The Closer You Look, The Meaner It Is

If your eyes glaze over at the prospect of getting down “in the weeds” of the Senate healthcare bill, Josh Marshall’s summary really tells you everything you need to know:

It has always been crystal clear for numerous reasons that the Senate health care repeal bill would be the like the House bill, both versions, just as it will be like the final bill that emerges from a conference committee. McConnell and Ryan knew that ball hiding about scores and legislative language would prevent reporters from saying this: Around 24 million Americans will lose their coverage, everyone will go back to the era of pre-existing conditions restrictions and lifetime limits. The freed up money will go to a big tax cut for the very wealthy. You didn’t need to see the legislative language to know this. It’s been a failure of journalism to pretend otherwise.

If, however, you want several specific compelling reasons to oppose this travesty, there are any number of reports and commentaries that can help. For example, we learn about several “buried” provisions from an article in the LA Times, in a column that describes the bill as a “poorly-disguised massive tax cut for the wealthy, paid for by cutting Medicaid — which serves the middle class and the poor — to the bone.” Then there’s this:

States will have more authority to reimpose lifetime and annual benefit caps and eliminate essential health benefits. This may be the most insidious provision of the repeal bill, and certainly is the most deeply hidden.

As several Governors–including Republican Governors– have noted, this grant of authority to the states will almost certainly be used, because the deep cuts in Medicaid and other federal funding will leave the states no choice.

The Affordable Care Act also had state waivers designed to allow for innovations, especially in state Medicaid programs. But under the ACA, those waivers could not  lead to fewer people being insured, or to the imposition of higher out-of-pocket expenses. The Senate bill repeals those limitations.

Under the measure, the secretary “must” approve a waiver request as long as it won’t increase the federal deficit. As a result, states would be able to eliminate the essential health benefits that all health plans must provide under the ACA — including hospitalization, prescription coverage, maternity care and substance abuse and mental health treatment. Since only essential health benefits are subject to the ban on lifetime and annual benefit limits, high-cost patients such as cancer victims and sufferers from chronic diseases could permanently lose their benefits in the course of their treatment.

And then there’s pre-existing conditions. As the Times reports,

Protection for people with preexisting conditions is destroyed. Senate Republicans claim in their talking points that the measure protects people with preexisting conditions from being denied coverage or priced out of the market. Don’t believe them…The Senate bill will open the door to states forcing people with preexisting conditions into segregated markets that will lead them to pay far, far higher costs than everyone else….This bill will bring the country back to a system in which insurance only works for the healthy, and the sick can’t afford the coverage they need.

There’s lots more. Older Americans will get hosed; under this bill as currently drafted, older Americans could be charged five times what younger, healthier Americans will pay. Meanwhile, the biggest tax cut for the rich is retroactive; a millionaire who already had booked a $1-million gain on a stock sale, for example, would collect a $38,000 benefit.(Even the Wall Street Journal was aghast at that one.)

And most despicable of all:

In fact, all the measure’s tax cuts taken together, valued at about $700 billion over 10 years, would be almost entirely paid for by the bill’s elimination of Medicaid expansion in the 30 states and the District of Columbia that accepted it.

The bill defunds Planned Parenthood. It cuts Medicaid so drastically that hundreds of thousands of elderly Americans will no longer be able to go to nursing homes, and rural hospitals that depend upon Medicaid will close. It will strip coverage from more than twenty million people, and take us back to the days when people had no choice but to use emergency rooms for primary care. The medical cost curve, which had been coming down under the ACA will once again rise more rapidly than the rate of inflation.

And why? To further enrich the already wealthy–and not so incidentally, to destroy the legacy of America’s first black President.

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Religious Liberty And the Marketplace

Most of us have heard the military admonition against “fighting the last war.” The point is obvious: generals and political actors need to evaluate and respond to the reality in which they live; getting stuck in the past–fighting the last war– is a formula for failure.That admonition also suggests one way of analyzing America’s current political situation.

Much of our contemporary political and cultural polarization is between people I have previously described as Puritans and those I have dubbed Modernists.

