Doing the Health Care Two-Step

Medium-size reform creates the conditions for bigger things.

Recent state elections — the Democratic landslide in Virginia, followed by Democratic gubernatorial victories in Kentucky and Louisiana — have been bad news for Donald Trump.

Among other things, the election results vindicate polls indicating that Trump is historically unpopular. All of these races were in part referendums on Trump, who put a lot of effort into backing his preferred candidates. And in each case voters gave him a clear thumbs down.

Beyond offering a verdict on Trump, however, I’d argue that the state elections offered some guidance on an issue that has divided Democrats, namely health care. What the results suggested to me was the virtue of medium-size reform: incremental enough to have a good chance of being enacted, big enough to provide tangible benefits that voters don’t want taken away.

Remember, there was a third governor’s race, in Mississippi, in which the G.O.P. held on. True, Mississippi is a very red state, which Trump won by 18 points in 2016. But Louisiana and Kentucky are or were, if anything, even redder, with Trump margins of 20 and 30 points respectively. So what made the difference?

Personalities surely mattered. Louisiana’s re-elected John Bel Edwards was widely liked, Kentucky’s defeated Matt Bevin widely disliked. Demography probably also mattered. Urban and especially suburban voters have turned hard against Trump, but rural voters haven’t, at least so far — and Mississippi is one of the few states left with a majority-rural population.

But there’s another difference among the three states. Kentucky and Louisiana took advantage of the Affordable Care Act to expand Medicaid, leading to steep drops in the number of uninsured residents; Mississippi hasn’t. This meant that voting Democratic in Kentucky and Louisiana meant voting to preserve past policy success, while the same vote in Mississippi was at best about hope for future reform — a much less powerful motivator.

Back in 2010, as Obamacare was about to squeak through Congress, Nancy Pelosi famously declared, “We have to pass the bill so that you can find out what is in it.” This line was willfully misrepresented by Republicans (and some reporters who should have known better) as an admission that there was something underhanded about the way the legislation was enacted. What she meant, however, was that voters wouldn’t fully appreciate the A.C.A. until they experienced its benefits in real life.

It took years to get there, but in the end Pelosi was proved right, as health care became a winning issue for Democrats. In the 2018 midterms and in subsequent state elections, voters punished politicians whom they suspected of wanting to undermine key achievements like protection for pre-existing conditions and, yes, Medicaid expansion.

And this political reality has arguably set the stage for further action. At this point, as far as I can tell, all of the contenders for the Democratic presidential nomination are calling for a significant expansion of the government’s role in health care, although they differ about how far and how fast to go.

Which brings me to the latest development in intra-Democratic policy disputes: Elizabeth Warren’s proposal for a two-step approach to health reform. Her idea is to start with actions — some requiring no legislation at all, others requiring only a simple Senate majority — that would greatly expand health insurance coverage. These actions would, if successful, deliver tangible benefits to millions.

They would not, however, amount to the full Bernie, eliminating private insurance and going full single-payer. Warren still says that this is her eventual intention, and has laid out a plan to pay for such a system. But any legislative push would wait three years, giving time for voters to see the benefits of the initial changes.

Sanders supporters are, predictably, crying betrayal. For them it’s all or nothing: a commitment to single-payer has to be in the legislation from Day 1.

The trouble with such demands, aside from the strong probability that proposing elimination of private insurance would be a liability in the general election, is that such legislation would almost certainly fail to pass even a Democratic Senate. So all or nothing would, in practice, mean nothing.

But is Warren giving up on Medicare for All? After all, what she’s offering isn’t really a transition plan in the usual sense, since there’s no guarantee that Step 2 would ever happen.

The lesson I take from the politics of Obamacare, however, is that successful health reform, even if incomplete, creates the preconditions for further reform. What looks impossible now might look very different once tens of millions of additional people have actual experience with expanded Medicare, and can compare it with private insurance.

