dennis Klein and Micha Schulze for queer.de: Keine Ehe für alle: Merkel lässt Schulz abblitzen: http://www.queer.de/detail.php?article_id=28537 - Grundgesetz, Art. 6: https://www.gesetze-im-internet.de/gg/art_6.html - Robert Klages for tagesspiegel.de: Gleichgeschlechtliche Ehen: Entscheidung über "Ehe für Alle" zum elften Mal aufgeschoben: http://www.tagesspiegel.de/berlin/queerspiegel/gleichgeschlechtliche-ehen-entscheidung-ueber-ehe-fuer-alle-zum-elften-mal-aufgeschoben/13683888.html - Campact Petition zur Öffnung der Ehe: https://www.campact.de/gleichstellung/appell/teilnehmen/ - Jackie Willis for etonline.com:  EXCLUSIVE: Troye Sivan to Become Youngest Recipient of GLAAD's Stephen F. Kolzak Award: http://www.etonline.com/awards/213909_troye_sivan_to_become_youngest_recipient_of_stephen_f_kolzak_award_at_glaad_awards/

Oh, and here’s some self-promo: - Last #TMIishTuesday: http://mightbedamian.tumblr.com/post/158934445048/tmiishtuesday-55-have-you-always-been-that - My Letter to society: http://mightbedamian.tumblr.com/post/152304851890/tmi-ishtuesday-33-a-letter-to-society - My comparison between the Dutch and the German culture: http://mightbedamian.tumblr.com/post/151988181967/tmi-ish-tuesday-32-cultural-differences-between - All #TMIishTuesdays: mightbedamian.tumblr.com/tagged/tmi - More #TMIishTuesdays on random topics: http://mightbedamian.tumblr.com/tagged/me - More very cool stuff: www.twitter.com/mightbedamian - Even more very cool stuff: mightbedamian.tumblr.com 

#tmi #lgbtqplus #me

[kristinsimmons]

Why Hillarycare failed…and what we need to learn from that failure

By MATTHEW HOLT

In July 2005 George W Bush had relatively recently won a Presidential election in which the Republican won the popular vote (something that will likely never happen again) & the Republicans controlled all three branches of Government. Those of us liberals at the bottom of a dark trench were wondering if and how we’d get to health reform. So in another reprint to celebrate THCB’s 15th birthday, here was my then take on what went wrong in 1994 and what would happen next–Matthew Holt     

There are lots of versions about what killed the 1993-4 health care reform effort.  Hillary Clinton has now decided that the problem was the lack of incrementalism in her plan.  Last week the New York Times said that since becoming a Senator:

“She has deliberately avoided the major mistake she made as first lady, namely trying to sell an ambitious plan to a public with no appetite for radical change. <SNIP>. She summed up her approach in the first floor speech she delivered in the Senate about four years ago, when she unveiled a series of relatively modest health care initiatives. “I learned some valuable lessons about the legislative process, the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done,” she said, referring to the 1994 defeat of her health care plan.”

On the other hand, some people are still claiming victory for the plan’s defeat even if they were at most modest bit players.  Here’s what one fawning bio says about former New York Lt Governor Betsy McCaughey

“A 35-year-old senior fellow named Elizabeth McCaughey…wrote an article for The New Republic on what she discovered in a close reading of the 1,431-page document containing the Clinton Health Care Plan: Namely, that it would put every citizen in a single government-operated HMO. That one article shot down the entire blimp, and Betsy McCaughey became a 35-year-old Cinderella. One of the richest men in America chose her as his wife, and George Pataki made her lieutenant governor of New York.”

Ignoring the fact that McCaughey spent her time thereafter putting poor New Yorkers into those HMOs she so despised, and then went off the deep end en route to divorce from Pataki, the rich guy, and reality (not necessarily in that order), it’s not really true that one article in The New Republic can be quite that influential. (Sorry Jon!).  Even if the overly geeky Clintonistas in the White House did feel that they had to come out with a point by point rebuttal. And anyway, the article only came out in January 1994 by which time the die was more or less cast the other way. Again we have to look elsewhere for the explanation.

