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Gradualism, Single-Payer, and the Debate We’re Not Having

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One of the things that I find truly frustrating about the way that the 2016 Democratic primaries have gone is that, while most of the attention and energy has gone to debating the virtues and identities of various groups of Bernie and Hillary voters and the ongoing attempt to turn fairly normal primary tactics into a grand moral crisis of something, we’re actually spending very little time talking about policy.

And we really need to be talking about policy, whether it’s whether Hillary’s actually always been on the left or the changes in the party platform that Bernie wants to fight for at the convention. Because while no one’s been paying attention, some lines are being drawn about what the Democratic Party is going to stand for.

The first place I noticed this was the fight over UMass economist Gerald Friedman’s report on Bernie Sanders’ ambitious proposals for Keynesian stimulus, where Democratic Council of Economic Advisers Chairs Alan Krueger, Austan Goulsbee, and Christina Romer rhetorically kneecapped a report suggesting that Sanders’ proposals would significantly boost the economy, all in the name of evidence-driven policy.

Now, this is a larger topic that deserves its own post, and one I’ll write when grading is over and I have a bit more time, but it was a noticeable attempt to boundary-police without being too public about why a policy that comes right out of the greatest hits of the Progressive Caucus was unacceptable to the party establishment. Are those ideas no longer acceptable within the Democratic Party? Were progressives just being humored because the larger Democratic Caucus needed their votes and knew that their bills were never going anywhere? I don’t know, because no one is actually talking about this – instead, we keep having oblique discussions about respectability politics.

The second place where this came up was with single-payer, which I discussed in a previous post. As I said in that post, there are some major problems with the current debate which make it very difficult to have the conversation that Scott Lemieux wants us to be having about how to build on the Affordable Care Act to get to a European-style health system.

Because when we look at an example like Colorado, signs are not very encouraging that the ACA is going to be used in that way, as opposed to being used as rhetorical cover for being opposed to further reform. It’s one thing to argue that gradualism is better than going for single-payer in one bite, but it’s another thing to openly campaign for the defeat of a single-payer initiative, to echo Republican attacks that single-payer will raise taxes and kill jobs, and to see Democratic consultants working for the vote no campaign.

It raises the question about how sincere some Democratic electeds are about sharing the goals of the progressive movement. After all, one of the few concessions made to the pro-single-payer camp in the Democratic Party during the debates over the ACA was the idea that, even if we couldn’t get single-payer this time, waivers would allow for experiments in single-payer on the state level. (Indeed, it was Bernie Sanders himself who wrote the provision that allows for single-payer waivers.) But if every time that progressives push to make use of that concession, whether it’s in Colorado or California, moderate Democrats (who were happy enough to be for single-payer when it wasn’t going to pass) walk sideways and torpedo the effort, people are going to start thinking they’ve been treated like Charlie Brown with the football.

And once again, this fight is happening without having a genuine debate about what the Democratic party’s goals should be and how to get there. Is single-payer just bad strategy or unacceptable on the merits? How are we going to build on the ACA to get to something better? At the very least, I’d like to see some genuine plans from pro-ACA folks about how we build from the status quo to a European-style system, because without that, no only isn’t there isn’t a basis for comparison, but there’s very little evidence that there’s intent to build in the first place.

But hell, who wants to talk about that? Let’s have another debate about superdelegates instead.

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  • DocAmazing

    Much of this wagon-circling by establishment Dems is visible in the latest dumb blasts from various people who should know better that Bernie’s Only Interested in Burning Down the Party and It’s All Due to Male Rage. There’s certainly a great deal of anger among the Sanders supporters, but Jesus, that’s a perfectly understandable reaction to the DWS wing of the Democrats shutting down every attempt to bring the conversation back to progressive economic goals.

    • delazeur

      I agree, the physical altercations at the Nevada convention were a perfectly reasonably response to getting 3 million fewer votes than the opposition.

      • carolannie

        What physical altercations? This appears to be a mostly whole cloth fabrication made up by Clinton delegates and repeated ad nauseam and upgraded to fisticuffs in the media
        http://www.snopes.com/did-sanders-supporters-throw-chairs-at-nevada-democratic-convention/
        I don’t think shouting obscenities counts. I don’t even think trying to move closer to the stage counts, unless people were assaulted.

        Beware the messengers trying to sow discord amongst Democrats.

        • thebewilderness

          The Sanders spokesman has clearly stated that people have no right to feel threatened when they are being threatened. Some people do view lifting a chair as a threat to throw a chair just as others view pointing a gun as a threat to fire a gun. However it is the view of Senator Sanders according to his spokes that we have no right to feel threatened when these things happen so we should all shut up and give them what they want without them having to threaten us. Just Like DWS did today. Give the bullies what they want but never never name the behavior.

          • Simeon

            The guy who lifted up his chair was making a joke about the announcements asking people to take their seats.

            • MyNameIsZweig

              Quiet you, can’t you see you’re interfering with a satisfying narrative!

            • cleek

              did everybody there get the joke?

              • Does the question of whether there were “physical altercations” and “violence” depend on the answer to this question?

              • To follow up on joe, if it really was a joke and went as describe there was no chair throwing and now threat to. Some people might have understandable mistaken the gesture or misinterpreted the photo, which is normal and ok in the moment, but less so as the full picture emerges.

                This is basic, right?

                • random

                  “No chair was actually thrown” is the new “you can’t tell the difference between a clip and a magazine”

                • ??

                  Were there then chairs or threats to? Sorry, I might be behind the latests. My understanding from snipes is that the chair throwing claim was debunked.

                • kped

                  I think it’s fair to say no chair was thrown, but there have been threats…they even have them on voice mail and text messages.

                • amped, sorry I meant rests to throw chairs or do other violence at the convention. My understanding is all the threats were afterwards. (No less repulsive, but rather different.)

                • I’m a week late coming back to this thread, too.

                  I just wanted to say that nobody does a better job of highlighting an amazing disappearing talking like Bijan Parsia.

            • DocAmazing

              Did he also chant “English Only” at Dolores Huerta?

    • DrDick

      Yep.

    • I wouldn’t phrase it this way. I would phrase it as some Bernie supporters doing really stupid and bad things, and then some Clinton supporters making the debate about that and only that.

      • Cheerful

        Exactly. There are a lot of people who don’t really like talking about policy because it is 1) hard and 2) reveals differences that are difficult to paper over and 3) arguing about other issues is more fun.

        You raised good points in this post. I would be particularly interested in the candidates being pressed on what they can do to make single payer a possibility in at least some states, and if not why they oppose.

      • Rob in CT

        Agreed with that.

      • Brien Jackson

        What else is it supposed to be about, in this context?

      • random

        I would phrase it as some Bernie supporters doing really stupid and bad things, and then some Clinton supporters making the debate about that and only that.

        The ‘bad things’ specifically involved doxxing yet another professional woman for doing her job. Followed by thousands of young men from all over the country threatening to murder her and her family.

        It kinda makes sense that Clinton supporters don’t see a debate over that sort of thing as a distraction from ‘real issues’. Over and above any dispute over the primary, it kinda goes to the core theme of her candidacy.

      • addicted44

        Agreed. Supporters doing stupid things is stupid. (Although I’m not sure that death threats don’t cross the line beyond stupid, but lets ignore that).

        Bernie’s response by dismissing those stupid things in general terms, and then complaining about “rigging” is not acceptable. (a) There was no rigging, and Bernie hasn’t provided any evidence or support for any such rigging. But (b) How can you respond by making implied excuses for death threats.

      • Phil Perspective

        I would phrase it as some Bernie supporters doing really stupid and bad things, and then some Clinton supporters making the debate about that and only that.

        Yes, because Clinton people never do stupid and bad things!!

        • cleek

          how many death threats have Clinton supporters made?

          • DrDick

            How many have verifiable Sanders supporters made? You have anonymous threats, so of course they are from Sanders’ supporters. The GOP has never engaged in dirty tricks like that.

            • random

              Actual literal death threats? Probably several hundred just in this one incident. Journalists did follow-up on several of these incidents and all of them were supporters of his.

              It’s crazy how reminiscent of Gamergate this whole episode really is. Even the excuses (‘Nobody in Gamergate would harass anyone, and their ethics were so bad, they brought it on themselves’) are the same.

              • I was saddened by Bernie not really stepping up here. His first statement was rather poor. I wish he would shift to laying groundwork for party building/shifting instead of staying on the old script. But oh well.

                • Brien Jackson

                  Frankly, it was unacceptable. I have no respect for anyone who can “yeah, but” the kind of harassment and threats thrown at Lange. And you certainly can’t do that and then claim super special ownership of the term “progressive.”

                • Well, I’m inclined to give him a little slack in that it’s not clear to me how salient the facts were to him at the time. People have these sorts of lapses all the time. That really did seem to be random people with big flares of
                  assholishness.

                  Now if he was fully cognisant of the messages and thought they were fine, then, yeah, what you said.

                • Brien Jackson

                  By the time Sanders made his statement, the texts and audio messages had been reproduced in multiple news outlets. I’m not sure what else needed to be known exactly unless we’re going to go further down the Alex Jones nuthole and pretend ratfucking is a real thing.

                • Brien, do you thing Sanders reviewed that material before making the statement? I doubt it. That’s all I meant. My guess is that someone said, “you need to say something about NV but don’t let it control the cycle”.

                • random

                  That really did seem to be random people with big flares of
                  assholishness.

                  It’s a direct continuation of a larger pattern of organized harassing / threatening / doxxing anyone who stands up to them. It’s not actually an isolated incident.

                • DocAmazing

                  So you have, of course, some evidence of this organization? It’s not merely some conspiracy theory?

                • kped

                  The reason I don’t give him any slack Bijan is that he repeated conspiracy theories. Enough days had passed that he should have known that of the 64 delegates that were deemed ineligible, only 8 even showed up, and 6 were seated after clearing up their information.

                  He also should have known that he lost because not only did those people not show up, but another 25% of his delegates didn’t show up. Had they shown up in the same % as Clinton’s did (98%), he would have won those 2 or 3 extra delegates. Instead, his people stayed home, a few were ineligible…and they stayed home anyway, and then he makes a statement saying there was fraud and misconduct by the Nevada party. That is a lie. Sanders had ample time to see the full information. Instead he released a letter that could have been written on reddit.

                • DocAmazing

                  we’re going to go further down the Alex Jones nuthole and pretend ratfucking is a real thing

                  Wow. Someone who’s never heard of Donald Segretti, Lee Atwater, or Karl Rove.

                  You may not believe ratfucking is going on in this particular incident, but if you don’t believe that ratfucking exists…

                • The rolling stone article certainly made it seem that those four cases were just response rage rather than any larger movement. I’d welcome links about other incidents.

                • The reason I don’t give him any slack Bijan is that he repeated conspiracy theories. Enough days had passed that he should have known that of the 64 delegates that were deemed ineligible, only 8 even showed up, and 6 were seated after clearing up their information.

                  Ok, but that’s a different thing than his failure to condemn the threats. I’m not happy about the conspiracy nonsense, but it’s a different thing. I would still be sad if he condemned the violence but still went “there cheating me out of the nomination” because I thing that’s crap and unhelpful, but it doesn’t seem as broken at failing to condemn doxxing etc.

                  YMMV

                • random

                  When you post someone’s private contact info on an organizing forum and say ‘destroy this person’ and then a thousand like-minded people on that forum do exactly that, that is not random people calling you on their own recognizance.

                • DocAmazing

                  It’s also no more a part of the Sanders campaign (or under Sanders’s control) than Lady Lynn Forester de Rothschild was part of Clinton’s campaign in 2008.

                • Yes, someone doxxed her and encouraged people to call her and people responded. But this was a coordinated ex ante organised conspiracy? Or the reaction of a bunch of people with little sense reacting to the opportunity?

                  I guess I don’t quite understand how you’re disagreeing with me. The individuals interviewed in the RS article were definitely Bernie supporters but weren’t delegates to even attendees to the convention. They were knuckleheads who got all excited at strike back at the (wo)man.

                  That’s wildly indefensible. Their apologies were mostly inadequate.

                  But what does this have to do either with threats at the convention or an organise group? Are the doxxers organised?

            • Brien Jackson

              Jesus Christ this is embarrassing.

            • brewmn

              Denial’s a helluva drug, doc. You might want to ease up on it a bit.

          • DocAmazing
            • sapient

              Wendell Pierce is an individual person in a private dispute (who was probably drunk). He wasn’t serving as a Clinton primary supporter. Get the distinction?

              • DocAmazing

                And the people who called up Roberta Lange were serving as Sanders primary supporters? I mean, if Sanders is supposed to come up with a public mea culpa for people who claim to support him acting on their own time, then why is Clinton not expected to do the same?

                • Sapient, yeah you got this wrong. Afaik, most if not all of the harassers were random people who followed the convention from afar and went a bit nuts. That’s exactly analogous, with the Lange case magnified by its publicity and dispersed response.

                • random

                  And the people who called up Roberta Lange were serving as Sanders primary supporters?

                  Yes, they directly stated their intent during the course of threatening her. And they were acting on instructions from other supporters, who had actually doxxed her and also stated the intent when they doxxed her.

                  The whole thing was an organized action by a large number of people coordinating in online forums. They’ve actually done it to several other victims, but this is the latest and worst incident.

                • DocAmazing

                  Evidence of organization?

                • random

                  Evidence of organization?

                  I already pointed it out. When you’re doxxing people on a devoted forum and thousands of others on that forum acting on your instructions all target that person, that is not “random”. It’s “coordinated” and “directed”.

                  “Random” would be these people finding her number on their own and hurling abuse at her on their own initiative. It would probably involve maybe 5-6 people if it were random. This is not what happened here.

                • DocAmazing

                  So we’ve got wannabe 4chan types; do we have a link to Sanders?

                • random

                  were random people who followed the convention from afar

                  They weren’t ‘random people’, it’s not like most of them were smart enough to find her private contact info on their own.

                  They were acting on specific instructions from other members of their group to harass this one singular target over a singular issue.

                  Some of them that were contacted were remorseful about their conduct, but most of them were not at all remorseful and were instead explicit in stating that their political beliefs justify far worse behavior.

                • They were acting on specific instructions from other members of their group

                  What’s their group? Is it a private message board or some thing? I didn’t see anything about a specific group. I though he doxxing was on a pretty public space with reasonable traffic and so drew a bunch of random nutters.

                  I’d really like a link to evidence otherwise.

                • “Random” would be these people finding her number on their own and hurling abuse at her on their own initiative. It would probably involve maybe 5-6 people if it were random. This is not what happened here

                  Ok, all I meant by “random” people is that they weren’t attendees at the convention or otherwise part of the Sanders organisation or even part of a group that routinely does that, but just a bunch of people who saw something on the Internet and then did some bad stuff. The inciter certainly meant to incite, but probably more like the schmuck who said he was trying to take on a Jason like character. The organisation isn’t meaningful or mediated.

                • DocAmazing

                  And it wasn’t “Sanders primary supporters”.

                • random

                  but just a bunch of people who saw something on the Internet and then did some bad stuff. The inciter certainly meant to incite, but probably more like the schmuck who said he was trying to take on a Jason like character. The organisation isn’t meaningful or mediated.

                  I didn’t buy this kind of excuse when Gamergate was making it either.

                  This is not the first time that Sanders supporters have organized to harass and insult Democratic figures and other people in their homes either.

                • I presume the phrase means “people who supported Bernie in the primaries” which afaict is true.

                  If it means “key. Or “significant” then that seems unsupported.

                • DocAmazing

                  If it means “key. Or “significant” then that seems unsupported.

                  If it means “in any way involved in the voting process or with the campaign” it is also unsupported.

                • How is it an excuse? Different mobs have different structures. A lot of the gamer game groups were very cohesive over time whereas there’s lots of viciousness against women that’s more opportunistic.