Although I’ve long argued against making Medicare for All a purity test, there is a good case for eventually going single-payer. But the only way that’s going to happen is via something like Warren’s approach: initial reforms that deliver concrete benefits, and maybe provide a steppingstone to something even bigger.

Looks Like the Trump Administration Lied About the Census

The administration said it needed citizenship data to protect voting rights. New documents tell another story.

A trove of documents brought to the attention of the Supreme Court on Thursday makes it hard to see the Trump administration’s efforts to include a citizenship question on the 2020 census as anything but a partisan power grab.

The court will decide before the end of June whether Wilbur Ross, the commerce secretary, was justified under federal law in adding the citizenship question — a move that would nearly certainly lead to a serious undercounts of Hispanics and in immigrant-rich communities. During a hearing on the case in April, it appeared that a majority of the justices was prepared to allow the administration to include the question.

But the explosive new evidence disclosed by the plaintiffs in the case ought to give the justices pause about the ruling they’re about to issue. This is one of the most consequential cases before the court this term. The decision on it will have far-reaching effects on the distribution of political power and federal funding across the country for the next decade and beyond.

According to the plaintiffs who brought the New York challenge to the citizenship question, Mark Neuman, a key adviser to Mr. Ross on census issues, and John Gore, a Justice Department official who oversees voting rights enforcement, gave false or misleading testimony during the course of the litigation about why the Trump administration was so intent on including a citizenship query in the decennial count.

The files show that he wrote to President Trump’s transition team to tack the question onto the census and helped to write a draft Justice Department letter claiming that the question was needed to enforce the 1965 Voting Rights Act. That was the pretext the administration later used to justify its decision to include it — and which Judge Furman rejected.

Judge Jesse Furman of Federal District Court, the first of three judges to strike down the citizenship question, has asked the Justice Department to respond to the charges and has scheduled a hearing for next week.

Lawyers challenging the citizenship question told Judge Furman on Thursday that, according to a 2015 study written by Mr. Hofeller, adding a citizenship question would create “a structural electoral advantage” that would benefit Republicans and non-Hispanic whites. The documents were unearthed last year by Mr. Hofeller’s estranged daughter, who found them among his effects on four external hard drives and 18 thumb drives.

The files show that he wrote to President Trump’s transition team to tack the question onto the census and helped to write a draft Justice Department letter claiming that the question was needed to enforce the 1965 Voting Rights Act. That was the pretext the administration later used to justify its decision to include it — and which Judge Furman rejected.

Mr. Neuman admitted in a deposition last year that Mr. Hofeller was the first person to suggest the addition of the citizenship question. The plaintiffs accuse Mr. Neuman and Mr. Gore of providing false testimony in their explanations for this whole charade.

“The new evidence demonstrates a direct through-line from Mr. Hofeller’s conclusion that adding a citizenship question would advantage Republican and non-Hispanic whites” to the rationale advanced by the Justice Department, the lawyers wrote.

In a civil rights case, this would be powerful evidence that the Trump administration took the action for the express purpose of disadvantaging minorities. This, however, is a case dealing with administrative rules, which require officials to act in good faith and offer legitimate reasons for advancing a particular policy goal.

An accurate and fair count of everyone in America isn’t just any policy goal. There’s much at stake with the 2020 census — from the future of the next redistricting cycle to how billions of dollars in federal funding will be allocated. The Supreme Court should see this new evidence for what it seems to reveal: A blatant attempt to rig a constitutional mandate.

Republicans left no doubt what they think of women

Sen. Orrin Hatch (R-Utah) barked at female sex-crime victims, “Grow up!” He called Christine Blasey Ford a “pleasing” witness. He shooed women away with a flick of his wrist. Hatch also posted “an uncorroborated account from a Utah man questioning the legitimacy and sexual preferences” of Julie Swetnick, one of Brett M. Kavanaugh’s accusers. The Salt Lake Tribune editorial board raked him over the coals:

The despicable attack launched by Sen. Orrin Hatch and the Senate Judiciary Committee — more precisely, the Republicans on that committee — on one of the women who has accused Supreme Court nominee Brett Kavanaugh of sexual assault is a textbook example of why more victims do not come forward.