If you want to go back and spend a few minutes wallowing in the era of trial balloons and secret task forces, there’s a very interesting time line of the whole process on the NPR website, as well as a briefer information over at the Clinton Health Plan Wikipedia site. It seems like there was a moment when it could have succeeded, and indeed there may well have been. What has been missing from the whole discussion over multiple blogs over the last couple of months has been the understanding that there’s a real world outside Washington and that sometimes (but not too often) what’s going on there has an impact inside the beltway.

The debate over health care had been building for quite a while by the time of the 1992 election even though it wasn’t a big factor in the Clinton victory. Harris Wofford had won a Senate seat in 1991 in Pennsylvania with some slogan about the right of every American to go to a doctor. And the debate was being picked up amongst the SCLM elite, with the NY times having several articles about it. In fact my only ever mention on the front (or any other page) of the NY Times (as the third banana author of a piece on Japanese health care) came in very late 1992. That was one of many tiny indications that the discussion about what was wrong with American health care which had been brewing in academia for some time, was starting to come to the notice of the politicos.

So why was that debate becoming politically important? The answer was recession and middle-class insecurity. The recession of 1991-2 was brief but deep and somewhat local (centered around Los Angeles — remember “Falling Down“?)….and it was the first time that a significant number of white collar workers were asked to pay towards their health benefits. It was also the second time that heath care costs rapidly went up much faster than economic growth (the first time was in the Reagan recession of the early 1980s) which woke up employers, and it was the first time that Americans were being put into managed care plans by their employers. But by far the most important factor was the fear that no job meant no health insurance.  And even though the recession in fact was over by the end of the election season, the carry-over effect of the “no job = no health care” fear went on into 1993.

Clinton was not elected to change the health care system — the slogan was “It’s the economy, stupid!”. But rational wonk that he was, when he started to look at the economy and the rate of growth of the health care sector, he realized that he had found the biggest problem, and he set out to fix it. But he wasn’t really a wonk about health care, and neither was Hillary. So after the election they decided that they had to study the problem first and then come up with a solution. As a more recent opportunist politician would say, Beeg mistake!

Instead what was important was the opportunity given to the reformer crowd by the recession. Harris has asked questions about Americans’ attitude to the health care system since 1982. They published a historical retrospective a couple of years back which I urge you to read if you only click on one link in this post. The proportion saying that the system needed to be completely rebuilt (the most negative of 3 choices) went from 19% in 1987 to 24% in 1989 (via a weirdly high 29% in 1988) to 42% in 1991. There’s always a big group in the middle looking for “fundamental change”, but the fact that 42% were looking for a complete rebuilding meant that there was an appetite for something real to be done.  But of course there was only so much of a window, and as the economy picked up by 1993 the number was down to the mid-30%s where it basically stayed until the boom of the 1990s took health care off the radar and it fell to hover around 30% and below.  (Note of course the 30% is still a pretty high number and a much higher “base of dissatisfaction” to start from when we have the next debate).

While they should have been petrified about the gradual reduction in concern around the “no job = no health care” issue, Hillary and Ira Magaziner basically ignored 15 years worth of study about what was wrong with the health care system and spent 4-6 months fact-finding. Clinton’s address to Congress about health care, the most important issue of his Presidency not involving interns and blue dresses, was not until  September 23, 1993–Nine full months after he came to office . (That was the speech when the wrong one was loaded into the teleprompter, but he aced it anyway)

While there was some optimism in the immediate aftermath of the speech, nothing got done and politically everything was going to pot. Paul Starr, the Princeton professor who ended up being the ideological parent of the Clinton plan published his version of reality in an article called called What Happened to Health Care Reform?. In the middle of that article he got somewhere near to the truth:

“With unemployment down, Americans were worrying less about their jobs and health coverage and more about crime. As health care inflation eased primarily because inflation was generally under control, businesses worried less about health care cost containment and more about the political implications of an expansion of government authority. Under these conditions, the ideological and interest-group opponents of reform were able to change the subject. Instead of health care, the focus of debate became government, which was a debate we were sure to lose.”