                  But again, if you have specific evidence by all means show it. I’m prepared to believe otherwise, just not on your bare assertion or inference.

                  If there was a reedit forum that the people who sent the texts regularly frequented where there was a bunch of talk over time about online attacks that’s more than enough. If it’s just a pro Bernie board that had at least seeming spontaneous eruption, then that seems less organised.

                • random

                  If there was a reedit forum that the people who sent the texts regularly frequented where there was a bunch of talk over time about online attacks that’s more than enough.

                  Yup. Several doxxings of their perceived enemies have been posted on the major Reddit organizing forums. They do eventually get moderated off, but it’s a pattern.

                • Brien Jackson

                  Don’t forget, many superdelegates have reported for months that they’re getting harassing and threatening phone calls demanding they vote for Sanders.

        • Origami Isopod

          “But MOOOOO-OOOOM, Billy stuck a peanut up his sister’s nose, so why are you mad at me for sticking a peanut up Susie’s nose?”

    • Alex.S

      Most of the people who are writing angry articles about the Sanders campaign right now would be very happy if he was talking about progressive economic goals.

      The problem is when Team Sanders has process arguments — such as Southern states have too much influence or conspiracy theories about Microsoft stealing Iowa or the DNC blocking their delegates who actually didn’t even show up (and they accepted blocked delegates who did show up and updated their information).

      • EliHawk

        Indeed, what stuck out to me from the NY Times article was all that ‘burn it down’ and goals for leverage in Philadelphia were about… process goals. Like more debates, or open primaries (but not fewer caucuses, because democracy). It wasn’t about progressive policy goals, or single payer, or Wall Street. It was “In 2024, there better be more debates!” Which is just the height of idiocy.

      • D.N. Nation

        Shifting the debate as seen in the first half of your post is why I was happy to vote for Sanders. That the debate has now become “DWS and Wall Street have their tentacles on the superdelegates which is why we must convince the superdelegates to make Bernie the nominee through Hot Takes” is why I wonder if I should regret it.

        • dn

          I’ll co-sign that!

    • wengler

      The DNC played a dirty game, it won, and now it’s telling everyone to shut up. What a wonderfully encouraging way to run a party. I’m sure the GOP elite are looking over in envy.

      • Rob in CT

        Dirty how, exactly?

        • ColBatGuano

          Hillary got more votes therefore fraud seems to be the logic.

          • so-in-so

            Plus failure to count the people (who didn’t bother to show up). How much lower can you get!

            • Fake Irishman

              But if you don’t count the states that Clinton won, Sanders has a majority of the votes.

    • Brien Jackson

      Yeah, that’s the only reason anyone could be angry that Sanders didn’t unequivocally condemn his supporters sending misogynistic death threats to Roberta Lange.

      • Davis X. Machina

        No revolution without martyrs.

      • Pat

        We can be angry because he’s abandoning his cause to promote conspiracy theories. And because he’s claiming a conspiracy against him which is people enforcing the rules that were established quite a while ago.

    • Origami Isopod

      There’s certainly a great deal of anger among the Sanders supporters, but Jesus, that’s a perfectly understandable reaction to the DWS wing of the Democrats shutting down every attempt to bring the conversation back to progressive economic goals.

      So calling up Roberta Lange and calling her the C-word, threatening her and her family, and calling up her family and her business to do the same thing was a “perfectly understandable reaction.” Got it.

      • DrDick

        Can you actually confirm who did that?

        • Brien Jackson

          Seriously?

          • DocAmazing

            http://theslot.jezebel.com/we-called-up-bernie-fans-who-threatened-nevada-dem-stat-1777177985

            Here’s about the best piece I’ve found of someone attempting to confirm who did that. None have been shown to have any actual connection to the Sanders campaign–they’re all acting on their own (and, yes, sharing information online, as Random repeatedly points out. The letter from the Nevada State Democratic Party (they really need to do something about those initials) names only one person, and that is for no violent acts, but an offensive presentation.

            This is a great deal of finger-pointing. About all that can be said with certainty is that Sanders failed to condemn bad acts in the strongest terms. As I pointed out above, it took me no time at all to find an act of violence on the part of a Clinton supporter; no one is calling for her to refudiate Wendell Pierce, and really, no one should. As Robert Anton Wilson put it, “A disciple is an asshole attempting to attach itself to a human being”. Neither Sanders nor Clinton are responsible for those particular disciples.

            • I do think there’s a difference between and individual who was arrested and a mob who probably won’t be. That’s a reason for Sanders to speak out.

            • random

              None have been shown to have any actual connection to the Sanders campaign–they’re all acting on their own

              This was the Gamergate defense as well.

              They don’t work for him officially and he might actually fire them if they did and were traced to him, sure. But it’s stupid to deny that the thousands of threatening messages weren’t coming from his supporters or that there isn’t a pattern of this sort of abuse committed by his followers that has been well-documented in the press.

              • DocAmazing

                And you complain about Sanders advancing conspiracy theories?

                • addicted44

                  From Sanders’s website.

                  At that convention the Democratic leadership used its power to prevent a fair and transparent process from taking place. Among other things:

                  The chair of the convention announced that the convention rules passed on voice vote, when the vote was a clear no-vote. At the very least, the Chair should have allowed for a headcount.
                  The chair allowed its Credentials Committee to en mass rule that 64 delegates were ineligible without offering an opportunity for 58 of them to be heard. That decision enabled the Clinton campaign to end up with a 30-vote majority.
                  The chair refused to acknowledge any motions made from the floor or allow votes on them.
                  The chair refused to accept any petitions for amendments to the rules that were properly submitted.

                  “These are on top of failures at the precinct and county conventions including trying to depose and then threaten with arrest the Clark County convention credentials chair because she was operating too fairly.”

                  58 people were not given an opportunity to be heard. You mean the people who did not show up? This stuff was posted days after the convention happened. Sanders is using lies to convince his supporters that there is a DNC conspiracy against him.

                  It’s Trump-whining level embarrassing.

  • Alex.S

    The first place I noticed this was the fight over UMass economist Gerald Friedman’s report on Bernie Sanders’ ambitious proposals for Keynesian stimulus, where Democratic Council of Economic Advisers Chairs Alan Krueger, Austan Goulsbee, and Christina Romer rhetorically kneecapped a report suggesting that Sanders’ proposals would significantly boost the economy, all in the name of evidence-driven policy.

    Now, this is a larger topic that deserves its own post, and one I’ll write when grading is over and I have a bit more time, but it was a noticeable attempt to boundary-police without being too public about why a policy that comes right out of the greatest hits of the Progressive Caucus was unacceptable to the party establishment. Are those ideas no longer acceptable within the Democratic Party? Were progressives just being humored because the larger Democratic Caucus needed their votes and knew that their bills were never going anywhere? I don’t know, because no one is actually talking about this – instead, we keep having oblique discussions about respectability politics.

    Briefly — what happened is that the Sanders campaign linked a report from an economist that predicted everything would be super duper awesome by counting gains from temporary spending as being permanent.

    It’s not that Sanders’ policies were problematic. It’s that the Sanders campaign was doing the liberal version of dynamic scoring, where rosy future predictions outweighed any negatives.

    • JKTH

      what happened is that the Sanders campaign linked a report from an economist that predicted everything would be super duper awesome by counting gains from temporary spending as being permanent.

      I think it was little different, more that Friedman was counting the cumulative spending increase in calculating how much economic growth would increase each year, using a stock measure to calculate the effects on a flow.

      But either way, I agree that it wasn’t a case of establishment economists rejecting Keynesian stimulus, just that the growth effects were way off. More generally, I don’t know why the campaign bothered to put the dynamic scoring stuff out there. GOP campaigns have to do it to justify hugely regressive tax cuts, progressives don’t.

      • Gregor Sansa

        It was a little bit more complex than that. The paper wasn’t clear enough to tell that it was a stock/flow mistake initially (though honestly I suspected it from the start), so early on the quick read version of the objections was essentially “that’s just crazy”, which sounds a lot like hippy-punching if you don’t know the details.

        • JKTH

          Er yeah, that is true that they sent a letter initially that didn’t have any analysis.

        • Alex.S

          I think the biggest eye test in “This doesn’t look right” is that the Sanders economic proposals were relatively balanced — taxes and spending were about equal. Now, taxes can have a minor effect on the economy and spending can have a big multiplier… but taxes do have an effect and spending programs don’t get to a double multiplier (2008 analysis had food stamps as the best multiplier at 1.73).

          In terms of overall effectiveness, it would represent a modest improvement on the current economy. In terms of policy goals, it would be really good — but, much like with Obamacare, it would not be a significant driver in job creation or job killing.

    • howard

      since two comments have already done the heavy lifting, i’ll add that “boundary policing” has literally nothing to do with the criticisms, that is an entirely off-base assessment.

      every single economist who critiqued the report agrees with the policy goals: they simply disagree that we should lie to people about the likely outcome of the policy goals.

      and i’m perfectly happy if “not encouraging dishonest policy sales pitches” is a line in the sand: that’s a boundary i want to police.

      after all, once you start inventing economic outcomes just because you like the policy and believe it should work just super-fantastically, what makes you any different from the tax cut crazies and their inane forecasts?

      • NonyNony

        and i’m perfectly happy if “not encouraging dishonest policy sales pitches” is a line in the sand: that’s a boundary i want to police.

        If the blink tag still existed, I would wrap it around this comment and make it dangerous for incoming airplane traffic.

        The Sanders team being openly and obviously dishonest about the benefits of their economic proposals was the first warning sign to me. I ignored it and voted for him anyway, but in retrospect it really should have been the line in the sand that I refused to cross and I’m mad at myself that I ignored it.

        I actually like being part of the “reality-based community” as it was derisively nicknamed during the W years. It’s a big chunk of the reason I’m a Democrat now and not an independent who leans Democrat as I was during the early part of Bush’s tenure. If that gets thrown away then all politics becomes nothing more than posturing and political theater and it becomes utterly worthless to participate in. (There’s a place for theater, but “lying to your core supporters” is not it IMO.)

      • I’ll get into this more in my next post, but it’s not insignificant that the economist in question was from UMass Amherst, one of the few centers of heterodox economics, whereas the rest were standard saltwaters.

        • Rich C

          But Friedman is very much not a macroeconomist. Essentially all of his scholarly work is in labor economics or economic history. So he was not really accustomed to using the kind of model he worked with in the paper, and he made some elementary (if understandable) mistakes. I don’t think anyone from among the Romer/Romer/DeLong/Krugman group think spending $250 billion on infrastructure over the next five years is a bad idea. They just don’t think that would produce an annual growth rate of 5.6% over the next decade, which is what Friedman’s analysis concluded. If he’d understood the model he was working with initially (or if the Sanders campaign had actively sought out a sympathetic macro economist to do the modelling), he’d likely have come up with a smaller predicted future growth rate (like 3%- 3.5% growth over the next decade) that would not have raised eyebrows while confirming that a big boost to infrastructure spending would be a good idea.

          • Dilan Esper

            Essentially all of his scholarly work is in labor economics or economic history.

            I really cannot comment on the merits of this– despite what some people think, I try to stay out of areas where I have little knowledge, and the weeds of macroeconomic modeling is certainly one of them.

            But I think this is unintentionally telling as a defense of the pushback on Sandersnomics. Does it really surprise you that a LABOR economist might come to different conclusions about macroeconomic policy than the orthodoxy does? And that such conclusions might more broadly align with Sanders’ platform?

            • Gregor Sansa

              He really did make some very basic mistakes. I am significantly to the left of Krugman and willing to swallow some pretty extreme heterodoxy; but some of this wasn’t heterodoxy, just mistakes.

              • sibusisodan

                Yes. It doesn’t surprise me that someone outside of mainstream can come to different conclusions.

                But it also should surprise no one that an academic outside of their speciality can make big errors. That’s…normal.

            • Hogan

              “Labor economist” is an academic/intellectual specialization, not an ideological stance. There are plenty of labor economists out there “proving” that the minimum wage and collective bargaining kill jobs.

            • Rich C

              Labor economics is a subfield, not an indicator that the people so identified care about outcomes for workers. You can care about outcomes for workers and operate in any economic subfield (macro, trade, finance, etc), and many labor economists, sadly, don’t really give a damn about workers. My point was that he was not necessarily familiar with the ins-and-outs of the either the model he was working with (the CBO’s conventional multi-equation model) or others that he might have used (like those developed by Stephen Marglin or Thomas Palley, both heterodox keynesians).

        • L2P

          But that doesn’t support your argument, which is that the criticism was a sign of boundary-setting by the Democratic establishment.

          The “establishment” (and really, it’s just a bunch of economics people, not the leadership of the Democratic party) didn’t say “economic stimulus is off the table,” or even “you can’t use heterodox economic theory to justify your proposals.” The debate was whether ANY economic theory justified those proposals, and there wasn’t. The vast majority of HETERODOX economists were appalled at the Sanders campaign for this.

        • I’ll get into this more in my next post, but it’s not insignificant that the economist in question was from UMass Amherst, one of the few centers of heterodox economics, whereas the rest were standard saltwaters.

          Isn’t this a bit of boundary policing? I mean among the “standard saltwaters” we have:

          Romer/Romer/DeLong/Krugman

          So…what does “standard saltwater” even mean here? What dismissal is supposed to follow?

          Cf Rich C and L2P below.

      • Rob in CT

        +1.

        The way the GOP uses dynamic scoring is rank bullshit. We should not be copying them.

        I do think there’s room to be more aspirational, and it might have been better overall if the reaction to Bernie’s plan and Friedman’s analysis thereof had been “no, that doesn’t pass the sniff test, but if you did this, this and this, it might work out…”

        Less of a total smackdown. More constructive criticism.

        • Brien Jackson

          But the issue wasn’t the proposals specifically, which the economists in question are basically supportive of, but Friedman’s (and by extension the Sanders campaign’s) hackery itself.

          • Rob in CT

            I’m fine with that. What I’m saying is that it would have been even better if they’d taken an extra step.

            It might’ve actually touched off more policy discussion had they gone there.

      • addicted44

        Exactly!

        Even the wonks debunking Sanders’s claims about his healthcare plans made clear that most people would be better off in the net with Sanders’s plan.

        What they were debunking was the claim that it wouldn’t lead to increased taxes for most people (it would increase taxes but most would save more on the lower premiums they would have to pay) and the magnitude of the numbers (which included stuff like savings on prescription drugs which are greater than the entire US expenditure on prescription drugs).

        • Brien Jackson

          And the most infamous of these was written by a guy so gosh-darned opposed to single payer insurance that he…wrote an actual honest to God bill crafting a single payer plan for the state of Vermont.

    • Alex.S

      And looking at a few pull numbers from Friedman’s analysis
      * Budget surplus by 2025
      * Sub-4% unemployment rate from 2020 through 2025.
      * 67% labor force participation rate. With a footnote explaining this with “Women’s employment will be encouraged by the Paycheck Fairness Act, which will raise the wages of women, encouraging more to seek paid employment.”

