‘Medicare for All’ Will Terrify Voters

It sounds good until people realize it means losing their existing plans.

Medicare for All becomes less popular when people hear more about its possible effects. Support dropped to 37%, with about 60% opposed, when respondents were told it would “eliminate private health-insurance companies” or “require most Americans to pay more in taxes.” Support fell to 32% when respondents were alerted it would “threaten current Medicare.” And it crashed to 26% if those polled heard it would lead to “delays in people getting some medical tests and treatments.”

.. Names matter, too. A November 2017 Kaiser poll found that, without mentioning negative effects, “Medicare for All” drew a 62% favorable rating. But labeling the same idea “single-payer health insurance” dropped support to 48%. Calling it “socialized medicine” produced a nearly even split, 44% favorable to 43% negative.

Medicare for everyone may sound good to voters at first. But after sustained reflection—and Republican attacks—it will likely be soundly rejected. Most Americans do not want to surrender control of their health-care decisions to an impersonal bureaucracy in Washington.

.. And the $32.6 trillion figure could be low. Mr. Blahous says the tab may “be substantially greater,” since his analysis accepted both the “significant administrative and drug cost savings” estimated by Medicare-for-all advocates and reimbursement rates 40% less than what private health insurance pays today, on average. Mr. Blahous, a former public trustee for Social Security and Medicare, believes the savings would not materialize fully and the cuts in reimbursements are unsustainable.
.. Congressional supporters of the plan fear that nearly doubling the federal budget could sink their proposal. That’s why Sen. Bernie Sanders, the father of Medicare for All, refuses to say how much it will cost.
.. Still, Republicans could lose the public-opinion battle unless they prepare an organized offensive. This will require the persistent involvement of a White House that has shown itself ill-prepared for extended campaigns of explanation and persuasion. It also requires Republicans to highlight the proposal’s weaknesses. For example, they should find a way to stage a Senate vote on abolishing private health insurance to show how few Democrats are willing to back that—isolating that party’s hard-core Sandernistas.
.. Nor can Republicans merely stand on opposition to Medicare for All; it’s hard to beat something with nothing. The GOP also must lay out ideas to make health care better, more affordable and more accessible with choice, competition and markets.The rush by Democratic presidential candidates to embrace Medicare for All—and measures like “free” college, guaranteed jobs and universal basic income—may make the 2020 election a contest between promise-them-anything democratic socialism and free enterprise. The stakes don’t get much higher than that.

Middle-Class Shame Will Decide Where America Is Headed

Who can appeal to the people who feel the most like they’ve gotten a raw deal?

.. Beto O’Rourke is one possible Democratic candidate for 2020 who seems to understand the power of talking to people who think they’ve gotten a raw deal.
Over the past few years, I have spoken to hundreds of people, like Ms. Womack, who define themselves as middle class but are seriously economically challenged. In their lives, an illness could mean bankruptcy. I talked to many people who had college degrees, were convinced they were on the right path, yet were shaken by their endless debt — from the cost of their graduate degrees, caring for an elderly parent or paying for a child’s medication.

Sometimes their professions had contracted, resulting in a loss of jobs. Sometimes it was because their work had become irregular and they had no union to negotiate for them. Health care and education cost far more than they once did and wages were barely inching up. As a result, they had personal pain — and ire — that many politicians didn’t take seriously enough.

After all, what I have called the “middle precariat” vote — or what could be called the anxiety vote — gave us this president, and now it has also given us a Democratic House. It is a powerful force.

Any Democrat who wants to win the White House in 2020 is going to need to harness the power of these voters. Indeed, the race has very much started, including the recent announcement of a presidential campaign exploratory committee by Senator Elizabeth Warren of Massachusetts, who has already started to emphasize how the middle class is “hollowed out.”

One of the first challenges is getting people to admit they are struggling financially, and to talk publicly about it. This can be hard for members of the middle class, a group that has a real sense of stigma about financial floundering. They are hobbled by a long-held obsession with privacy and don’t always acknowledge what is troubling them, according to research by Caitlin Zaloom, an anthropologist at New York University.

The second — and most basic — way of addressing the anxious middle-class vote is by acknowledging people’s suffering. At rallies, ask people with student or medical debt to raise their hands, so that they don’t quietly carry it with them for their lives, afraid to speak because they don’t want to admit they need help.

