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.

Nancy Pelosi SABOTAGES Trump’s Impeachment

And then there’s the corporate Democrats, who are like, I don’t know, what will Trump
voters think?
But guys, look, this one is so over the top.
It really got me to question like, do they not wanna dig because folks are gonna find
out things about Democrats.
>> Yes, I think that’s part of it.
I mean, obviously, that’s speculation.
But the fact that they have shied away from possible financial crimes, as aggressively
as they have, really makes you wonder, why do they wanna limit the scope of this investigation?
I mean this argument that they want to keep it simple is a little ridiculous to me because
I think that there are way more issues out there that Trump is involved in that the American
public deserves to know about and he should be held accountable for.
The fact that they are avoiding those incredibly important questions makes me worried and it
also makes me worried that Jerry Nadler, who is the Chairman of the House Judiciary Committee
was not included in this closed door meeting with Nancy Pelosi.
Now remember, Nadler is the one who had some tension with Pelosi when it came to the question
of impeachment.
He wanted impeachment, he was pressuring her on impeachment and she was resisting.
she resisted that more than she’s ever resisted Donald Trump.
Let’s keep it real.
And the fact that he wasn’t included in this meeting makes me worry.
>> So why doesn’t Richard Neal, the head of the House Ways and Means Committee want Donald
Trump’s taxes?
He would not ask for his New York state taxes.
What a weird thing.
I mean, there’s just It makes no sense at all.
In this case, Pelosi says, well, if we get another issues will be bogged down on the
courts, what are you talking about?
You’re already investigating those things, and that it’s already in the courts.
There’s like, how would the tax returns issue bring the Ukrainian issue into the courts.
It makes no sense at all.
She’s just saying things that are not only not true but not logically coherent.
So that’s what makes me wonder like, what is going on here?
What are you guys trying to hide?
Why do you not want to look into trump’s businesses under any and all circumstances?
Under the most obvious circumstances?
And I don’t pretend to know why.

Guatemala Doesn’t Need Bernie Sanders

Central America has already tried his style of social justice and found it wanting.

In a Democratic debate last week, Vermont Sen. Bernie Sanders argued that to deal with the migration crisis at the U.S. southern border, “we’ve got to ask ourselves, ‘Why are people walking 2,000 miles to a strange country where they don’t know the language?’ ”

It’s a sad day when a septuagenarian U.S. senator can’t grasp the reason for Central American poverty.

The migrants were born in countries that lack rule of law, respect for private property, and economic freedom. The nations of the Northern Triangle—El Salvador, Guatemala and Honduras—instead have pursued Sanders-style social justice as a path to prosperity. It’s hardly a surprise their citizens enjoy neither.

Environmental mobs close down mining projects and chase away investors. Activists block roads to shake down the government; they invade farms and steal electricity with impunity. Well aware that upward economic mobility is nearly impossible, Central Americans vote with their feet.

The prospects for change aren’t promising. Ideas matter, and for generations the global left—mostly from Europe and the U.S.—has treated the region as its sandbox, where it goes to play with policies that don’t sell at home. Central America is macerated in the collectivist bunk of this elite, who promise utopia and deliver special-interest mercantilism and corrupt statism.

This is one reason Guatemalans were freaked out Friday when their Prensa Libre newspaper reported that Speaker Nancy Pelosi would lead a congressional delegation to Guatemala City this week “to meet with civil society, businessmen and other sectors.” Her office declined to comment for security reasons. But if she is going, it is worth asking why she would visit in the week before the Aug. 11 presidential runoff election.

The election is an important milestone in Guatemalan politics, and the deciding factor may be urban turnout. Despite a solid lead in a recent poll, center-right Vamos Party candidate Alejandro Giammattei isn’t a shoo-in. If voters in the big cities stay home, social democrat Sandra Torres of the National Unity of Hope Party could prevail.

Ms. Torres was first lady during the presidency of Alvaro Colom (2008-12) but divorced him in 2011 in an attempt to circumvent a constitutional prohibition on consecutively following a spouse into the executive office. The high court didn’t buy it, but she did make an unsuccessful run in 2015.

Ms. Torres is a left-wing populist. Her party, which is known as UNE, dominates rural and small-town Guatemala. Pocketbook issues are a priority in these parts and machine politics are the name of the game. By promising things like child and elder subsidies and tin roofs, UNE maintains a solid base.

Mr. Giammattei is by no means the first choice of Guatemalan conservatives. That designation goes to Zury Ríos, daughter of the late Gen. Efraín Ríos Montt, who held the presidency for less than 17 months after a 1982 coup. Ms. Ríos is a popular politician and made her own run for the presidency in 2015. This time around, the constitutional court blocked her candidacy because of her father’s role as a military dictator.

Yet Mr. Giammattei ran the prison system and pledges a tough-on-crime agenda. He says he will bring investment to the country. With UNE controlling Congress and much of the judicial branch, voters may prefer an executive check on social-democrat power.

Both candidates oppose the immigration-cooperation framework agreement that President Jimmy Morales signed with President Trump in July. The accord is short on detail, but as protocols are added, the expectation is that it will oblige Salvadorans and Hondurans who try to move north to the U.S. to apply for asylum in Guatemala. Speculation was running wild last week that Mrs. Pelosi’s visit was partly aimed at derailing the agreement for domestic American political reasons.

Both candidates promise to fight corruption, but voter apathy implies a high degree of public skepticism. The United Nations International Commission Against Impunity in Guatemala—a k a CICIG—was supposed to bring about the rule of law. But somewhere along the way the left realized it could use CICIG, accountable to no one, to grab power without the fuss of elections. A judicial reign of terror, designed to silence opposition, ended only in January, when President Morales kicked CICIG out of the country.

The media ran news stories for nearly a decade that read like CICIG press releases. But in March the Guatemalan attorney general petitioned the court to arrest CICIG’s closet Guatemalan collaborator, former Attorney General Thelma Aldana, on corruption charges. As the country’s top prosecutor, she ought to have protected civil liberties. Instead she permitted the commission’s abuses while it refused calls to investigate her. Guatemalans are still trying to recover confidence in their justice system.

Ms. Aldana, who had presidential aspirations, says she is being politically persecuted. But she has fled the country rather than face trial. If voters are uninspired by their political class, and afraid of help from Democrats, who could blame them?

Shields and Brooks on Trump-Pelosi feud, 2020 Democrats

Syndicated columnist Mark Shields and New York Times columnist David Brooks join Judy Woodruff to discuss the week’s political news, including NewsHour interviews with 2020 presidential candidates Eric Swalwell and Kirsten Gillibrand, the escalating feud between President Trump and House Speaker Nancy Pelosi and whether ongoing congressional investigations are leading to impeachment.