      And from the analysis of how he got those numbers, and why they were off–

      https://evaluationoffriedman.files.wordpress.com/2016/02/romer-and-romer-evaluation-of-friedman1.pdf

      One fundamental problem with the analysis is that the estimated demand-side effects are grossly too large given Friedman’s own estimates of the scale of the policies. Friedman reports that new government spending (excluding the spending associated with Senator Sanders’s healthcare policies) would raise output in 2026 by about 9% relative to what it otherwise would have been;

      Friedman says that the additional spending under the proposed policies would rise from $300 billion in the first year to close to $600 billion in the fifth, and be between about $300 and $400 billion per year thereafter (Friedman, Table 19). As a share of CBO’s baseline projection of nominal GDP, spending would peak at 2.4%, and in 2026 it would be just 1.4%. An output increase of 9% in 2026 from this amount of spending is grossly out of line with all existing evidence about the impact of changes in government spending. To see this, it is important to realize that although temporary government spending, such as the roughly $1 trillion that Senator Sanders proposes to spend on infrastructure from 2017 to 2021, may have a powerful impact on output and employment in the near term, the demand effects would have faded away completely by 2026. The government would have stopped the temporary spending years before, and so it would have long since stopped contributing to demand. That is, temporary spending could cause a temporary boom, but its effect on the level of GDP a few years after its end will be, to a first approximation, zero.3 For the permanent increase in spending, of which Senator Sanders is proposing roughly 1.4% of GDP, standard estimates indicate that it would increase GDP growth in the first year by between 1.4% and 2.2%. That is, the fiscal multiplier is between 1 and 1.6.4 After the first year, the continued higher spending would maintain the effect on the level of GDP, but not have any additional impact on its growth rate. Therefore, even under the assumption that output in 2026 will be determined entirely by demand rather than productive capacity (an assumption that we do not believe to be correct, as explained in Section II), GDP in 2026 would be higher (relative to the baseline) by at
      most about 2.2% from the permanent increase in government spending—not the 9% that Friedman estimates.

      Thus, Friedman’s figures for the effect of additional government spending exceed conventional ones by at least a factor of four. He offers no evidence for such effects. Indeed, his estimates appear inconsistent with his own assumptions: he assumes that rise in government spending of $1 would typically raise real output by slightly less than a dollar (Friedman, p. 47).5 We have a conjecture about how Friedman may have incorrectly found such large effects. Suppose one is considering a permanent increase in government spending of 1% of GDP, and suppose one assumes that government spending raises output one-for-one. Then one might be tempted to think that the program would raise output growth each year by a percentage point, and so raise the level of output after a decade by about 10%. In fact, however, in this scenario there is no additional stimulus after the first year. As a result, each year the spending would raise the level of output by 1% relative to what it would have been otherwise, and so the impact on the level of output after a decade would be only 1%.

      The TLDR: Friedman starts with 1% in increased spending represents 1% in increased output. And then that number multiplies itself each year, without actually increasing in spending. So 1% in 2016 represents 4% growth in 2025, without actually spending that much.

      At least I think that’s the TLDR — please correct me if I’ve got that wrong.

      • Fake Irishman

        And it’s worth noting that Romer and Romer say right up front in that piece that they deeply value the policy outcomes that Sanders wants (and both of them have a history of fighting for it — Christy Romer was the most energetic member of Obama’s economic advisors in 2009-2010 when it came to pushing for more aggressive stimulus), but they do want to be realistic about paying for it. Part of that realism isn’t assuming magical economic growth from a favored policy This isn’t Lieberman-style or Bayh-style concern trolling on a public option here.

      • I have a mass of stuff on Friedman to get through and I will get through it, so let me throw down a marker here and say I will explain myself in further detail later.

        • howard

          i read all the way down to here, and i’m happy to look forward but i hope you’ll address why one specific individual forecast is important here: there is a broad consensus that government policy could easily accelerate economic growth in ways that would be of benefit to middle and lower income households. why should we be hung about the specific prediction as to the amount of growth? why is that a policy matter worth the effort to defend?

          • Hogan

            Overpromising can have some long-term costs. (“If you like your plan, you can keep it.”)

    • The Lorax

      This.

  • Murc

    One of the things that I find truly frustrating about the way that the 2016 Democratic primaries have gone is that, while most of the attention and energy has gone to debating the virtues and identities of various groups of Bernie and Hillary voters and the ongoing attempt to turn fairly normal primary tactics into a grand moral crisis of something, we’re actually spending very little time talking about policy.

    This is not unusual to 2016, Steven. In fact, 2016 is actually an improvement over 2008 in terms of talking about policy, because there’s actually a ton of daylight between Bernie and Hillary which makes substantive discussion of their differences at least possible.

    In 2008, anytime people tried to contrast Obama and Hillary’s actual policies it was very hard because there simply was very little actual difference. Indeed, a big problem back then was a lot of people invented huge differences between them that only existed in their own minds. So this is actually a marginal improvement!

    That said: I think this year there might also be a bit of a tacit admission among a lot of people that policy matters less than it otherwise might, because we’re not taking the House which means anything other than keeping the lights on is DOA.

    And frankly I expect even keeping the lights on to be problematic; the issues facing a hypothetical President Clinton will not be “how to pass even a modest domestic agenda” but rather “every year the Republicans shut’er down for six weeks to prove a point.”

    raises the question about how sincere some Democratic electeds are about sharing the goals of the progressive movement.

    Many Democrats aren’t progressive. Indeed, many Democrats aren’t liberal. It’s the weakness of our broad coalition. We have a lot of center-right people in here who are mostly Democrats because the Republican Party has become an engine of fear and hate, but who still hate them some “socialism.” This has been known for years. Indeed, this has been the perennial problem of the Democratic Party since the New Deal; it’s why we only get a bite at the apple once every twenty to forty years or so, when we secure majorities large enough to render them irrelevant or at the very least put them in a position where they feel the need to go with the rest of the party. I yield to no man in my contempt for Evan Bayh and Ben Nelson, but they did eventually get dragged along with the rest of the party and they did at least kinda-sorta care about people not dying in the gutter.

    At the very least, I’d like to see some genuine plans from pro-ACA folks about how we build from the status quo to a European-style system,

    This may literally not be possible in an American context without a massively destabilizing event like another depression, which isn’t to be desired because those sorts of things are coin flips between getting FDR, getting Mussolini, or getting Lenin.

    But the only actual maybe workable plan in an American context would be “win some elections.” The ACA would almost certainly have already been modified in many salutary ways if the Democrats hadn’t gotten the shit kicked out of them in 2010.

    • Mac the Knife

      those sorts of things are coin flips between getting FDR, getting Mussolini, or getting Lenin.

      That’s one hell of a coin!

      All kidding aside, your observation that the “more” is an important part of “more and better Democrats” is one that I wish people would keep in mind more than they do.

    • Davis X. Machina

      Are you suggesting the reasons why the US is not a social democracy is the lack of social democrats?

      Some poli-sci type should run with that for a dissertation. I’m sure the insight is novel…

      • revrick

        The reason the US is not a social democracy is that we don’t have a parliamentary system. We have a Presidential democracy, which has two distinct loci of political legitimacy in the executive and legislative branches. With all the veto points in our system, both internally in its design and externally in contending interests, progressive moments are few and far between. And they usually arise at a time of crisis.

    • Brien Jackson

      This may literally not be possible in an American context without a massively destabilizing event like another depression, which isn’t to be desired because those sorts of things are coin flips between getting FDR, getting Mussolini, or getting Lenin.

      But the only actual maybe workable plan in an American context would be “win some elections.” The ACA would almost certainly have already been modified in many salutary ways if the Democrats hadn’t gotten the shit kicked out of them in 2010.

      Yeah, I don’t really understand what the point of that paragraph was supposed to be. It’s not super relevant as long as Republicans have the House, and if we get past that I’ll take “any proposal that expands the ACA in positive ways” and run with it. There’s no real point to having a “plan” right this second.

    • Phil Perspective

      Many Democrats aren’t progressive. Indeed, many Democrats aren’t liberal. It’s the weakness of our broad coalition. We have a lot of center-right people in here who are mostly Democrats because the Republican Party has become an engine of fear and hate, but who still hate them some “socialism.”

      And a lot of people around here would rather vote, apparently, for a ethically compromised DINO rather than an ethically compromised Democrat who was right about the GOP(“Let them die, and die quickly!”) from the get-go. Yes, I’m talking about the race in Florida on the Democratic side to replace empty suit Rubio.

      • Murc

        Does LGM have that many Floridian readers?

    • random

      We have a lot of center-right people in here who are mostly Democrats because the Republican Party has become an engine of fear and hate, but who still hate them some “socialism.”

      Conservative Democrats (especially white ones) prefer the ‘socialist’ candidate by substantial margins. Bayh and Nelson both come from states where the socialist candidate won the Democratic primary for example.

      So this is running aground on that whole ‘what actually is the definition of right and left’ issue. A lot of the Democrats who are currently elevating trade policy and health care above literally every other issue, have the latitude to do that because they aren’t strongly-connected to liberalism in general.

      Also, there was least one major incident where left-wing Democrats were the ones who screwed the centrists out of a chance to move the ball forward on health care (I think Kennedy said it was one of his biggest regrets). So the history and dynamics here just aren’t straightforward.

  • jimpharo

    Those elected dems who are squishy aren’t really dems at all. I suspect we’re seeing a realignment in which a new center-right party emerges under the HRC banner and a new left party emergences under Bernie (or, more likely, their successors, since this’ll take a bit). The current wild-eyed GOPers will go back to their lunatic fringe.

    One reason we’re not talking about this is that, just as the GOP is cracking up, so too are the dems, except we’re not being forced to confront it on CNN every 30 seconds. But the corp. dem vs. progressive dem split will end up being just as…realign-y.

    • Murc

      Neither party is anywhere close to cracking up in a 19th century collapse-of-the-Whigs sense. That is just not going to happen, period.

      Your scenario is flatly insane. For it to happen either the Republican Party would need to actually vanish and a new hypothetical party to the left of the Democratic Party would need to emerge, with massive numbers of Democrats migrating to this new party and massive numbers of former Republicans migrating to the Democratic Party, or a ton of Democrats, including but not limited to Hillary Clinton, who hates her some Republicans, would have to become Republicans.

      And that, if you’ll forgive me, is just looney tunes. It isn’t going to happen.

      • njorl

        Yep. I see the tensions in the political parties, and it seems like some sort of realignment should happen, but who should go where? You have to assume an end result of 2 competitive political parties. If you don’t, the party out of power adapts to attract a faction to make it competitive.
        I’m just not seeing any assortment of factions between two parties of rough parity which has less internal tension than we are seeing now.
        The most likely switch, in my opinion, would be white middle class wage earners becoming more likely to vote for Democrats. They might de-prioritize racism and seek more equitable taxation. As a response, who would Republicans try to woo over to their side? White middle class wage earners.

        No realignment is going to happen soon. Agendas might change, but only to maintain the status quo.

      • Phil Perspective

        Neither party is anywhere close to cracking up in a 19th century collapse-of-the-Whigs sense.

        Yes, because the Democratic Party is in such great shape!! Have you paid attention to anything besides the presidency lately?

        • Murc

          Can you outline a plausible scenario in which tens of millions of people leave either major political party and join the other one or join a third party?

          This is what is required, at minimum, in order for a party to actually crack apart.

    • anapestic

      I have grown weary of the “aren’t really dems at all” arguments. My daughter tried to use it on me to explain why Bernie is the only “real” Democrat running this time out. Just because you don’t like someone’s positions doesn’t mean they aren’t a Democrat.

      • Karen24

        Hear, hear! Reading people out of the party for trivial failures of purity tests is an excellent way to lose forever.

        • postmodulator

          Yes, those kinds of purity tests have really hurt the Republicans, with the notable exceptions of two out of three branches of the federal government, the majority of statehouses, and a supermajority of governors’ mansions.

          • brewmn

            There are tactics of the Republicans I wish the leftier than thous would emulate. Enacting purity tests to drive out all who fail them isn’t one of those tactics.

            • postmodulator

              I don’t necessarily want to emulate them either, but it can hardly be argued that they’re ineffective.

              • But one real problem is that they want to tear down, while we want to build up. Their tactics work better for tearing down, and even there they haven’t been nearly as successful as they’d like. I mean, look at destroying Obamacare.

                But then, they don’t really have to be. A bit of luck (like a republican local level wave just when the census is going in) can take you far.

                • postmodulator

                  There are things Republicans would like to build up, like a national Sex Police force. But in the broad strokes you have the truth of it.

              • searcher

                They’re really effective at saying “No”. They’re notably poor at enacting any positive change (their biggest legislative achievement right now involves bathrooms).

          • revrick

            There are three reasons why the Democrats had their heads handed to them in 2010 and 2014:

            1). It’s the economy stupid! While all the blame for the Great Recession belongs with the Bush administration and the GOP Congress, all the pain has been experienced in the Obama years. To compare it to FDR’s election, Obama got elected in 1929.
            2). Obama and the Democratic Congress got a lot accomplished in the five months of effective control and that often mobilizes the opposition (Tea Party).
            3). We had a wing of the party throwing feces on the progressive things that were accomplished. The ACA and Dodd-Frank are only GOP lite! That had the effect of demobilizing Democrats.

      • Mac the Knife

        Yep. Having to win 50% of the votes locally, let alone statewide, let alone nationwide doesn’t leave a lot of room for writing off everyone who is to your right on any issue.

        Strange bedfellows, etc…

      • Marc

        I’ve gotten exceptionally tired of the related argument by Clinton supporters that Sanders supporters aren’t real Democrats too.

        Primary seasons sometimes make people act as if they’ve taken stupid pills, unfortunately, and it can happen to as many people on your side as on mine or on anyone’s.

        • MyNameIsZweig

          Christ, yes. This.

        • L2P

          People actually say that? Damn.

          • Matt McIrvin

            What I’ve said many times is that the small minority of Sanders supporters who have vowed not to vote for Clinton in the general, and prefer a Trump win to a Clinton win, are mostly not Democrats. I still think that’s true.

            (The very loud one who I personally know is a former Ron Paul supporter.)

            • so-in-so

              Well, the complaints about closed vs. open primaries certainly feed this. If you are running as a Democrat, but depend on independents to win in the primary it is somewhat fair to say your support is not all from Democrats.

        • Rob in CT

          To be perhaps overly fair, some of them really aren’t (and are loud & proud about that fact).

          But most are.

          • Jhoosier

            Anecdata and all that, but a former coworker and friend of mine recently posted on fb that he’s moving back to unaffiliated as soon as possible, and he had quite a bit of agreement from others. That said, he did repost Robert Reich’s statement about supporting Clinton no matter what, because we have to stop Trump.

            I’m interested to find out his actual thought processes, but it’ll have to wait until I see him in person.

        • twbb

          “I’ve gotten exceptionally tired of the related argument by Clinton supporters that Sanders supporters aren’t real Democrats too.”

          Aren’t at least some of those accusations aimed at people who quite literally are not Democrats — they are registered independents who support Sanders and vote for him in states with open primaries and have never actually voted for a Democrat?

          • Aren’t at least some of those accusations aimed at people who quite literally are not Democrats — they are registered independents who support Sanders and vote for him in states with open primaries and have never actually voted for a Democrat?

            My guess is that most of the independents who vote for Sanders in the open primaries are “lean Democrat” independents whose voting behaviour is identical to that of registered democrats.

          • Phil Perspective

            Why should I, as a taxpayer, pay for primaries if I’m excluded from them?

            • Malaclypse

              For the same reason you pay for Yosemite, even if you never visit – because there is such a thing as a common good. And you are only excluded because you choose not to sully yourself affiliating with us.

            • Origami Isopod

              This is stupid even for you, Phil.

            • Hogan

              Free stuff!

      • MyNameIsZweig

        Interesting how in your daughter’s formulation, the only “real” Democrat is the one who …. isn’t even actually registered as a Democrat.

        I mean, come on.

        • Murc

          Bernie Sanders is, in fact, registered as a Democrat.

          • Davis X. Machina

            For now…

          • delazeur

            I would still feel comfortable saying that Bernie Sanders is less of a Democrat than Donald Trump is a Republican.

            • addicted44

              I completely disagree.

              Bernie caucuses with the Dems. He may not be a registered Democrat, but his policies and philosophies align very closely with the Democrats.

              Donald Trump, OTOH, has no policies. He just says whatever comes to his mouth. When agreeing with Democrats is convenient he agress with Dems. When agreeing with Repubs feels right he does that.