Worse, it betrays a positively medieval attitude toward all women as sex objects who cannot be believed or taken seriously.

Not a single Republican spoke up to criticize him. One would think someone would point out that he brought dishonor on himself, his party and the Senate. But clearly Republicans take no umbrage at such conduct.

Senate Judiciary Committee Chairman Charles E. Grassley (R-Iowa) attempted to excuse the lack of a single Republican woman — ever — on the Judiciary Committee. “It’s a lot of work — maybe they don’t want to do it.”

Kavanaugh snapped and sneered at female senators on the Judiciary Committee. Republicans didn’t bat an eye or hold it against him. He was just mad, you see.

President Trump repeated the calumny that if the attack was “as bad” as Ford said she’d have gone to the police. He declared it was a “scary time” for young men. He openly mocked Ford at a rally to gin up his base’s anger. Republican apologists said he was just explaining the facts. He actually misrepresented her testimony, falsely claiming she couldn’t recall many facts — the neighborhood of the house where she was attacked.

 William Saletan called out Trump and his defenders: “It’s true that Ford can’t recall important details about place and time. It’s true that she can’t recall how she got to the house or how she left. It’s true that every accused person is entitled to a presumption of innocence. But Trump’s portrayal of Ford’s testimony wasn’t true. It was a pack of lies. And people who defend it, like Lindsey Graham, are liars too.”

Trump Will Have Blood on His Hands

His demonization of the news media won’t fall on deaf ears.

.. “Hey Bret, what do you think? Do you think the pen is mightier than the sword, or that the AR is mightier than the pen?”
.. Perhaps the reason Trump voters are so frequently the subject of caricature,” I wrote, “is that they so frequently conform to type.”
.. Which brings me to the July 20 meeting between Trump and two senior leaders of The Times, publisher A.G. Sulzberger and editorial page editor James Bennet.
.. he warned the president that “his language was not just divisive but increasingly dangerous,” and that characterizations of the news media as “the enemy of the people” are “contributing to a rise in threats against journalists and will lead to violence.”
.. Sulzberger’s warning had no effect.
.. By now, it almost passes without comment that the president of the United States not only violates the ground rules of his own meetings with the press, but also misrepresents the substance of the conversation.
.. in a follow-on tweet, that the media were “very unpatriotic” for revealing “internal deliberations of our government” that could put people’s lives at risk. That’s almost funny considering that no media organ has revealed more such deliberations, with less regard for consequences, than his beloved WikiLeaks.

.. What can’t be ignored is presidential behavior that might best be described as incitement. Maybe Trump supposes that the worst he’s doing is inciting the people who come to his rallies to give reporters like CNN’s Jim Acosta the finger. And maybe he thinks that most journalists, with their relentless hostility to his personality and policies, richly deserve public scorn.

Yet for every 1,000 or so Trump supporters whose contempt for the press rises only as far as their middle fingers, a few will be people like my caller. Of that few, how many are ready to take the next fatal step? In the age of the active shooter, the number isn’t zero.

.. Should that happen — when that happens — and journalists are dead because some nut thinks he’s doing the president’s bidding against the fifth column that is the media, what will Trump’s supporters say?

..  neither is he the child who played with a loaded gun and knew not what he did.

.. Donald Trump’s more sophisticated defenders have long since mastered the art of pretending that the only thing that matters with his presidency is what it does, not what he says. But not all of the president’s defenders are quite as sophisticated. Some of them didn’t get the memo about taking Trump seriously but not literally. A few hear the phrase “enemy of the people” and are prepared to take the words to their logical conclusion.

.. We are approaching a day when blood on the newsroom floor will be blood on the president’s hands.

 

Comment:

Mocks Bernie for his hair.
Mocks Maxine for a low IQ
Attacks the media for “Fake news”.
Another perfect Projection score.