America’s Puritans still see liberty as “freedom to do the right thing,” defined as behavior consistent with their particular theology. They still believe, with the earliest American settlers, that government should have the authority to weigh in on the side of “Godliness” as their theology conceives it.

Modernists–in and out of religious communities–accept the post-Enlightenment notion that liberty means personal autonomy, your right to do your own thing, so long as you aren’t harming anyone else and so long as you are willing to grant an equal right to your fellow citizens.

The shorthand for modernism is “live and let live.”

Conflicts over recognition of same-sex marriage and bathroom use by transgender individuals, and efforts to allow “religious” merchants to refuse service to LGBTQ customers are really conflicts between America’s Puritans and its Modernists. Puritans  believe that government should throw its weight behind their theological beliefs; Modernists understand the importance of separating church and state, of preventing  particularized religious doctrines from marginalizing or disadvantaging otherwise law-abiding citizens.

Even in the churches, the Modernists are winning. As the Religion News Service reports,

In no U.S. religious group does a majority think it’s acceptable for businesspeople to invoke their religious beliefs to refuse service to gays.

This finding from a 2016 Public Religion Research Institute survey is a first, said Robert P. Jones, CEO of the nonprofit research group.

The change in opinion among even conservative religious adherents has been relatively rapid:  In 2015, more than half of white evangelical Protestants and Mormons surveyed approved of merchants who cited religious belief to deny service to LGBT customers; in the 2016 survey, the percentage of white evangelical Protestants who expressed approval had dropped to 50% from  56% the year before.

The percentage of white mainline Protestants who approved of businesspeople who withhold services to gay people dropped to 30 percent in the recent poll, down from 37 percent in 2015.

Overall in 2016, twice as many Americans disapproved than approved of those who refuse service to a gay person based on religious beliefs (61 percent to 30 percent).

PRRI’s findings corroborate a more dramatic overall shift in attitudes about same-sex marriage and LBGT Americans in the past decade.

Most religious groups today support same-sex marriage, Jones noted. “The religious groups in which majorities oppose same-sex marriage make up less than 20 percent of the public.”

Despite the diminishing number of Puritans, state and federal legislators continue to support discriminatory measures aimed at the LGBTQ community, just as they continue to support a variety of measures disadvantaging women–all piously justified as “protecting religious liberty.”

They are fighting the last war. And thankfully, they’re losing.

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Buy This Book!

I think I may be in love with Al Franken. In fact, I think he’d be a great President! (Of course, next to the one we have, my cat would be a great President–and I don’t have a cat. Still…)

I just finished reading Al Franken: Giant of the Senate. I recommend it highly–and not only for its humor. (But the humor is great.)

The book tells the story of Franken’s improbable voyage from Saturday Night Live (and other venues for less than decorous humor) to the U.S. Senate, and it is more informative than most textbooks if you want to learn about the political process, the operation of the United States Senate, the day to day job description of a Senator, and the pros and cons of a variety of thorny political issues.

As the flyleaf says, “it’s a book about what happens when the nation’s foremost progressive satirist gets a chance to serve in the United States Senate and, defying the expectations of the pundit class, actually turns out to be good at it.” It’s also “a book about our deeply polarized, frequently depressing, occasionally inspiring political culture, written from inside the belly of the beast.”

The book is a testament to democratic decision-making and public service, written by a mensch. (Google it.) Franken’s self-deprecating storytelling, his willingness to credit his staff and his family and even his constituents for his accomplishments, is particularly refreshing at a time when America’s Commander-in-Chief insists on taking personal credit for any event that is even remotely positive, whether he had anything to do with it or not. (Any day now, I fully expect him to take credit for the sun rising in the morning.)

If the real Al Franken is the same person who comes across in this book, he’s a great guy–down to earth, level-headed, self-aware–with a great sense of humor. (Genuine humor, when you think about it, requires a sense of proportion and an appreciation of reality.) Evidently, you can speak truth to power without being an asshole; you can be a committed progressive and still get along with equally committed conservatives; and you can take seriously your obligation to represent the people who live in your state without being a sanctimonious prig.