              • so-in-so

                We said we didn’t want ideologues, right? How much less ideological can you get?

                I still liked the commenter who said Trump used the GOP like an Uber car. Less so when Sanders does it.

              • delazeur

                Bernie caucuses with the Dems. He may not be a registered Democrat, but his policies and philosophies align very closely with the Democrats.

                I’m not sure I buy that. His voting record might look similar to a Democrat’s, but that doesn’t mean he’s really in the same boat (just that when given a binary yes/no option, he tends to the pick the same one as the Democratic caucus).

                • Well, it would be consistent with the poly sci understanding of “independent” voters. Most studies show that most registered independents either “lean Republican” or “lean Democrat” (strongly or weakly), that is, their voting behaviour is indistinguishable from registered party members. Only 8% or so are “true” independents.

                  So, what’s wrong with going with his voting record? And committee memberships. And presidential run?

                  Bernie is and pretty much always has been a democrat (functionally speaking). His registration mostly just harmed him a bit this run at least with the party elite and some voting blocks and helped him a bit with some other voting blocks.

              • He may not be a registered Democrat

                He is of course, registered now.

          • MyNameIsZweig

            Well shit. That was pretty stupid.

      • wengler

        Bernie’s not a Democrat at all and I don’t blame hit one bit. At the Democratic convention they are already influence peddling the nominee to the tune of $100,000 for a meet.

        • cleek

          someone tell the owner – there’s politics going on in this political party!

      • Dilan Esper

        I have grown weary of the “aren’t really dems at all” arguments.

        I take your point, but some of this is an understandable pushback to parts of the party that really are beyond the pale.

        I mean, does anyone here really disagree with Scott’s periodic posts bashing on Jim Webb?

        The other big source of “aren’t really dems at all” argumentation is closeness to corporate interests. And that’s a real divide, which has been debated here before. Some of us really believe that bankers and finance types (and some other corporate types as well) are basically malefactors, pure and simple. And that one of the things the left side of the spectrum should stand pretty strongly for is the idea that we don’t associate with malefactors, we don’t want their money, we don’t want their quid pro quos and their purchasing of access, etc. We want to deny them a seat at the table, and when we get the chance, we want to prosecute them and throw them in a highly uncomfortable prison for long periods of time.

        And there’s a significant number of people who feel that isn’t correct at all. Either that bankers and finance types are not that bad to begin with, and the only thing we really need to do is regulate them a little more and tax them a little more, or that maybe they are bad but there’s just no way to ever win elections without them so our politicians taking huge amounts of money from them, taking corporate largesse and private jet rides from them, and taking their phone calls and sometimes doing their bidding is the price we have to pay.

        As I said, that’s a real debate, which lies behind the arguments about what a Democrat is.

        • mpowell

          But framing it as an argument regarding who is really a democrat is just a rhetorical device. Given their viewpoint, the left should be pissed that they have to do business with neoliberals but that’s the price of political relevance in the United States today.

          • Dilan Esper

            I’m not sure it is.

            Given the move of young voters to the left, maybe its time for the neoliberals to give ground.

    • Why would a center-right party coalesce around the banner of a center-left figure like Clinton?

      • Murc

        I still encounter people trotting out the twenty-year-old joke that Bill Clinton was the best Republican President since Eisenhower.

        I get that people don’t like the Clintons. I don’t like the Clintons. Bill supported a lot of bad shit, Hillary got the most important question of her Senate career catastrophically wrong and reportedly learned very little from it. I fully expect her to get us involved in a shitty war of choice somewhere during her first term.

        They’re still not conservatives or Republicans. Not in the American political context.

        • Matt McIrvin

          These days, I mostly hear people saying that about Obama.

        • Dilan Esper

          I still encounter people trotting out the twenty-year-old joke that Bill Clinton was the best Republican President since Eisenhower.

          So you know, both Michael Waldman and Bob Woodward quoted Clinton as calling himself a “fucking Eisenhower Republican” in White House meetings.

          • Rob in CT

            Some of which was probably hazy recollection of very, very different times.

            I mean, Obama says stuff like that too, and I think Scott could explain in detail why it’s really not true (except, perhaps, on one or two particular issues).

            What I think it typically means (and what it’s meant when I’ve used that formulation) is: “hey, I’m a pretty reasonable moderate guy. You’re treating me like I’m friggin’ Mao, and I’m not. Sanity, please!”

            • Dilan Esper

              Actually, the context was the opposite. It WAS, in fact, a reflection of how far “right” Clinton was governing. (It came in the context of spending cuts, deficit reduction, the bond market, and Alan Greenspan.)

              • Rob in CT

                Ah. I was thinking of the 1993 tax increase, which happened when Clinton had a Dem congress to work with. Fair enough.

                Obama, I think, uses it my way.

          • Murc

            So you know, both Michael Waldman and Bob Woodward quoted Clinton as calling himself a “fucking Eisenhower Republican” in White House meetings.

            Yes? And?

            Not sure how that’s responsive to anything I said.

        • Hogan

          I went with “most pro-business Democratic president since Grover Cleveland.” I’m not sure everyone in my union got it.

          • DocAmazing

            “Wait–he doesn’t have blue fur…”

        • revrick

          Yet nobody rakes Bernie over the coals for his catastrophically bad vote against TARP. He was like a fire chief telling his crew that was faced with what would easily become a Great Chicago Fire economic conflagration, “Don’t put out the fire in the house it started, because known drug dealers live in it.”

  • Pingback: Sanders: We Loved Him -- Until It Mattered!()

  • mutterc

    Given the extremism of Republicans, I have trouble seeing the political value in being a squishy centrist Democrat. If you’re anywhere to the left of Reagan, Republicans will treat you exactly the same as if you were Lenin & Stalin’s love child.

    If you’re going to get painted as a socialist no matter what you do (as Obama was), why not go seize the means of production?

    • Murc

      Because people actually believe in things beyond their political value?

      Seriously. Those squishy, centrist Dems have actual beliefs that position them as centrist Dems. Why would you assume they are less sincerely passionate in them, and more willing to change, than anyone else with strong political beliefs is?

      • LWA

        I’m thinking more of the voting base.

        Its one thing to support candidates in a red leaning district, as a pragmatic move to secure a win.

        But there’s also a time to go for the jugular and seize the initiative.
        But this goes back to the issue of getting progressives interested and engaged in local politics and capturing school boards and planning commissions.

        I honestly believe that at this low utilitarian level, liberals have the edge because everyone- every-fucking-one- loves government spending, on their street and for their school.

        • NonyNony

          If you believe that most Democrats are hard left liberals you need to look at more polling.

          Most Democratic voters are what would be dubbed “squishy centrists”. This is why “squishy centrists” become the preferred candidates. This is why Dianne Feinstein became the Senator from California and could never get removed.

          • DrDick

            No, the prevalence of centrist candidates is why mostly centrist Dems actually bother to vote. As Obama demonstrated, we get far more progressives voting if the candidate is perceived as offering real change.

            • DrDick

              Most Americans actually support very progressive policies. We are not a center-right country.

              • NonyNony

                You’re right – we’re a center-left country.

                But we’re still in the center, and that’s the point.

              • Murc

                I don’t think is true, DrDick. People support what they vote for, and when given a chance to vote for progressive policies, it’s hard to even get a majority of Democrats to do so, much less the country.

                Unless you’re arguing that the electorate is so incompetent it can’t effectively articulate its genuine wants through voting, which is a whole different problem.

                • Fake Irishman

                  That’s a possibility. Political Scientists were shocked in the 1950s when they discovered Americans really didn’t know all that much about politics, didn’t pay that much attention, and generally didn’t have coherent ideologies. Philip Converse spent 50 very fruitful years exploring this. (And Jean Converse, his wife, did a lot of work to improve survey design to better capture it.) Full disclosure, I’m a Michigan grad, in case you hadn’t figured it out.

                • LeeEsq

                  Chait would describe this, and has done in the past, as Americans being ideologically conservative and operationally liberal. Your description that Americans are incompetent voters is another fair description of the phenomenon.

              • LeeEsq

                Most Americans might say they support very progressive policies but they don’t vote for politicians that will vote for them. When asked grander and more general questions rather than specific ones, more Americans identify as conservative than liberal or progressive.

                • Brien Jackson

                  Another way to say it is that Americans are progressive…so long as none of the benefits go to non-white people.

                • LeeEsq

                  I think its way more complicated than simple racism. Many non-whites can be just as ideologically conservative as White Americans. Andrew Cuomo beat Zephyr Teachout because non-White Democratic voters preferred him. I also think that you would still see the same sort of ideological weirdness even if race was not or less of a factor in American politics.

                • Phil Perspective

                  Most Americans might say they support very progressive policies but they don’t vote for politicians that will vote for them.

                  And why would that be? Have you ever seen the candidates the Democrats run in most races? Most of them aren’t worth a warm bucket of spit. Have you ever seen the commercials most Democratic candidates run? They’d cure your insomnia, if you have it.

              • Rob in CT

                I think there’s a mile wide/inch deep thing going on there. Or rather “yeah that sounds ok” until it’s Real, and people get cold feet.

                Also, non-voters are more progressive than voters, so the electorate skews conservative.

                I think most people are small c conservative: if it ain’t broke don’t fix it. If/when people think things really are FUBAR, then you get major changes.

                • mpowell

                  People are going to vote for lower taxes more consistently than socialism. And you see this all the time in local politics. People don’t really like the government raising taxes to provide services that sound really nice before you have to pay the bill.

            • NonyNony

              Obama campaigned as a centrist. A centrist who gave rousing high-minded speeches, but his policy differences were micrometers in difference from Clinton’s.

              So what I’m getting is that what the Dems need is more candidates that progressives can pretend are progressive but are actually centrists. That strikes me as amazingly cynical, but perhaps you’re right.

              • The Lorax

                Yep. And all the people who thought he was a Scandinavian-style social democrat weren’t paying attention to his actual policy pronouncements.

            • Murc

              Did he demonstrate that?

              Or were 2008’s numbers based as much on “oh god, eight years of Bush was long enough” as anything else?

              Legitimate questions, not snark.

              There was also the fact that Obama’s political track record was sufficiently short at the time that the leftier-than-thou types who clasped him to their bosom couldn’t claim perfidy and storm off in a huff. That, to be frank, cannot be relied upon.

              • so-in-so

                Yet many of them did storm off, shortly after it became clear that all the leftmost’s favorite dreams would not become reality.

                I clearly recall, and there are many posts here discussing, the leftist complaint that Obama lied about being something other than a centrist, and was not to be trusted ever again.

                • Murc

                  Yet many of them did storm off, shortly after it became clear that all the leftmost’s favorite dreams would not become reality.

                  Yes, afterwards.

                  His political track record at the time of his nomination was sufficiently short that said purity types could at least delude themselves. As I said, that isn’t a circumstance that can be relied upon.

                • NeonTrotsky

                  I’ve never understood this to be honest. The place most people first heard Obama was a his 2004 convention speech, where he talked about how there isn’t a red america and blue america but one america or however it went, which isn’t exactly the kind of thing you’d see Eugene Debs or even George McGovern throwing around

                • addicted44

                  I found it funny that people were pissed that Obama didn’t prosecute anyone from the Bush administration.

                  Obama’s campaign slogan was “Turn the Page”.

                  The only way he could have been more clear he wouldn’t be dealing with the past administration than if he had literally come out and said he wouldn’t be prosecuting the Bush-Cheney clan.

                • pseudalicious

                  Obama’s campaign slogan was “Turn the Page”.

                  So that’s why his 2012 slogan was “Night Moves”.

              • Fake Irishman

                That’s a good point, and it also lines up with the “accountability” idea of democracy: your vote is a referendum on the job the people in office are doing.

            • NonyNony

              Why are the candidates in the center the ones who win Dem primaries then?

              And please – don’t say “because the system is rigged”. Leftist candidates don’t even seem to bother to run for state legislature seats where it costs a pittance to actually get yourself onto the ballot and run and where door-to-door GOTV campaigning is reasonable to do. So where are those local left-leaning candidates who should be overwhelming our state legislatures?

              • shah8

                Well, yes. The system is rigged. What you said might have been true pre-Citizens United, but it’s not true today.

                • jim, some guy in iowa

                  but that shouldn’t have happened, because if the US was any more than “center-left” *at best* we’d have had the kind of legislature and judiciary that would have enacted and upheld publicly-financed elections *decades* ago

                • so-in-so

                  The system has ALWAYS been rigged!

                  And we have ALWAYS been at war with Eastasia.

                • Rob in CT

                  Pre-CU there were TONS of “squishy centrist” Democrats.

                  So yeah, there’s rigging for sure, but that doesn’t explain away the plain fact that even most Democratic voters are not super progressives. The LGM commentariat is WELL to the left of the center of the Democratic party – the voters, not the corrupt, good for nothing politicians.

                • shah8

                  RobinCT, read that TheNation article on charter schools that Loomis posted a bit of time ago. Pay attention to how much school board elections have become swamped in cash.

                  And sure, it was always hard–particularly for minorities who want better representations, the usual issues with one area of the location benefiting at the expense of others…

                  But let’s not underestimate just how much CU changes things, ok?

                • shah8

                  Heh, and also, let’s not underestimate the progressiveness of the democratic base. Plenty of things happened, from the sort of historic initiatives on the West Coast, the public banks, of which SD still has, the Harold Washington mayoral administration, etc, etc…

                  Those impulses just face barriers of race, gender, and class, ultimately.

                • Rob in CT

                  I hate that CU happened! I think it’s very bad and yes, local-level stuff is probably where it’s going to have the worst impact.

                  What I’m saying is that it doesn’t explain the prevalence of moderate Democrats.

                • shah8

                  And where do you think the dem bench comes from?

                • LeeEsq

                  shah8, the Democratic base is everybody with official party membership who participates in the intra-party politics. This includes many squishy centrists.

                • Rob in CT

                  I think we’re talking past each other.

                  You seem to be saying that CU will result in shifting Dem officeholders to the Right.

                  That may be true, but we’d expect that to be playing out since 2010. So we’d expect the impact to be 2012-forward.

                  Yet, in the past there were tons of centrist Dems. I mean… we’re discussing this in the context of Hillary Clinton beating Bernie Sanders in a primary: HRC didn’t become a prominent Democrat because of CU (rather, CU happened in part because she’s the liberalist liberal to ever liberal dontchaknow, but that’s another story). She, and the Dems the progressive left tend to hate the most, pre-date CU.

                  So: CU is definitely bad. It just doesn’t explain the current Dem lineup.

                • shah8

                  I don’t think we’re talking *that* much past each other. On my end, I’d argue that the word “moderate” is probably inappropriate. We *should* be using “cronyist” in its place. Then the debate becomes simpler, I think.

                • Brien Jackson

                  Also too, the Democratic Party “establishment” has been robustly committed to overturning Citizens United since about 4 seconds after the decision was announced. Hillary Clinton has identified overturning the case as a litmus test for any potential nominee she would appoint to SCOTUS.

                • ColBatGuano

                  Is there any evidence that Democratic candidates have become more “cronyist” other than the fact that Clinton is winning?

                • shah8

                  Andrew Cuomo vs Mario Cuomo.

              • shah8

                Also, in responding to NonyNony, I was talking about the Democratic lineup from top to bottom, without an exclusive focus on gubernatorial/national contests.

      • LeeEsq

        Many people operate under the assumption that people with squishy, centrist beliefs rather than extreme beliefs are acting in good faith. Its sort of an authenticity test for politics. Your only assumed to really believe in something if it can be seen as extreme or hard core or something.

      • mutterc

        Good point – just because a Democratic politician can’t move right to pick up Republican support anymore, that doesn’t mean they or their constituency are hard-left.