Candidates and politicians should follow the example of New York’s new Democratic congresswoman, Alexandria Ocasio-Cortez, who acknowledged that she wouldn’t be able to pay the costly rent for a Washington apartment until her government paychecks start coming in. They should openly discuss the tendency of many people to blame themselves for their professional and financial distress. Donald Trump jumped on this discomfort in 2016, after all, and made it part of his rhetoric, even though, of course, he had no intention of changing much.

“They have imbibed this idea that your economic well-being is traceable principally to your own efforts,” Ms. Shenker-Osorio said.

As a result, what the electorate doesn’t need to hear are Horatio Alger stories of how candidates worked their way up from humble origins, with the implied moral that anyone can make it in America with enough hard work. These kinds of tales can insidiously lead middle-class people today to blame themselves more for not flourishing.

Instead, the new Congress and candidates of the future should tell voters that it’s O.K. to be mad about being in debt, that this is a savage society we now live in. They could talk about their own experience of debt, be it student or medical, or the debt of someone in their family. (What makes this a bit harder is how unrelatable, and depressing, the wealth of our Congress still is: in 2015, it was majority millionaire.)

To win the anxious middle-class vote, politicians must offer real solutions for the challenges in the lives of these voters, especially on health care and education. One example of this is the scholarship program that Gov. Andrew Cuomo of New York put in place: 940,000 middle-class families and individuals making up to $125,000 per year will qualify to attend tuition-free at colleges in the New York State and New York City public university systems. Though not perfect, it’s a step in the right direction.

It is important to get these voters beyond the shame of debt, perhaps by allowing student debtors to be able to declare bankruptcy related to student loans, something that is nearly impossible to do now, and obtain debt forgiveness.

An actual “Medicare for all” proposal would get at the heart of what is a real challenge for many. Michèle Lamont, a sociologist at Harvard who specializes in culture and inequality, told me that her work found that when candidates promote a policy like Medicare for all, even if it doesn’t come to fruition they are signaling that they understand voters’ need for solidarity and give voice to their hopes and difficulties by making them visible.

A few possible Democratic candidates for the 2020 nomination, from Bernie Sanders to Beto O’Rourke, seem to understand this possibility, and have been attempting to redirect Americans’ anger toward fighting for the things they need, like reasonably priced education and health care. Mr. Trump, no doubt, will continue to mine this territory in a re-election campaign, despite his role in fueling our neglect to begin with.

Middle-class and poor voters have more in common with one another today than they do with the economic ultra-elite. And if they can continue to organize into coalitions, they could be truly powerful forces. Maybe they’d take to the streets most weeks and shut down our cities on a more regular basis, like they do in France.

Then again, maybe the people we elect can express our pain for us instead, so we wouldn’t have to.

Who’s Afraid of the Budget Deficit?

Democrats shouldn’t put themselves in a fiscal straitjacket.

On Thursday, the best House speaker of modern times reclaimed her gavel, replacing one of the worst. It has taken the news media a very long time to appreciate the greatness of Nancy Pelosi, who saved Social Security from privatization, then was instrumental in gaining health insurance for 20 million Americans. And the media are still having a hard time facing up to the phoniness of their darling Paul Ryan, who, by the way, left office with a 12 percent favorable rating.

There’s every reason to expect that Pelosi will once again be highly effective. But some progressive Democrats object to one of her initial moves — and on the economics, and probably the politics, the critics are right.

.. The issue in question is “paygo,” a rule requiring that increases in spending be matched by offsetting tax increases or cuts elsewhere.

You can argue that as a practical matter, the rule won’t matter much if at all. On one side, paygo is the law, whether Democrats put it in their internal rules or not. On the other side, the law can fairly easily be waived, as happened after the G.O.P.’s huge 2017 tax cut was enacted.

But adopting the rule was a signal of Democratic priorities — a statement that the party is deeply concerned about budget deficits and willing to cramp its other goals to address that concern. Is that a signal the party should really be sending?

.. Furthermore, there are things the government should be spending money on even when jobs are plentiful — things like fixing our deteriorating infrastructure and helping children get education, health care and adequate nutrition. Such spending has big long-run payoffs, even in purely monetary terms.

Meanwhile, the federal government can borrow money very cheaply — the interest rate on inflation-protected 10-year bonds is only about 1 percent. These low borrowing costs, in turn, reflect what seems to be a persistent savings glut — that is, the private sector wants to save more than it’s willing to invest, even with very low interest rates.