You can also learn how to be an effective “insider” without getting co-opted by “the system.”

The best thing about this book? It restored my faith in the possibilities of democracy. (Note the word “possibilities.”) Given Franken’s candid reporting on the current state of our nation, democracy is far from being realized, but it does remain a (tantalizing) possibility.

Buy the damn book.

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Anticipating Unanticipated Consequences

These are horrific political times. It’s hard not to be depressed–every day, it seems, we wake up to a new assault on what we thought were American values, new evidence of deplorable behaviors and attitudes we thought we’d left behind, new efforts to roll back hard-won progress.

But.

We need to remind ourselves that the turbulence and upheaval we see around us is not a new phenomenon. Times of social transition are typically unsettled and contentious. (Think of the Sixties, not to mention the Industrial Revolution, the Civil War…). The question is: what comes next? What are we transitioning to? 

My own prediction–based on history and a lot of hope–is that the election of Trump will prove to be a turning point, that the resistance and increased activism we are already seeing will grow more pronounced, and the political pendulum will swing back toward sanity and concern for the common good. The problem is, in the meantime, Trump and the Congressional GOP are doing incalculable damage to the environment, to the rule of law, to the economy and to America’s place in the world.

Yesterday, McConnell finally unveiled the Senate’s Trumpcare bill, and it is even worse than the House version; it proposes to take health care from millions of struggling Americans in order to give a huge tax break to the rich.

Despicable as it is, I’m not the only person who sees potential for eventual progress lurking in short-term disaster. Take Ezra Klein’s recent article for Vox, “Republicans are about to make Medicare-for-All Much More Likely.”

On Friday, McConnell reportedly “delivered a private warning to his Senate Republicans: If they failed to pass legislation unwinding the Affordable Care Act, Democrats could regain power and establish a single-payer health-care system.”

History may record a certain irony if this is the argument McConnell uses to successfully destroy Obamacare. In recent conversations with Democrats and industry observers, I’ve become convinced that just the opposite is true: If Republicans unwind Obamacare and pass their bill, then Democrats are much likelier to establish a single-payer health care system — or at least the beginnings of one — when they regain power.

And if the GOP successfully unwinds Obamacare, the Democrats are far more likely to regain power in 2018. As Klein says,

The political fallout from passing the American Health Care Act — which even Donald Trump is reportedly calling “mean” — will also be immense. In passing a bill that polls at 20 percent even before taking insurance away from anyone, Republicans will give Democrats a driving issue in 2018 and beyond — and next time Democrats have power, they’ll have to deliver on their promises to voters. Much as repeal and replace powered the GOP since 2010 and dominated their agenda as soon as they won back the White House, if the American Health Care Act passes, “Medicare for all” will power the Democratic Party after 2017.

The bubble that Congressional Republicans occupy has become so divorced from the reality of American life and opinion–so in thrall to a (shrinking) base that is itself divorced from reality–that they no longer connect with most Americans. And presumably, the Democrats will have learned some important lessons from their experience with the ACA.

If Republicans wipe out the Affordable Care Act and de-insure tens of millions of people, they will prove a few things to Democrats. First, including private insurers and conservative ideas in a health reform plan doesn’t offer a scintilla of political protection, much less Republican support. Second, sweeping health reform can be passed quickly, with only 51 votes in the Senate, and with no support from major industry actors. Third, it’s easier to defend popular government programs that people already understand and appreciate, like Medicaid and Medicare, than to defend complex public-private partnerships, like Obamacare’s exchanges….

Obamacare was the test of the incrementalist theory, and, politically, at least, it’s failed. Democrats built a law to appeal to moderate Republicans that incorporated key ideas from Mitt Romney’s Massachusetts reforms, and it nevertheless became the single most polarizing initiative of Obama’s presidency. All the work Democrats did to build support from the health care industry has proven to be worth precious little as Republicans push their repeal plan forward. And the complex public-private design of the Affordable Care Act left the system dependent on the business decisions of private insurers and left Democrats trying to explain away premium increases they don’t control. The result is a Democratic Party moving left, and fast, on health care.