        • Fake Irishman

          There’s also the question of how much they misestimate (or misunderestimate) where their constituents are on an ideological spectrum. There was an interesting paper a few years back by Skovron and Brockman, I believe that suggested state legislators tended to think their constituents were more right than they actually were. That relationship held for all legislators, though it was stronger for those on the right. Of course we can argue what polls actually mean, but it was a striking finding.

      • MattT

        I’d qualify this a bit. There are definitely center left people who actually have real policy goals that they take seriously and are trying to achieve. I’d put people like Clinton or Biden into this category.

        There are also “centrists” who don’t care at all about policy, they just want a more “moderate” version of whatever is proposed. They don’t identify with the crazies, but they ultimately don’t want to associated with anything they could be held responsible for. The prime example of this to me is someone like Evan Bayh, who’s prime goal seemed to be getting David Broder to write nice columns about him without ever actually accomplishing anything.

        There can be a lot of overlap between these groups on some issues, which can muddle things up, but I think both exist.

        • I always considered this the significant difference between “moderate” and “centrist”.

  • Jordan

    Good post, at least as a reminder to “progressives” or “leftists” that while you should basically always vote for democrats outside of some local elections, do not trust them and do not believe them. Instead, *pressure* them, in whatever way you can.

    Also, I am not really sure that Lemieux actually supports single payer in the first place, regardless of practical concerns. I think he believes we can transition to one of the non-single-payer european models more easily than we can to single payer (I mean, pretty obviously true), and maybe thinks that is preferable as well (In our context, I think this is false). But you are right that this is the conversation that we should be having.

    • Denverite

      and maybe thinks that is preferable as well (In our context, I think this is false)

      Scott’s position as I understand it is that based on the empirical evidence that we have to date, single payer is neither preferable nor inferior to other forms of European-style universal coverage.

      There are huge issues with state-level single payer models (sick people moving into the state, employers leaving, etc.). There also would be massive tax increases — as the article notes, Colorado would immediately catapult to the highest-taxing state.

    • Murc

      Also, I am not really sure that Lemieux actually supports single payer in the first place, regardless of practical concerns.

      Scott is on the record about 1) caring about results, and 2) considering a variety of non-single-payer systems to deliver results equivalent to a single-payer one. That’s his policy position. His political position is that while he thinks any system of universal healthcare is going to be a breathtakingly hard, nigh-impossible life in an American context, he see non-single-payer systems as at least marginally to somewhat easier to get to than a single-payer system.

      I am of course not Scott and cannot speak for him.

    • That’s why I quoted Lemieux as wanting a European-style system.

      • Fake Irishman

        … with the understanding that there’s a lot of variation in those systems I presume.

    • I think the structure of payment is much less interesting that other features. As long as the payers are 1) big enough to control costs and 2) sufficiently regulated on care and charges, you’re pretty much fine. It doesn’t have to be *one*.

      For example, I’d would pick the French system over the UK one for quality of care, but I much prefer the UK’s free at the point of care. (It makes a HUGE difference day to day. I’m not so bothered by co-pays (we have a kind of super modest copay for prescriptions) as by deductibles. Any non-modest deductible just sucks. And it sucks over and over again.)

      UK is single payer and French is “public utility” insurers. The UK could introduce more copays, while the French could go free at point of care. Better funding would improve the UK system.

      • Fake Irishman

        I understand the problems with co-pays, but it should be important to point out that the French system also has a sliding scale for those co-pays, which is a lot different than “everybody pays $20” (It also functionally makes that part of it a much stronger and broader version of the CSR subsidy system in the US on the exchanges).

      • Dilan Esper

        The UK is actually not single payer. It’s socialized medicine, with doctors directly employed by the government. Like the Veteran’s Administration here.

        It’s the best system, because there’s no middleman at all.

        I personally think the major determinant is that there’s as little profit making in the system as possible. That’s why the UK and the VA work so well– the doctors make a modest profit, the system bids down drugs and devices as low as possible (so drug and device makers make less), and there’s no insurance bureaucracy so most of the rest of the money goes to care.

        The more people in there making a profit, the worse the system is.

        • burnspbesq

          It’s the best system

          Mosr of the Brits I know would take issue with you.

          • Ronan

            Most of the Brits I know complain about it endlessly but wouldn’t swap it for any existing alternative (I’m not agreeing with that position,but that’s generally been my experience of how the NHS is viewed )

            • Phil Perspective

              And Cameron is trying to dismantle the NHS as we speak.

        • It’s socialized medicine, with doctors directly employed by the government. Like the Veteran’s Administration here.

          Once again, GPs are generally independent contractors. Indeed, preserving this status was apart of the gold their mouths were stuffed with. They are not NHS employees, unlike most hospitalists.

          It so annoying to have to make the same factual correction ad nauseam esp when getting it right really wouldn’t harm anything.

          • What makes your factual error even more ridiculous is that GP practices typically are profit making eg

            http://www.pulsetoday.co.uk/your-practice/practice-topics/practice-income/tax-on-some-gp-profits-set-to-triple/20003141.fullarticle

          • Dilan Esper

            Independent contractor / employee is a legal issue. The point is they contract directly with the government who sets their fees. A single payer is a government insurer.

            It’s tiring that you don’t know the difference between the UK and Canada.

            • Independent contractor / employee is a legal issue.

              Yes?

              The point is they contract directly with the government who sets their fees.

              So…single payer. They are not government employees.

              A single payer is a government insurer.

              You certainly like to contort language to fit your error. In the UK, most people’s heath care is funded via taxation (like Medicare enrolees). Some of the health care is provided by private, profit seeking businesses (GPs mostly, though they have a collective organisation that generally negotiates on their behalf. Pharmacies, also.) Some of it is provided directly by the government, e.g., hospitals, mostly, but also urgent care clinics. Like Medicare, all these are paid for by the government. This is single payer, unequivocally. In one case, the government owns the buildings, etc. and employes the workers. In the other, they don’t. In all cases (except for some small amount of out of the NHS stuff), it’s paid for by the government.

              And I’m not an outlier in my usage of the term, let’s take Wikipedia:

              Single-payer healthcare is a system in which the state, rather than private insurers, pays for all healthcare costs.[1] Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom).

              (There’s some Canada for you!)

              If wikipedia is too low brow, here’s an academic article:

              Ditching the single-payer system in the national health service: how the English Department of Health is learning the wrong lessons from the United States.

              So, no, I won’t accept your stupid move, esp. when I showed that GPs are profit making which really undermines your whole line. Sad lil fraud!

              It’s tiring that you don’t know the difference between the UK and Canada.

              As I’ve not mentioned Canada (before this post), nor have I confused it with the UK which is where I live, I don’t know what you think you are about here.

              Interesting, the wikipedia article goes on to say that the UK isn’t single payer:

              The term “single-payer” thus only describes the funding mechanism—referring to healthcare financed by a single public body from a single fund— and does not specify the type of delivery, or for whom doctors work. In this sense, however, the UK Health Care system is technically not “single payer”, as in reality it consists of a number of financially and legally autonomous Trusts, for example the Kent Community NHS Trust, which provides services in Kent, East Sussex and parts of London.

              But I think this is a quibble. The NHS is devolved onto trusts, but the trusts are funded directly by Parliament and aren’t free to raise funds in arbitrary ways.

              • Hogan

                Oh Bijan, when will you give up this pathological obsession with Dilan and his wrongitude? GET HELP, MAN.

                • Wait! It’s only wrong if I use the googlz to bring up old stuff!!!! NEW wrongs are fair game! He is not a crank.

                  Though this pretty much gives the lie to Dilan being honest about thinking I’m obsessed or a possible danger to him or myself: you don’t spontaneously reply to such a person’s comments.

                  So, he’s just the sort of pig who likes to use mental health stuff as an insult. Quell surprise. <— Gotta love that autocorrect.

            • I went back to your original post:

              The UK is actually not single payer. It’s socialized medicine, with doctors directly employed by the government. Like the Veteran’s Administration here.

              This is utterly refuted. You set up the standard (doctors directly employed by the government). GPs are not. That this is a legal distinction is true, but doesn’t help your cause at all. I mean, *really*. Of course it’s a legal distinction! But one that *matters*.

              It’s the best system, because there’s no middleman at all.

              This is hilariously stupid. The NHS is lovely in many ways, but it’s not the best on, say, outcomes (cf the French). It’s the cheapest, but it’s also underfunded. I *guess* you wanted to make a causal claim, but you didn’t establish what metric for “bestness”.

        • so-in-so

          Given recent news reports, citing the VA for “working so well” is probably not the best plan for reaching your goal.

        • sibusisodan

          I love the NHS, but it’s got big flaws. And those flaws get worse when you transpose it into the US system.

          How, exactly, do you end up with the ‘best system’ if you have a situation where almost all national healthcare is at the mercy of however much a Republican budget allocates?

          Single payer/NHS requires a political settlement which believes in it existing and being well resourced. That’s one hell of a can opener to assume in a US context.

          • And doesn’t impose stupid requirements that destroy the fiscal position. Most trusts are being killed because they can’t hire thus are forced to use lots of contractor workers which are far more expensive.

            It’s like the Republicans requiring the perfectly solvent US post office to fully fund it’s pension 10 years out. No organisation does this and it’s a hell of a lift. Done solely to destroy it.

  • libarbarian

    Having a policy of being supported by total Bro’s is a kind of policy.

  • Robert Cruickshank

    This whole primary has been driven by policing the boundaries of what is considered acceptable for the Democratic Party, a gatekeeping process designed to stop the populist left from getting further traction. That process began right after the 2008 election, but has gone into overdrive now that there has been a serious electoral contest over the future of the party.

    The result is that the unelectable side has won. The liberal wonks keep telling us that, because incrementalism, the status quo of American domestic policy is the maximum we can possibly achieve. But because that doesn’t help resolve numerous problems facing the American people, our base of infrequent voters isn’t inspired by that to show up and vote. Other voters look at that and correctly conclude that what the liberal wonks offer is insufficient, and then decide to vote for Republicans who do a much better job selling their snake oil as some kind of cure for the problems voters face.

    The Democratic Party has collapsed since 2008, yet to hear the gatekeepers and boundary-policers tell it, everything’s just wonderful and fine. It’s not.

    LGM can at least have a worthwhile discussion of what left-wing strategy looks like given the limiting nature of the American political system. But that’s not what drives the mandarins of gradualism and incrementalism. They use it to defuse populist policy, especially those that, like single-payer, have widespread public support.

    I don’t see how we solve the problems we face today without more substantial changes to the way the Democratic Party operates, and to the way our system of government is structured. Yet that was what Bernie has tried and the resistance has been fierce. Hence the conundrum.

    • Murc

      The result is that the unelectable side has won.

      Hillary Clinton is not at all unelectable. Indeed, she may be more electable than Sanders is, and I say that as someone with multiple outstanding bets riding re: Sanders with people who think he’s a cackling arsonist.

      The liberal wonks keep telling us that, because incrementalism, the status quo of American domestic policy is the maximum we can possibly achieve.

      Nobody with any sort of wonkish influence at all is saying this. I mean… they’d be transparently wrong. The status quo of American policy has moved to the left every year of the Obama Administration. They just finalized new overtime pay rules that moved the status quo further left!

      • Marc

        Clinton is uniquely ill-suited to the current political environment. If she’d won the primaries in 2008 she’d have easily won in 2008 and 2012. But an election where a socialist is getting mid-40s support on the Dem side and where Trump / Cruz were the overwhelming preference on the Rep side is one where a don’t-rock-the-boat establishment candidate is not a good match.

        • Murc

          Nothing you say here is obviously, unassailably wrong, but it is far cry from those very reasonable points to “unelectable,” which is what I was responding to.

        • EliHawk

          Eh. It’s also an environment where the POTUS has above-50 approvals for the first time in 8 years, where she’s comfortably winning the primary 56-42 with a hand tied behind her back, and where the socialist is the only game in town if you don’t like the frontrunner (e.g. West Virginia). Worth remembering in the most tumultuous, anti-establishment, riotous election year of all time, the electorate ended up turning to…Richard Nixon.

          • Murc

            where she’s comfortably winning the primary 56-42 with a hand tied behind her back,

            “Hand tied behind her back?”

            and where the socialist is the only game in town if you don’t like the frontrunner

            This wasn’t true. Martin O’Malley was in there. So was Jim webb.

            Worth remembering in the most tumultuous, anti-establishment, riotous election year of all time, the electorate ended up turning to…Richard Nixon.

            … yes? And?

            Nixon was viciously anti-establishment. Famous for it.

            • junker

              Nixon was a house member, senator, and vice president of the Republican party when he ran for President. If he doesn’t count as an establishment politician I’m not sure what that term is supposed to mean anymore.

              • Murc

                By this rubric Bernie Sanders is also an establishment politician.

                • Brien Jackson

                  Um….yes?

                • djw

                  *Of course* he is. Don’t fall for marketing campaigns so easily.

            • EliHawk

              a) She really hasn’t gone negative on him, either over the air or in the press. She didn’t drop all that much oppo on him. And she comfortably allowed him to blow through cash rather than trying to match him on air pretty much since mid-March. It’s one reason her Cash on Hand at the end of April is $30M and his is $5M.

              b)Yeah, Martin O’Malley was there for a hot second until Iowa. In 49 of the 50 states and every district and territory, it was literally a two person race. It’s like saying, oh, Biden, Richardson and Dodd were around in ’08, so it wasn’t really a two-person race.

              c) Nixon was Established and Establishment Republican, elder-statesman, former VP, who’d moved to New York and practiced Corporate Law in the 6 years before running. He wasn’t Goldwater, he wasn’t Reagan, he wasn’t McCarthy, and he wasn’t Wallace. Just because he hated the mythical ‘Eastern Establishment’ and ‘Liberal Elites’ didn’t make him any less pure political establishment, certainly by 1968.

      • Robert Cruickshank

        Hillary will be using the same playbook that Alison Lundergan Grimes and Michelle Nunn and Mary Burke and Martha Coakley tried in 2014: run to the center, appeal to center-right swing voters, don’t look like you’re going to rock the boat, play it safe, scare people about the other guy. It might work for Hillary where it failed all those candidates in 2014, but only because she has more popularity than they did, and because Trump is so deeply loathed.

        But when this model is tried downticket, it just fails. The liberal wonk incrementalist Democratic Party isn’t electable and numerous elections since Obama was inaugurated have proven this.

        The new overtime pay rules are fantastic. I helped organize to make them happen. It’s exactly what should be done. It’s also not very likely to decide who wins the elections this fall.

        • Rob in CT

          Marginally attached D-leaners don’t show up for mid-terms. Dems do fine in Presidential years. The same Dems who are terrible and can’t do anything right.

          The D coalition includes a bunch of groups that have massive turnout dropoff for mid-term elections (all groups show dropoff, but it’s much more dramatic for young voters, low-income voters, and minorities. All of whom lean D).

          If you think you have the magic formula needed to get them to the polls, wonderful. There have been D candidates who ran fiery progressive campaigns in mid-terms and they got their asses kicked just like centrist blue dog Dems did.

          Frankly, I don’t know what to do about it.

          • Robert Cruickshank

            The first thing we do is not treat it as an inevitable fact of life – because it isn’t. There isn’t a magic formula. We do what Bernie does: name the problem and offer bold solutions that will fix it. In 2014, candidates that ran on progressive values did well. But there weren’t very many of them.

            • The Lorax

              Yeah, but often Bernie isn’t offering bold solutions to fix problems. Take health care. He starts with a false premise: Every other advanced (really?) country in the world has single payer. This is bullshit, and I think Bernie knows it’s bullshit. They have a mix of private and public insurance, and that includes those with the best healthcare systems in the world. And that’s what we ought to have too, especially given where we’re starting from. Outlawing private insurance in United States would be a financial disaster: from the economic impact of substantially higher taxes to the mass unemployment of those who are connected to the insurance industry.