It didn’t help that the Clinton’s taskforce had mystified and excluded even potential allies.  For example the whole thing was supposed to be an employer mandate based on managed competition a la Enthoven. Sara Singer in Enthoven’s office told me that by putting Medicaid into the Regional Health Alliances, the Clinton plan would kill the employer risk pool and become de facto single payer. I didn’t see too much wrong with that as a policy but it was enough for Enthoven to declare that all 1400 plus pages of the plan should be ripped up. So without the ideological father of managed competition, it’s not surprising the the Jackson Hole Group and the employers they carried with them wouldn’t sign on. And, of course, because of the employer mandate the small employers (including the doctors) and smaller insurers were always going to be opposed, hence the Harry and Louise campaign of late 1993. When it came out around that time that they were going to pay for the plan by cutting Medicare and Medicaid reimbursements, they lost the doctors and providers, and it was all over bar the shouting.

By December 1993 Harvard pollster Bob Blendon was telling the corporate clients we worked with that the only way to save the plan was for Bill to sack Hillary and Ira, and like the Palestinian-Israeli peace process (remember that?) he should take a few trusted Senators to a Norwegian hotel and let them come up with a whole new bill. Magaziner and Hillary continued to press forward, but the meeting in the Norwegian Hotel never came about.

Of course the delays and all the other scandals like Whitewater, Vince Foster, and the various fluffed appointments and nannygates — not to mention the stress of getting the budget passed in 1993, took away attention from the health care reform initiative. But the key point was that a plan as detailed as that coming out of the task force was never going to be more than a first offer, and that it never needed all that time in preparation, or all that detail. Clinton’s six simple principles for health reform, that he announced in the September speech, would have sufficed in February 1, 2003. By the time he tried to bargain away universal coverage in mid-2004 it was too little too late.

Compare and contrast with how a real political operative got stuff done. Here’s a description of the Medicare Act passage, also passed with a Democratic President, House and Senate.

“This act was signed into law by President Lyndon Johnson on July 30, 1965, in Independence, MO. It established Medicare, a health insurance program for the elderly, and Medicaid, a health insurance program for the poor.”

In 1965, the passage of the Social Security Act Amendments, popularly known as Medicare, resulted in a basic program of hospital insurance for persons aged 65 and older, and a supplementary medical insurance program to aid the elderly in paying doctor bills and other health care bills. It was funded by a tax on the earnings of employees, matched by contributions by employers, and was well received. In the first three years of the program, nearly 20 million beneficiaries enrolled in it.

Debate over the program actually began two decades earlier when President Harry S. Truman sent a message to Congress asking for legislation establishing a national health insurance plan. At that time, vocal opponents warned of the dangers of “socialized medicine.” By the end of the Truman’s administration, he had backed off from a plan of universal coverage, but administrators in the Social Security system and others began to focus on the idea of a program aimed at insuring Social Security beneficiaries whose numbers and needs were growing.

Between 1960 and 1965, the health coverage debate was a front burner issue in Congress, with dozens of proposals introduced and testimonies given by representatives of major organizations, including the American Hospital Association, the American Medical Association, and the AFL-CIO. After Congress passed the legislation in the summer of 1965, President Lyndon Johnson decided to sign the bill with former President Truman at the Truman Presidential Library in Independence, MO, in order to recognize Truman’s early effort to establish a national health insurance program. What that doesn’t tell you is the three key aspects of the Medicare and Medicaid Act; 1) It explicitly bought off the AMA by telling them that Doctors could keep billing at UCR rates and would not be interfered with by the government. 2) It explicitly gave the Blues plans a role in processing Medicare claims, one which they still by and large have, and 3) most important, look at the date. The whole bill was done and dusted less than 6 months after the new Congress was sworn in. So the potential opponents were bought off, and then it was pushed through fast before they realized what was hitting them.