“I have been in contact with a lot of Democrats in Congress,” says Yale’s Jacob Hacker, who is influential in liberal health policy circles, “and I am confident that the modal policy approach has shifted pretty strongly toward a more direct, public-option strategy, if not ‘Medicare for all.’”

As bleak as our current political environment is, Klein and others see Ryan, McConnell and our clueless President unwittingly sowing the seeds of fairer and more cost-effective policies.

The accuracy of that prediction, of course, depends upon the strength, savvy and persistence of the Resistance.

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It’s All About Turnout

Many Americans are convinced that gerrymandering–while admittedly a bipartisan offense–  has operated since 2011 to given Republicans power vastly disproportionate to their vote margins. (If you don’t believe that, read Ratf***ked).

I for one am thrilled that the Supreme Court will take up the issue during its coming term, and I’m cautiously optimistic that the new statistical and analytical tools that can distinguish between purposeful game-playing and “luck of the draw” redistricting will persuade the court to abandon its prior reluctance to weigh in–a reluctance based largely upon the absence of such tools.

That said–and fingers crossed–David Leonhardt made a critically-important point in a recent New York Times column.

If liberals voted at the same rate as conservatives, Hillary Clinton would be president. Even with Donald Trump’s working-class appeal, Clinton could have swept Michigan, Wisconsin and Pennsylvania.

If liberals voted at the same rate as conservatives, Democrats would control the Senate. Clinton or Barack Obama could then have filled the recent Supreme Court vacancy, and that justice would hold the tiebreaking vote on campaign finance, labor unions and other issues.

If liberals voted at the same rate as conservatives, the country would be doing more to address the two defining issues of our time — climate change and stagnant middle-class living standards.

Leonhardt’s point is important, and too often overlooked.

Even the most sophisticated gerrymandering is based upon prior voter turnout in the areas involved. If polling and survey research are correct, a majority of Americans hold progressive policy preferences–but large numbers of them don’t express those preferences at the polls. They don’t vote. To repeat the obvious, gerrymandering is based upon prior voting patterns.

I vividly remember conversations with John Sweezy, then the Marion County Republican Party Chair, back when I was a Republican. At the time (late 1970’s) Indianapolis/Marion County was safely Republican; it remained that way for thirty-two years. Even then, however, with the GOP in firm control of every local office, Democrats in the county outnumbered Republicans by a margin of 3-2.  Had the same percentage of registered Democrats voted as Republicans, they’d have won those offices. As John said more than once, “Thank God, Democrats don’t vote.”

It’s all about turnout. Even supposedly “safe” legislative districts can be won by the “loser” party if that party can generate a sufficient increase in turnout.

There are all kinds of theories about why Democratic turnout lags that of the Republicans, and several of those theories have explanatory power. Right now, the more important question is: how do we motivate these voters? How do we convince them that their votes really can make a difference, that the game hasn’t been so rigged by gerrymandering and crazy Voter ID requirements and inconvenient polling places and the like that it just isn’t worth the effort?

As Leonhardt says,

What can be done? First, don’t make the mistake of blaming everything on nefarious Republicans. Yes, Republicans have gerrymandered districts and shamefully suppressed votes (and Democrats should keep pushing for laws that make voting easier). But the turnout gap is bigger than any Republican scheme.

Second, keep in mind that turnout is a human-behavior problem. It involves persuading people to change long-established habits. And there is a powerful force uprooting all kinds of habits today: digital technology.

More specifically, smartphones are changing how people interact with information. I’d encourage progressives in Silicon Valley to think of voting as a giant realm ripe for disruption. Academic research by Alan Gerber, Donald Green and others has shown that peer pressure can lift turnout. Smartphones are the most efficient peer-pressure device ever invented, but no one has figured out how social media or texting can get a lot more people to the polls — yet.

Even a really good gerrymandering decision from the Supreme Court will be followed by years of state-level game-playing and obstruction–in both red and blue states. But we can work on turnout right now.

Democrats don’t have to “peel off” Republican voters, a tactic that failed to deliver Tuesday in Georgia. We just have to get the people who already agree with us to the polls.

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