              Bernie’s offering bold solutions, but Hillary usually is right that things are much more complicated than Bernie says they are.

              • efc

                When you falsely state a premise it’s easy to make a counter argument. From Sanders website’s health care paper:

                “Other industrialized nations are making the morally principled and financially responsible decision to provide universal health care to all of their people—and they do so while saving money by keeping people healthier. Those who say this goal is unachievable are selling the American people short.”

                The word I see is “universal”. If you can find one quote where Sanders said every other country in the world has single payer show me. You can’t because you made it up. It’s bullshit trying to make the argument look dumb.

                Now it’s clear the argument isn’t “we need single payer because every other county has single payer” but “single payer is I believe [Sanders] the best way to leverage our current system into full universal coverage”. There are plenty of real arguments to make, but not your stupid one that no one ever said.

                And can you point out in Sanders plan where he bans private medical insurance? I must have missed it. Because Canada and the UK both still have private insurance providers. So does medicare.

                • The Lorax

                  He says all over the place in speeches and on his website that the only solution to HC woes in the US is a single payer system, like they have in every other advanced country. If you claim not to have heard that you’re trolling.

                  There is no way to get the savings Bernie claims from single payer while maintaining a robust private market as many European countries do. Indeed, it’s not *single payer* with private insurance as well as Medicare for all. The whole point of his system is that all is covered with no copays. There’s no need for supplemental insurance.

            • Fake Irishman

              And yet Bernie hasn’t really drawn in massive amounts of voters all things considered. So do we now give up on his agenda? I mean Udall in Colorado pushed real hard on healthcare access issues, especially for women, and he still lost. Wolf won in PA despite a fairly standard campaign promising to bring back manufacturing jobs.

            • There isn’t a magic formula.

              And yet:

              We do what Bernie does: name the problem and offer bold solutions that will fix it.

              Christ, you could at least wait to the next paragraph to totally contradict yourself.

        • Fake Irishman

          The electorates also tend to be different in presidential and not presidential years, Robert. I’m pretty sure that most of those candidates would have been dead in 2014 no matter what they did (with the possible exception of Coakley), and I’m also pretty sure that Coakley and Burke would pretty easily win 2012, with Nunn having a fighting chance.

          • Robert Cruickshank

            Unless we move all elections to presidential years, we have to find a way to win in the midterm years, rather than just write them off as inevitable defeats – because they’re not.

            The answer is to promote policies that will be bold enough to meaningfully improve people’s lives. Democrats don’t really do that right now. And as a result, our voters don’t show up.

            • The Lorax

              This is absurd. You think Dem policies over the last 8 years haven’t improved people’s lives? Start with me: Obama and the Dems saved my job by funneling money to the states in ARRA.

              • Fake Irishman

                I was able to get health insurance in 2014 because of Obamacare.

            • geniecoefficient

              Could it be Rs turn out for midterms because churches and Chambers of Commerce actively mobilize them, while the unions that used to fulfill the same function for Ds have left the scene? I can’t remember where I read this explanation or if evidence backs it up, but it seems like a compelling hypothesis.

              • geniecoefficient

                Of course, it’s a less hopeful explanation because a huge institutional problem would have to be solved before Ds can even put a dent in the disparity.

        • junker

          This is the pundits fallacy at its worst. A much more pertinent commanilty of those three is that they ran in midterm years.

    • Karen24

      What, precisely, would you change? I support ditching caucuses, and caucuses are the only reasons your candidate has more than a couple dozen delegates + MIchigan.

      On less testy note, please get out in the real world. Most Americans are not in fact “seize the commanding heights” leftists and I seriously doubt if even a plurality want single-payer. What they want is not to be bankrupted by a sudden illness or injury. They want to be able to afford both food and their kids’ braces. Single-payer is only one of several ways to accomplish that goal, and treating single-payer as the One True And Only Goal of public policy will very likely destroy the only chance we’ve got of creating a world where one case of appendicitis doesn’t send families into destitution.

      • Marc

        You’d end up with more than a couple dozen delegates in a proportional system if you consistently get 40 percent plus of the vote, which is what Sanders has been doing. You can accept that Clinton has fairly won a majority without needing to pretend that a 55-45 race is an 80-20 one.

        • L2P

          The problem is there’s no difference between winning 80-20 and 55-45 in a winner take all race. Not sure where you’re going here…

      • NonyNony

        And the ones who have jobs would like to keep the health insurance that they have and not have it replaced by single payer.

        The thing is – Americans are small-c conservatives in that they would really like stability and to be free from the fear of the unknown that grips us all. “Freedom from fear” is one of the big “four freedoms” for a good reason – and when someone is proposing to kick over the table and change everything that’s very likely to cause a whole lot of fear.

        • DrDick
          • NonyNony

            If people voted that way I’d believe you.

            Given how people actually vote when given the chance, I’m going to go with “people hate and fear change” as a really good explanation for why we have the politics that we have.

            (That and the lack of a parliamentary system – which makes change in either direction more like ripping off a band-aid than our presidential/legislative system which makes change painful and prolonged no matter which direction the change is being made in.)

        • Robert Cruickshank

          They’re not. They actually want substantial and meaningful change. But they don’t trust our politicians to deliver it, so they stay home when hopes are raised and dashed.

          • Murc

            This is completely falsifiable. When centrist democrats lose, you can simply claim they weren’t offering meaningful change. When left-wing Democrats lose, you can claim its because people don’t trust them. It’s never “the people didn’t actually want what they were selling.”

            I live in New York. Zephyr Teachout got her ass kicked by Andrew Cuomo not because people didn’t trust her not to deliver, but because the Democrats here preferred Andrew Cuomo. The problem isn’t that the party doesn’t reflect the electorate, it is that it does.

            • Murc

              I meant of course completely unfalsifiable. I am an idiot.

            • Phil Perspective

              I live in New York. Zephyr Teachout got her ass kicked by Andrew Cuomo not because people didn’t trust her not to deliver, but because the Democrats here preferred Andrew Cuomo.

              She got 40% of the vote and only spent $50 dollars. Give her half of Cuomo’s money and she would have won. Do you remember why she got in the race in the first place?

            • Phil Perspective

              When centrist democrats lose, you can simply claim they weren’t offering meaningful change.

              I can! Have you ever seen the campaign commercials any of them run? They’d cure your insomnia!! Banal, non-specific with a side-order of kumbaya.

          • cleek

            the system is not designed to deliver substantial change. we all only get two Senators and one Representative.

            if you elect the leftiest lefty Representative ever, some district in OK or TX or AK or MI will counter with the wingnuttiest conservative ever. repeat 269 times.

            you want FDR? first you need a Depression. this ain’t it.

            • sapient

              But in 2008, it was it. And nobody is giving Obama ant the 2008-2010 Congress for making it not nearly as bad as all that. The boring technocrat neo-liberals won this thing – this thing meaning recovery.

              Sure, it’s not good enough yet, as everyone acknowledges. But it’s not half bad.

              • cleek

                no, definitely not bad.

                • Fake Irishman

                  plus they got it done by kick starting a green energy revolution (and to a lesser extent a transportation revolution) that every progressive liberal would have stood up and cheered for if it had been a stand-alone bill.

                • sapient

                  I so wish that the trend could be continued. I can’t even imagine what might be accomplished with Dems in the White House and Congress. Even w/o the House, the Supreme Court will make such a difference.

                  Sorry about my bad typing above. Bad keyboard, and had to leave without editing, even with the generous edit feature.

      • wengler

        What, precisely, would you change? I support ditching caucuses, and caucuses are the only reasons your candidate has more than a couple dozen delegates + MIchigan.

        Yes, Hillary would have won the states that Bernie won in caucuses. Keep telling yourself that.

        • Fake Irishman

          I don’t think that Hillary would have won the states Bernie won in the Caucuses, but I suspect they would have been more like 55-45 Bernie or 60-40 Bernie instead of 70-30 Bernie (Think about the differences between Washington and Oregon — not a perfect comparison, but rather illustrative).

        • Alex.S

          Nebraska’s non-binding primary had Hillary win by 6%, 53-47. The earlier caucus gave a Sanders win of 15%.

          There will be a non-binding Washington primary later this week for another way to compare.

          • Fake Irishman

            Yeah, I’m really curious to see how that comes out. Many of my friends on social media were talking about how “diverse” Washington was as a state, but none of them could tell me how diverse the electorate of the caucus was (and I’d be genuinely curious!)

      • Robert Cruickshank

        I’m on record calling for the end of caucuses. Here in WA State, most of the anti-caucus people are Bernie supporters like me. This tends to shake out along establishment/grassroots lines.

        58% of Americans support replacing the ACA with single-payer, according to Gallup this week.

        Two years ago my wife had appendicitis. We took her to the nearby ER. They caught it before it ruptured and removed the appendix. We’re insured, thankfully. But the cost was still $2000. If we were like most Americans in the middle class and lived paycheck to paycheck, as we did until just a few years ago, that appendicitis would have sent us into destitution.

        But I know facts can be inconvenient things.

        • Rob in CT

          PRINCETON, N.J. — Presented with three separate scenarios for the future of the Affordable Care Act (ACA), 58% of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans. At the same time, Americans are split on the idea of maintaining the ACA as it is, with 48% in favor and 49% opposed. The slight majority, 51%, favor repealing the act.

          This is… incoherent, really.

          I’m not sure how much stock you can put in that. I mean, I’d love to think that 58% is real, and would translate into voting. I’m for it, and would actually vote for candidates proposing it (and I have, given that I voted for Bernie in the primary). But… yeah, I think that number’s about as firm as ice cream on a hot summer’s day.

          ETA: that poll indicates that 44% of Republicans and R-leaners would go for single payer. BULL FUCKING SHIT.

        • Murc

          58% of Americans support replacing the ACA with single-payer, according to Gallup this week.

          No, they don’t.

          Want to know how I know that? Because they won’t vote for people who would do that, or do anything close to that.

          Talk is cheap. Show me numbers about how people are voting. That’s what they support.

          • Rob in CT

            Dude, 44% of Republicans support single payer. Totally!

            Polls are useful things, but sheesh.

          • The Lorax

            Once they took a look at the expanded taxes and realize that single payer would mean that they would lose their insurance, which most people like, those numbers would drop to the 20s.

        • ColBatGuano

          Here in WA State, most of the anti-caucus people are Bernie supporters like me.

          Funny, I haven’t heard a single Sanders supporter here claim that they should do away with the caucus.

          • I voted for Bernie in the Democrats abroad primary. I think we should kill caucuses dead dead dead and have said so before.

            I don’t know if this helps? Perhaps I’m not the right kind of Sanders supporter? I certainly am not very happy with him right now, but that’s independent of my stance on caucuses.

            I thought pretty much everyone here was anti-caucus? I’ve not seen anyone support them.

            • Pseudonym

              Having a Democrats Abroad caucus might be kind of fun though!

              • Oy, please no. I bet it would done on Skype. Or maybe a google hangout. And everything would suck!

          • Malaclypse

            Seconded to all of this, except I voted in MA, not Abroad.

      • Matt McIrvin

        The weird thing about this whole intra-party process debate is that I think most Clinton supporters would be OK with getting rid of both caucuses and superdelegates. There might be some debate as to whether the superdelegates fulfil an important position or not, but I doubt anyone would regard their elimination as a travesty of democracy.

        But neither of those changes would have caused Bernie Sanders to win the nomination; if anything, they might have reduced his chances. Yet I keep hearing that the DNC somehow rigged the game against Sanders, and I don’t get the mechanism by which this is supposed to have happened.

        • Rob in CT

          Right: she’ll win easily with pledged delegates alone. Caucuses seemed to have helped Bernie (probably only mildly, but still).

          The other ‘rigging’ seems to be about HRC being the establishment choice, which given her resume and the fact that she’s been a committed Democrat for decades (whereas Bernie chose to be the “socialist” independent gadfly) kinda makes total sense and doesn’t seem sleazy to me. It was definitely a disadvantage for Sanders but that doesn’t make it cheating.

          • Fake Irishman

            Plus she did the totally inexcusable, horrible, low-road tactic of quietly talking with represenatives of all the groups in the Dem coalition, listening to their needs, including them in the development of her campaign and platform and getting their endorsements before any one else (with the partial exception of O’Malley) got their boots on. How dare she!

    • burnspbesq

      I don’t see how we solve the problems we face today without more substantial changes to the way the Democratic Party operates, and to the way our system of government is structured.

      You are welcome to believe that, but your candidate failed to convince a substantial majority of Democrats.

      Try again next time with a more viable candidate.

    • xq

      But because that doesn’t help resolve numerous problems facing the American people, our base of infrequent voters isn’t inspired by that to show up and vote. Other voters look at that and correctly conclude that what the liberal wonks offer is insufficient, and then decide to vote for Republicans who do a much better job selling their snake oil as some kind of cure for the problems voters face.

      Evidence for any of this? Or is it just speculation?

      • Evidence for any of this? Or is it just speculation?

        It’s just fever dreams!

    • Davis X. Machina

      The Democratic Party has collapsed since 2008,

      The Democratic Party has collapsed more times than I can count. It’s what it does.

      But then, so has Broadway.

      • Fake Irishman

        Robert’s right in that the party has lost a ton of legislative seats, and some of those losses are really disturbing (states in the Midwest where Democrats are reasonably competitive are pretty depressing), but that collapse is exaggerated by several effects.
        1. Some (not all) of that collapse is concentrated in states where the tide has been running against the Dems for awhile (I’m thinking the South and Appalachia — West Virginia, Missouri both flipped big time, while Alabama and Mississippi and Arkansas (which actually had larger state legislative majorities of Democrats until 2010-2012 or so) also collapsed as well. I’m not saying we should write those states off over the long term, but we’re not realistically competing there for a while.

        2. Structural features: Losing in 2010 really screwed us because of redistricting. In Michigan, Ohio, Wisconsin and Indiana for example, the Dems drastically improved their statewide percentage of the legislative vote between 2010 and 2012, but actually lost seats in the later three states (and didn’t win a majority of seats in the first three, despite winning a majority of the vote.)

        Finally, remember that we always prematurely kill off parties. After 2004, everyone thought the Dems were doomed (although we actually did pretty well in state races that year — taking back chambers in Colorado and Michigan for the first time in a long time, for example). After 2008, we all declared the GOP dead. After 2014, it’s Dems in disarray. It’s OK to be worried, but lets not overestimate problems (or opportunities and keep our heads here.)

        • Matt McIrvin

          That stuff was nothing compared to the deaths of liberalism in 1980, 1984 and 1994.

        • Robert Cruickshank

          While those two factors definitely play a role in the collapse, as does racist backlash to Obama, it goes well beyond that. The electorate that showed up in 2008 has largely stayed home since then, and it didn’t have to be that way. We’ve seen Democratic fortunes slide even in deep blue states like Washington. Even in the face of the most extremist politics and governance we’ve seen in at least 150 years in this country, state Republican Parties continue to get re-elected.

          Why? We have to consider the possibility that liberal wonk incrementalism is bad at the ballot box.

          • Fake Irishman

            … or maybe that voters have limited bandwidth and judge things by which party controls the White House. That would be an argument for getting rid of federalism and going to a unified central government.

            I think that political science evidence shows us that campaigns can make a difference at the margins, but I’m just not buying this “liberal wonk incrementalism is the reason why we don’t win elections.” especially when you offer zero evidence in support of the assertion. (but I guess that just means I’m one of those liberal wonks who are killing the party.)

            (And 2012 wasn’t quite at 2008 levels, but it was close to 2004 and higher than any other election going back to 1968).