Or consider what happened after Democrats enacted the Affordable Care Act, going to great lengths to pay for the additional benefits with tax increases and spending cuts. A majority of voters still believed that it increased the deficit. Reality doesn’t seem to matter.

.. Anyway, the truth is that while voters may claim to care about the deficit, hardly any of them really do. For example, does anyone still believe that the Tea Party uprising was a protest against deficits? From the beginning, it was basically about race — about the government spending money to help Those People. And that’s true of a lot of what pretends to be fiscal conservatism.

.. In fact, even the deficit scolds who played such a big role in Beltway discourse during the Obama years seem oddly selective in their concerns about red ink. After all those proclamations that fiscal doom was coming any day now unless we cut spending on Social Security and Medicare, it’s remarkable how muted their response has been to a huge, budget-busting tax cut. It’s almost as if their real goal was shrinking social programs, not limiting national debt.

.. So am I saying that Democrats should completely ignore budget deficits? No; if and when they’re ready to move on things like some form of Medicare for All, the sums will be so large that asking how they’ll be paid for will be crucial.

Could an Amy Klobuchar Solve Democrats’ Dilemma?

They seek a presidential candidate who appeals to both their liberal coastal base and to Midwestern working- and middle-class voters

When asked recently who Republicans should fear most in the 2020 presidential campaign, two prominent GOP figures, both women speaking independently of each other, gave the same response: Sen. Amy Klobuchar of Minnesota.

A third Republican, a male, asked which kind of candidate Democrats should want, replied: “They need a boring white guy from the Midwest.”

So, there you have it: The dream ticket of Amy Klobuchar and Sen. Sherrod Brown of Ohio. Case closed, cancel the primaries, on to the general election.

So if all that creates an opportunity for Democrats in 2020, here’s their dilemma: Can they pick a candidate who can blend the party’s conflicting impulses?

This may seem a long ways off, but the reality is that most Democrats thinking of running for president—and the number probably runs into the 20s—plan to make their decision over the next several weeks, so they can move out starting in early 2019.

As this drama begins, the key question is whether the party will find somebody who appeals both to its coastal base dominated by progressives, upscale college graduates, millennials and minorities, or choose someone who is more appealing to traditional working- and middle-class voters in industrial Midwest states such as Pennsylvania, Wisconsin and Michigan, all of which helped Democrats reclaim the House in this year’s mid-term elections.

.. The winning lottery ticket, of course, goes to somebody who can appeal to both. And that’s why Ms. Klobuchar’s name—and profile—attract attention. She’s a woman, obviously, which is important at a time when newly energized women are a growing force within the party. She pleased her party base in the hearings on the Supreme Court nomination of Brett Kavanaugh when she challenged him about his use of alcohol, but did so in a sufficiently calm and understated manner that she won an apology from Mr. Kavanaugh after he initially responded angrily.

.. She also won re-election this year with more than 60% of the vote in the one state Trump forces lost in 2016 but think they have a legitimate chance to flip their way in 2020.

.. The question is whether she or anyone can put together a policy agenda that pleases both party liberals, who are pushing for

  1. a Medicare-for-all health system,
  2. the demise of the Immigration and Customs Enforcement system and an
  3. aggressive new climate-change action plan, and more moderate Midwestern voters, who may be scared off by all of those things.

Ms. Klobuchar’s policy priorities may suggest a path. To address health care, the top priority of Democratic voters, she advocates a step-by-step approach, one that seeks to

  • drive down prescription drug costs by opening the door to less-expensive drugs from Canada,
  • protect and improve the Affordable Care Act, and
  • expand health coverage by considering such steps as allowing more Americans to buy into the Medicare system.

.. She’s talked of a push to improve American infrastructure that would include expanding rural Americans’ access to broadband service, paying for it by rolling back some—though not all—of the tax cuts Republicans passed last year. She pushes for more vigorous antitrust enforcement, more protections for privacy and steps to curb undisclosed money in politics

.. For his part, Sen. Brown, a liberal who this year won Ohio as it otherwise drifts Republican, offers a working-class-friendly agenda that combines progressive impulses for government activism to drive up wages with Trumpian skepticism about trade deals and corporate outsourcing.