Now Johnson had advantages. He had won a landslide; he had more Democratic Senators on his side (although many were very conservative); he didn’t have to worry about the deficit and thus could afford to buy off his industry opponents, who of course were much weaker than they were 30 years later, and he wasn’t going for universal insurance for everyone (just the most expensive ones). And of course he lied about the cost (Note that that worked for Bush in 2003 too!). But one lesson at least is, if you want to get something done, make it simple and get it done fast before opponents can get it together to stop you. So don’t be too fussed about the details so long as it works for your overall principles.

I remember going to the American Association of Health Services Researchers meeting in DC in 1993, and I, like everyone else, thought that the Clintons were going to get something passed. How naive. But I do remember one speaker saying that he remembered when it failed last time (1973), because everyone’s second best option then was to “do nothing”. He hoped that we had a better second option. We didn’t.

Instead the option was to trust the market. If I had a nickel for every health executive who told me that market reform was happening and that meant we didn’t need government reform, then I’d probably have had two bucks by the end of 1994. But as soon as the “market” (i.e. doctors and hospitals) realized what “market reform” meant they started squealing for government protection. That put the Republicans in a bind that they’ve yet to get out of. We used to call it “The market is working but managed care sucks”,  as exemplified by Republican M. Stanton Evans in The National Review in this 1998 article. Of course nothing that came out of the period of market “reform” was that different to the mechanisms for cost control in the Clinton plan — aggressive managed care plan pricing and Medicare cuts.

The memory of this foul-up may not be enough to matter. Even if employers and the public can’t afford the bill for health care, and even if providers fear that no reform may be worse that reform they have a stake in, it still may be impossible to do. In an article called The Great Health Care Debate of 1993-4 Derek Bok essentially argued that health care reform can’t be done. as it’s just too damn political. He also intriguingly noted that the Clinton plan was very popular in 1994 until it was associated with that name. So politics trumped policy in a triumph of Limbaugh over logic. And if you remember the vitriol over the very moderate Clintons from the newly loud right in the early 1990s maybe nothing would ever have worked. And we are no less polarized today.

But there are some positive points.  If you look at Harris polls taken nearly more than a decade apart, philosophically as a nation we are still in favor of universal health care access. (Below are the 2003 results)

“By 75% to 21% (including a 66% to 30% majority of Republicans), most people agree that “people who are unemployed or poor should be able to get the same amount and quality of medical services as people who have good jobs and are paying substantial taxes”.

By 69% to 27% (including a 63% to 32% majority of Republicans), most people disagree that “it’s fair that people who pay more in taxes (or in health insurance premiums) should be able to get better medical care than those who pay little or nothing.” In fact despite 15 years of arrant egotism and conservatism this whole series also shows that we’ve only become slightly meaner since 1991. And in principle we as a nation want to move to universal health care. So I think that at some point reform can and probably will be done, particularly as all the pressures of 1991-3 are worse now.

But we unquestionably need to take advantage of the opportunity that the failure of the system is presenting us with. Especially the new equation that “a job doesn’t not equal health care access”. We need to get the debate into gear about how the system isn’t working for most Americans, and how “that means YOU!” for what’s left of the middle class. Particularly the white, male, southern, middle class.

The main lesson of HillaryCare is that when the right moment comes along politically we need to get whatever form of universal reform can be agreed on shoved quickly through the Congress. Make no mistake, universal insurance is a big bang and a necessary big bang.  Getting it through will be a hell of a confluence of opportunity and tactics.  Once we get it done, then we have a while to worry about sorting out the system to the purists’ satisfaction later.

So will you all still please stop arguing about what it should look like!

Why Hillarycare failed…and what we need to learn from that failure published first on https://wittooth.tumblr.com/