            Also, I’m not sure I buy the Democrats are having a particularly rough time in Washington state — they’ve managed to maintain majorities and statewide offices in the state and the state ledge, but often by very narrow margins (remember 2004?), leaving them vulnerable to losing a chamber of the state ledge. And if those gubernatorial elections were held in non-presidential years, you’d probably have had a string of GOP governors, with a possible respite from 2006-2010.

          • If liberal wonk incrementalism is bad at the ballot box, why did those voters come out in such quantity in 2008 for the poster child for liberal wonk incrementalism?

            • efc

              That’s exactly why voters came out for Obama in 2008. Nothing else. People were crying as they cast their votes for the most liberaly, wonky, candidate ever.

              • I don’t think the voters came out for “liberal wonky incrementalism” in 2008, and I don’t think they failed to come out in subsequent elections because of it, either. Voters are generally unmotivated by actual policy proposals.

                Obama’s rhetorical positioning was one of bold change, but it focused on things like changing the tone in Washington, healing wounds and rifts, reaching across the aisle to make things work, empowering the people to effect change (“we are the ones we’ve been waiting for”), etc. His message was explicitly one of restoration and regeneration, not revolution.

            • Robert Cruickshank

              They came out for change. Obama did not run as an incrementalist wonk. He ran on a platform of big, bold, inspiring change we can believe in. Am I the only one who remembers 2008?

              • The Lorax

                But he didn’t run as a social democrat. For instance he ran on a health plan to the right of the affordable care act. Maybe you heard social democrat, but many of us who were listening heard centrist Democrat. And we still happily voted for him anyway.

                And he’s been an amazing president.

                • PJ

                  many of us who were listening heard centrist Democrat

                  That might be the rub.

                  A lot of people weren’t listening/don’t listen/etc.

              • Fake Irishman

                … and also mealy-mouthed bipartisanship “bringing the country together and ending partisan rancor” that’s not exactly Sanders “burn down the banks” platform.

              • Pseudonym

                He ran on rhetoric of big, bold, inspiring change we can believe in, and a rather incrementalist wonky platform.

          • cleek

            The electorate that showed up in 2008 has largely stayed home since then

            Obama’s 2012 vote total was the second highest ever. second only to his 2008 total. (69.5M, 66M)

            • The Lorax

              Yep.

            • The 2012 congressional Democrats won the popular vote (in aggregate), 59,645,531 to 58,228,253 and gained 8 seats.

              Which is clearly a sign of TOTAL PARTY COLLAPSE!!!!

              • Fake Irishman

                not to mention winning the state legislative vote in Wisconsin, Michigan, Ohio and Iowa, and still getting legislative minorities.

    • The Democratic Party has collapsed since 2008, yet to hear the gatekeepers and boundary-policers tell it, everything’s just wonderful and fine. It’s not.

      This is an extraordinary claim giving that in 2008 they had control of the law making and enforcing branches of government and had the single largest advance in progressive policy enactment since Johnson.

      I mean, that’s just a horribly broken claim.

      • Robert Cruickshank

        The party then went on to lose 1000 seats across the country and is at 90-year lows in number of elected offices held.

        But don’t let me stop you putting lipstick on that pig.

        • Murc

          And the Republican Party got equally shellacked in 2006 and 2008 and bounced back. You need to provide evidence as to why this is different than that.

        • Fake Irishman

          As Charlotte the spider might say, that’s SOME PIG! One of the complaints was after 1994 was that the Dems didn’t actually use their majority to do anything (which isn’t quite true, but we’ll go with it) In 2009-2010, though, we had progressive legislation passed on a scale only equaled in 1965-66, 1933-1938 and 1861-1868. Nancy Pelosi, Harry Reid and Barrack Obama made hay while the sun shined despite only having a rickety filibuster proof majority in the Senate for seven months.

          • The Lorax

            Indeed. And Ben Nelson had to approve of everything passed. And they still did amazing work.

        • Your timing is still off. 2008 was fine.

          After a wave election there is generally a rebound. So what? We used that wave well. We won the presidency again. (We lost the senate in part due to an unfavourable line up.)

          You aren analysing at all.

          • Robert Cruickshank

            You all are just making excuses. A party that gives up on midterm elections is the definition of a party in collapse.

            • What?

              The party in the White House traditionally loses seats in midterm elections. How does this become the definition of collapse?

              Plus, how have the Democrats “given up” on midterm elections?! They run pretty aggressively every time.

              This is just weird.

              • addicted44

                Democrats spend months campaigning and fundraising for their mid-term primaries, and then elections, but it really is all just a head fake. They may do all that grinding and soul crushing work but in reality they’ve already given up.

            • Fake Irishman

              And who says the party or we are giving up?! We just aren’t entirely on board with your description of what is wrong; we don’t want to jettison a lot of the good policy making that’s happening to chase a majority based on a flawed description of what is wrong.

            • Murc

              Has… has the Democratic Party given up on midterm elections?

              Because I’ve seen no evidence of that.

              • That’s because you aren’t in a fever dream!

                • Murc

                  Bijan, that’s the nicest thing you’ve ever said to me.

                • Damnit!

                  I meant your aren’t in *that* fever dream ;)

                  And I’m sure I said something nicer! Just maybe in my own fever dream ;)

  • Marc

    Incrementalism is a reasonable argument when you’re making a wedge argument: we start small and then we’ll expand. You’ve hit one troubling aspect of this: that this shifts into “be happy with what you have” instead of trying to get more.

    Another, even deeper problem is that major historical shifts were advocated for *as major shifts*, not as tinkering. There were compromises in implementation for things like Social Security, but the underlying concepts were broad and general. What we’re being offered instead by people like Clinton are tiny gestures even in the idea phase. These then get watered down even more.

    Yes, I know full well that if you offer 10 dollars for a 10,000 item you don’t end up with 5,000. But if you don’t even bother to offer a compelling vision you don’t even get into the market. Like it or not, you can leverage major change by articulating strong general principals that you then follow up with after you win an election. Thousand page blueprints have a much worse track record for a reason.

    • Fake Irishman

      On the other hand, we could argue that the Affordable Care Act is the big policy shift, which some lefties deride as inadequate. Then we can think Clinton’s proposals are the first steps to expand and deepen its reach. Consider: Increasing the generosity of premium subsidies to insure that people under 400 percent of FPL pay no more than 8.5 percent of their income on premiums instead of the current 9.5 percent, providing a public option to ensure insurance competition and availability, allowing for a Medicare buy-in for people over 62, further incentivizing states to take the Medicaid expansion by allowing them a 100 percent Federal match for the first three years, and expanding access to the exchanges and subsidies to all immigrants, and investing heavily in outreach to make sure everyone who’s eligible actually signs up if they want to are all concrete things she proposes on her Web site that make the ACA more affordable and universal (and I’m sure there are a lot more things she details in white papers, say on drug prices and OOP costs).

      These proposals are things that are similar to the steady expansion of the reach and inclusion of Social Security from the 1950s-1970s, or the expansion of the Fair Labor Standards Act to cover more workers during the same time period, or the steady inclusion of more groups in Medicaid in the 1970s.

      (And incidentally, it took 15 years for the original Medicaid to be accepted by all states.)

      • addicted44

        You got numbers in your plan.

        That means it isn’t BOLD CHANGE! If it was BOLD CHANGE it would have words, like UNIVERSAL and SINGLE PAYER.

  • louislouis

    Hillary voters are the future GOP: socially liberal, economically conservative (I’ve heard a more than a few of these Hillary in NYC call DiBlasio a “commie,” express support for stop-and-frisk to “keep them safe” (from superpredators), and generally rail against the Bernie “free stuff” agenda (i.e., the welfare state)).

    There’s a fundamental difference on whether the system is essentially fair but needs to be made more of a meritocracy inclusive of previously marginalized groups, or whether a system that leaves so many young people indebted with nonexistent or marginal job prospects is a failed system.

    A good analogy is the college administrator making six figures and the student at the same school going into debt for six figures. It’s likely both are Democrats, with the former a Hillary supporter and the latter a Bernie supporter. I suspect the former will probably more excited about the prospect of a minority transgender WalMart CEO than having to pay higher taxes to benefit the Bernie supporter. And I think this goes to the heart of the Bouie tweets that have come up in the past few days: that there are Dems who are suspicious of or disdainful of large scale welfare state programs as symptomatic of populist white supremacy and would simply prefer a more inclusive status quo, warts and all.

    • Murc

      And I think this goes to the heart of the Bouie tweets that have come up in the past few days: that there are Dems who are suspicious or disdainful of large scale welfare state programs as symptomatic of populist white supremacy and would prefer a more inclusive status quo.

      Balderdash.

      You would have to look very hard to find someone fighting like hell for a more inclusive status quo who also doesn’t passionately support massive expansions of the welfare state.

      The college administrator example you cite does not, in fact, actually support a more inclusive status quo, because they have no answer beyond free-market bromides to the question of what to do about the massive, gut-wrenching economic immiseration that disproportionately affects traditionally oppressed groups.

      This is a matter of grave concern to said groups, who would like to have good jobs and dignity, please.

      • louislouis

        Ok – an example would be the FAMILY Act. Hillary trumpeted the need for family leave as a major campaign goal, but now she’s against it because of a minor tax increase. I think that sums up this group well; they support liberal goals ideologically but take a center/right-approach to paying for them. Hillary herself ran on a “no free stuff” script in opposing Bernie’s college plan. They like the ideas but oppose social security-style across-the-board taxes. For that reason it’s illusory liberalism. What will really happen is Rhee-style education “reform,” overseas military engagement, maybe a few tax credits that will overwhelmingly benefit rich people (such as her home health care worker plan), and diversity initiatives. The young people who are struggling so bad will get nothing from HRC, she’s kicking them out of the Obama coalition to make it reflect older boomer priorities. This is a campaign predicated on trumpeting the greatness of the status quo; Obamacare isn’t a step, it’s Candide’s best of all possible worlds for the rabble.

        • Murc

          Hillary herself ran on a “no free stuff” script in opposing Bernie’s college plan

          This is disingenuous. She ran on a no free stuff for rich people script. That’s different.

          Clinton comes out of a liberal tradition that is really very scared of being seen to give anyone something they don’t “need.” In many ways this is disgusting, but its different from just not wanting to give anyone anything.

          The young people who are struggling so bad will get nothing from HRC,

          This assumes Hillary Clinton is much dumber, meaner, and right-wing than I think the evidence supports.

          • Brien Jackson

            As someone who has basically just finished up their college work, it’s also wrong on the merits. Bernie Sanders college plan, as proposed, would likely have done more or less nothing for me, having spent most of my time in college in a red state. Clinton’s plan would have likely put me through college for free.

            .3*96

            • efc

              Hope you don’t need childcare in a red state because apparently Clinton expects states to chip in for her (universal) “no more than 10% of a family’s income” child care plan.

              “I’m committed to increasing federal investments and incentivizing states so that no family ever has to pay more than 10 percent of its income for child care. This is a big idea, and I’m determined to fight for it. ”
              https://www.washingtonpost.com/opinions/hillary-clinton-child-care-now-costs-more-than-rent-heres-how-to-fix-this-crisis/2016/05/20/9055a200-1dd6-11e6-b6e0-c53b7ef63b45_story.html

              Maybe trash talking Sanders’ funding plans from the right isn’t a great idea when you propose something pretty much the same.

              • Brien Jackson

                I don’t know what your last graph is supposed to mean but….capping childcare at 10% of income certainly doesn’t seem like an onerous bill to me at all. And really, are we actually working under the pretense that all of Sanders’ proposals will be cost free now?

                • efc

                  What graph? The point is Clinton’s plan also seems to rely on buy ins from states. The cost is estimated around $35 to $100 billion a year, but I don’t know if that takes into account the increase in provider payments Clinton proposes
                  http://www.huffingtonpost.com/entry/hillary-clinton-child-care_us_573c5555e4b0646cbeeb88d1

                  Sanders’ college plan he estimates at $75 billion a year so the plans are pretty similar in cost.

                  So the cost is similar, the method of funding is similar (federal money with state contribution) and Sanders is crazy but Clinton’s plan is a game changer?

                  When Clinton supporters (as the original op talks about) use the kind of rhetoric they have to attack Sanders’ policies it makes it difficult for Clinton to introduce her own progressive policies because there are always going to be a lot of similarities in costs and funding mechanisms.

                • Brien Jackson

                  Ok, but what does this have to do with the fact that Sanders’ policy proposals aren’t actually that far to the left of Clinton’s, young people, etc?

          • louislouis

            For the record I didn’t call her any of those things. I do think her solution to the high cost of child care will be tax free accounts since everyone has $40 to $50 grand laying around (I mean that’s like a quarter of one Goldman speech, so chump change). The Republicans might even go along, making it a centrist bipartisan victory. But yeah it won’t help younger people living paycheck to paycheck.

    • L2P

      Hillary voters are the future GOP: socially liberal, economically conservative

      Literally not a single Hillary supporter I know. Not a one of then is economically conservative. They all want more government spending, more government regulation of ALL SORTS OF THINGS. You’re mistaking a desire to make relatively small changes with not wanting change at all.

      • louislouis

        They’re economically conservative if they support a candidate and her surrogates (like John Lewis) who are against “free stuff” (meaning the welfare state). That is straight out of the Romney playbook.

        • burnspbesq

          The “free stuff” reference is a canard.

          Nothing is free.

          The quesion is “who pays.” And if everybody refuses to pay …

          • louislouis

            John Lewis:

            “I think it’s the wrong message to send to any group. There’s not anything free in America. We all have to pay for something. Education is not free. Health care is not free. Food is not free. Water is not free. I think it’s very misleading to say to the American people, we’re going to give you something free.”

            Lewis said Americans, and especially young people, must learn the value of hard work. Growing up in Alabama, he said, when he complained that his chores were too difficult, his mother had a message: “Hard work never killed anybody, child.”

      • Fake Irishman

        In fact, this is if anything the opposite of most African American Voters, who are one of the fundamental supports of the Clinton coalition.

        • louislouis

          She gets older black voters, especially in areas that skew female. I don’t think it’s fair to generalize that “black people support Hillary” — but to the extent they do, the factors are strong ties to a form of Democratic machine politics, fear of Republicans winning, and name recognition. I have yet to see any evidence of black voters supporting Clinton because of her more conservative college plan. To the contrary, the more black voters hear about Bernie and his proposals the more they like him.

    • Scott P.

      Hillary voters are the future GOP: socially liberal, economically conservative

      Outside the DC bubble essentially nobody is a social liberal and economic conservative.

      • Pseudonym

        Much of Silicon Valley, for one.

        • Have you ever actually looked at who gets elected in Silicon Valley?

          • DocAmazing

            If the race between techbro centrist Ro Khanna (now moving left with great agility) and old-school liberal Dem is anything to go by, the Cyberselfish crew just doesn’t signify at the polls:

            http://www.dailykos.com/story/2015/5/30/1389024/-Honda-vs-Khanna-a-Ro-rerun-in-CA17

            • Pseudonym

              48.2% in a primary against a long-time incumbent is not exactly nothing. Granted, that’s after spending a metric fucktonne of money from Silicon Valley donors, but that’s not inimicable to my point. I’m not sure what exactly they have against Honda though. (And a patent lawyer for Wilson Sonsini is only an honorary techbro.)

          • Pseudonym

            Uh, yeah, having voted for some of them too. It’s also a place where people like Tom Campbell can be elected. But I meant Silicon Valley as a metonym for the tech industry, which I think tends more fiscal/economic conservative than the region itself as a whole.

            • Nobody even remotely similar to Tom Campbell has been elected in the area in over 20 years.

              • Pseudonym

                With the notable exception of Tom Campbell. I think some of that has to do with the collapse of the California Republican Party, especially among immigrants and their recent descendants. But are you denying that there’s a significant social liberal/economic conservative contingent in the tech industry? Their votes may not be decisive but their money can certainly be influential.

    • junker

      Hillary voters are the future GOP: socially liberal, economically conservative (I’ve heard a more than a few of these Hillary in NYC call DiBlasio a “commie,” express support for stop-and-frisk to “keep them safe” (from superpredators), and generally rail against the Bernie “free stuff” agenda (i.e., the welfare state)).

      Hmm, are you sure these voters are from NYC? They sound more like they’re from your imagination. Are any of them cab drivers?

      • louislouis

        Yes – upper class gay professionals. In the “D” party since the Republicans are homophobes. Loves Hillary’s style and hate BernieBro type hippie scum.

        • Rob in CT

          Well, there really aren’t very many such people, so that’s not much of a voter base. There are some such folks in the D coalition now, and a few in the R coalition, but together they’re maybe 10% of the electorate? 20% at most?

          • louislouis

            I think there are a lot of these Bloomberg type democrats out there, and Hillary, the presumptive nominee, represents that too. She takes her foreign policy cues from Fox News commentators (see recent NYT Mag profile), and she ran away from family leave over a minor tax. She’s talking about bringing anti-Trump Republicans into the Democratic tent. This is all the recipe for a more conservative democratic party. Younger people are gong to want a bigger welfare state and I think a lot of social liberals with money are going to oppose it. Why wouldn’t that be the impetus of a new Republican party with the Christian right marginalized?

            • burnspbesq

              ”Minor tax?’ That’s like “minor surgery,” i.e., something that happens to somebody else. You’re vastly underestimating the practical difficulty of enacting expensive policy initiatives in the current political environment. There may be some parallel universe somewhere where voters are willing to pay for stuff, but none of us are lucky enough to live there right now.

              • efc

                So it’s going to be cheap to have a universal program where no family in america pays more than 10% of their income for child care?

                “I’m committed to increasing federal investments and incentivizing states so that no family ever has to pay more than 10 percent of its income for child care. This is a big idea, and I’m determined to fight for it. ”

                As an aside, I though “incentivizing the states” was a Clinton laugh line about Sanders’ college plan since we all know what happened with medicaid expansion.

                It really the inconsistency. Going back to the original OP, the rhetoric used to attack Sanders has in a way closed off policy options. If we all know it’s impossible in this political environment to enact expansive policy initiatives why should anyone care when Clinton announces a “big idea” and says “I’m determined to fight for it.”?

                I suppose this election the GOP won’t have a good person to lead the counter attack, but the clear attack against any of Clinton’s policy proposals is “You already explained why these kind of programs and spending is unwise/impossible/foolish, etc. with Sanders. Your proposal is the the same for the same reasons.”

                • louislouis

                  Yeah, this exactly. She’s out there making conservative arguments for why her “big ideas” can’t happen. She’s against Senator Gillibrand’s family leave bill because it isn’t solely funded by taxes on rich people. My overall view is that she wants to be Prez for personal reasons but unlike Obama isn’t going to do anything while she’s there, that’s what she’s telegraphing now.

            • efc

              There are tons. That’s why Bloomberg specifically said he would only consider a run if Sanders won. He knew there are plenty of Clinton voters who wouldn’t vote for Sanders on a policy level.

              • junker

                Well gosh, if Michael Bloomberg thinks so it must be true!

                • efc

                  Sure, Michael Bloomberg spent millions of dollars on polling and consultants for the fun of it. Just to stretch out his check writing hand.

                  Actually, it was probably some super secret plot between Bloomberg and Sanders for Bloomberg to make it seem like he and Clinton may have some voter overlap in order to make Sanders look less “establishment” and help Sanders win the nomination.

      • geniecoefficient

        Based on my experience, this describes the NYC Rs that will be fleeing Trump for Hillary in November. Indeed, they’re Hillary voters, and the (past and) future GOP.

    • Matt McIrvin

      Hillary voters are the future GOP: socially liberal, economically conservative (I’ve heard a more than a few of these Hillary in NYC call DiBlasio a “commie,” express support for stop-and-frisk to “keep them safe” (from superpredators), and generally rail against the Bernie “free stuff” agenda (i.e., the welfare state)).

      Did all the black people vote for Bernie while I wasn’t looking? (Sure, some did.)

      • louislouis

        “black people” aren’t a monolith. Hillary got the portion of the black electorate that still functions on a machine politics basis. If you think that’s nuts, think about the fact that the black vote in Chicago went for Rahm. It’s patronage.

        • Fake Irishman

          They’re not. But their voting patterns are the closest to monolithic in the United States of any major racial or ethnic group. And that tends to go down to the primary level, at least since 2008.

        • junker

          Black people aren’t a monolith. They just all vote the way their told by their political machines.

      • louislouis

        Also let’s not forget that Hillary ran a crypto racist campaign in ’08 trumpeting her appeal to hardworking white voters and raised the possibility of a “June surprise” a la RFK for Obama, raising one of the biggest documented fears about him in the black press.

        • burnspbesq

          How is your assertion about what Clinton did in 2008, even if true, relevant today?

          You’re flailing.

          • louislouis

            Just saying that the idea that there has been some kind of overall black voter referendum rejecting Bernie’s idea’s and embracing Hillary’s isn’t borne out by the facts, which show that the more black voters get to know Bernie the more they like him.

            Hillary has cynically argued that attacking her anti-single payer stance is an attack on Obama. What will happen in the general when she attacks him as a squish on foreign policy as she did when her book came out.

    • ColBatGuano

      express support for stop-and-frisk to “keep them safe” (from superpredators)

      Your anecdote smells of BS.

      • louislouis

        It’s anecdotal of course. But it happened, and I think there are a lot of pretty conservative Dems out there that are focused on gay rights and education reform and are horrified by the idea of wealth redistribution in any form.

    • Origami Isopod

      And I think this goes to the heart of the Bouie tweets that have come up in the past few days: that there are Dems who are suspicious of or disdainful of large scale welfare state programs as symptomatic of populist white supremacy and would simply prefer a more inclusive status quo, warts and all.

      If there really are such people, they’re hardly numerous enough to make a difference. The “upper class gay professionals” and others of their socioeconomic niche who oppose Sanders’ policies are either incrementalist liberals who would rather get half a loaf than none, or they’re libertarians.

      • louislouis

        Bouie has argued in his columns that women and people of color will essentially decide the election. He has also expressed the view that ties big gov’t welfare state programs to white supremacy. So I think it’s fair to say he’s on the side of the economic status quo with more minority representation at the C-suite level.

        It’s true that populist movements in the US have been racist and it’s fair that they’re open to suspicion on that count. But it’s also true that there are wealthy Democrats who simply prefer the economic status quo, and that seems to be Hillary’s big message: things are great and let’s keep it that way (with the exception of foreign policy where we need more boots on the ground). The other guy is “dangerous” for promising change. But what if people are so fed up that they vote whatever change is on the ballot?

  • mutterc

    A less-scary increment than single-payer would be all-payer rate setting, and it plus ACA could accomplish most of the goals of single-payer. (Defining the goals as: reducing health-care costs to something more in line with the rest of the world, while getting universal or universal-ish access)

    To bring costs down, we need price controls, and single-payer is just one way to get those controls, via monopsony buying power. APRS would institute the controls by fiat, and needn’t disrupt anyone’s existing insurance plan.

    It might hurt a plan that had negotiated lower rates than the board sets, or a plan that relied on narrow networks as a bludgeon to reduce utilization. (The effect could be thought of as making every provider in-network, and every plan using the same network).

    • Fake Irishman

      Maryland has experimented with some of these ideas with success; also see some CALPERS reference pricing mechanisms that have helped drastically reduce and standardize payments for joint replacement surgery among California hospitals. Finally, you might want to check out Oregon’s global budgets approach that they’ve been tinkering with for about two decades now with some success.

    • addicted44

      I think it’s also important to consider that the reason the US will not have Universal health care has nothing to do with whether it is single payer, or multi payer.

      It will have everything to do with the fact that under any system, it’s ridiculously unlikely that Americans will agree to pay for or subsidize healthcare for millions of undocumented immigrants.

      • Pseudonym

        EMTALA already does, no? Just not directly. Maybe that’s the trick.

  • Rich C

    Steve, not sure you’ll ever see this, but on the topic of how to move the existing ACA toward being more like a single payer system: I think there are two key things to think about. First, we ought to clarify what the components of a single payer system are, particularly those that cause the beneficial outcomes (lower costs, more progressive distribution of costs). Second, we really should explore every potential way of making change to the ACA as it exists without new Federal legislation passed via the regular order.

    On the components, I think the most important are:
    1) All payer rating. Every health care payer pays the same price to every provider for any given service. This is the mechanism -basically bargaining power – through which the various other universal health care systems keep cost growth low. In Germany, the Netherlands, and other countries that have multiple private insurance funds, the rates are set through collective bargaining with all the plans on one side and the providers on the other. Maryland has had all payer rating since the late 1970s, and it has helped the state to keep the growth rate of its hospitals costs to one of the lowest in the country over that time.

    2) All employer health insurance spending on pay stub: this may seem minor, but if we want to shift the sources of health insurance payment from premiums and out-of-pocket costs to taxes, its critical that people know exactly how much money they are spending on health insurance right now, how much their paycheck is reduced by their employer’s health insurance spending. Having that info on the paystub seems to me to be a necessary precondition to convincing people that even if their taxes go up, their premiums plus out of pocket will go down by more.

    3) Reduced administrative costs: micro level research shows that doctors offices and hospitals in the US spend around 24% of their total costs on administration, compared to something like 3-4% for doctors offices and hospitals in Canada and Germany. The ACA’s floor on the medical expense ratio is a first step, but squeezing out these excessive admin costs is a big deal.

    4) Reduce out of pocket costs: a lot of criticism of Sander’s campaign proposal for single payer (which is quite different from the actual legislative proposals from Dingle, Conyers, etc.) stems from Sander’s call for the elimination of all deductibles and co-pays. There is reason to believe that these out of pocket charges reduce health care spending, so if you eliminate them, you may spur a much higher level of spending. I’m skeptical of this argument with respect to deductibles (I think the research shows that they don’t produce savings over the long run, because consumers are deterred from relatively cheap, early interventions that would prevent more expensive, later interventions), but I think that small co-pays can be used to help reduce unnecessary spending. I think almost every single payer or single payer like health care system out there has some kind of user charges, at this point.

    5)A public health insurer: this could be Medicare, Medicaid, or something new.

    How could we get those in place:

    1) All payer rating could be adopted at the state level by legislation, as in Maryland. In some states, it might be possible to implement all payer rating via executive action, either based on existing statutes or, in the case of states running their own exchange, based on the states regulatory powers over the exchange and over health insurers and health care service providers. It might be possible to use the regulatory powers vested in the HHS Secretary to put in place all payer rating for plans offered on the Federal exchange.

    2) I’m pretty sure this could be done through executive authority at the federal level.

    3) We need to think through how to accomplish a big reduction in admin costs. Standardizing claims forms, increasing medical loss ratios by state level legislation or regulation, could help. There are experiments built into the ACA that could be relevant, and the Medicare Advisory Panel has the power to impose a lot of changes through Medicare, but this is a hard one for a gradualist approach.

    4) This would take actual Federal legislation, though since its a spending money issue, you could use reconciliation to avoid the filibuster.

    5) States can allow exchange participants to buy into the state Medicaid plan, thereby providing a public option. Federally, though, I think we’d need legislation.

    • Rob in CT

      Thanks for this.

      #1 seems very important. There’s been tons of reporting over the past few years about wild disparities between what different providers pay for the same procedures.

      I like #2. Even that is tricky, b/c of course that employer spending is tax-advantaged. But still, it would be an improvement to show people the hidden costs.

    • L2P

      No. 2 is impossible. Federal law doesn’t even REQUIRE paystubs, that’s all state law. Plus it’s an administrative nightmare. They can track payroll deductions, but allocating an expense to an individual could be done, but yikes.

      No. 1 would require rewriting ALL of insurance law in the country and federalizing it. Yikes. I mean, there’s ways you could do it and try to simplify it, but sheesh.

      • JKTH

        The ACA required that the cost of health insurance be reported on the W-2, so a bit different and not as tangible (I also don’t know how well that’s actually worked in practice). Either way, I think even if it’s just done roughly (like total cost divided by number of employees with insurance) it would be helpful.

        • L2P

          That was a nightmare. My wife does ERISA work and did thousands of hours since 2010 counselling on how to do it.

      • Rich C

        My point – and the Maryland example – is that individual states can introduce all payer rating. Since that appears to be a major source of savings under single payer systems, it would help push our current health care system in that direction, without requiring federal legislation. Of course, if you want a fully uniform, national all payer rating system, you’d likely need new legislation. I’m not sure if any of the regulatory authorities vested in HHS by the ACA would enable the implementation of all payer rating through executive action.

        Didn’t know that pay stubs were only required by state law! Thanks! But my point would then be that there is another change you can make at the state level (not requiring federal legislation through the regular order) that pushes us closer to single payer.

        • L2P

          Fair enough!

    • Denverite

      Good post. Some comments and nits.

      3) Reduced administrative costs: micro level research shows that doctors offices and hospitals in the US spend around 24% of their total costs on administration, compared to something like 3-4% for doctors offices and hospitals in Canada and Germany. The ACA’s floor on the medical expense ratio is a first step, but squeezing out these excessive admin costs is a big deal.

      IME, the biggest driver of provider administrative costs BY FAR is billing/coding compliance. Most providers with more than a couple of people on staff have at least one person who’s sole job is to make sure services are properly coded and billed, and likely more than one if they are of any appreciable size. Then you have all of the write-offs due to improper coding/billing. Make it easier to code and bill. It’s that simple.

      I think the research shows that they don’t produce savings over the long run, because consumers are deterred from relatively cheap, early interventions that would prevent more expensive, later interventions

      I’m going to need to see cites for this, because my understanding is that the research is really inconclusive, leaning towards preventative care costing more in the aggregate. That isn’t to say there aren’t SOME preventative care services that are cost effective, but a lot of them (1) are expensive themselves (see, e.g., colonoscopies), and (2) if they do find something, it is something that requires expensive medical treatment for that would not require expensive medical treatment if they didn’t catch it (either because it is unlikely to progress [prostate cancer] or because it would kill you very quickly [cervical cancer]). This isn’t to say preventative care is bad, of course, just that claims that it “saves money” is not clearly true on the whole, and certainly not true for a lot of different types of care.

      States can allow exchange participants to buy into the state Medicaid plan, thereby providing a public option. Federally, though, I think we’d need legislation.

      No way this happens. Medicaid rates are sooooooo low. Virtually every provider group imaginable except the LTC folks would throw all of their influence against it, and if it did pass, you’d see a ton of providers terminating their Medicaid participation status.

      • L2P

        A lot of providers won’t even take ACA insurers anymore b/c the rates are so low. It’s hard to see a Medicaidish option working unless they expand per patient funding. And if they can do that, they might as well just give out a pony at the same time.

        • Fake Irishman

          You know I keep hearing this over and over, yet I haven’t seen any research or analysis suggesting that providers are fleeing Medicaid or the exchange plans. If anything, somewhat the opposite.

          • Denverite

            Yeah, CMS bumped E/M codes up to Medicare levels for a couple of years. You’ve got to figure that really incentivized previous Medicaid providers to stay in the program, and perhaps some new ones to join.

            But the bump is gone, so who knows. Though though the draconian rate cuts from 2008-2010 largely have been restored (at least as I understand it), so that helped matters a bunch, you’d think.

    • Man, after a comment thread that (for the most part) eerily replicated the very problem I was arguing against, it is good to see some actual policy getting discussed.

      1. All-payer rating. Absolutely. I would also add the need for a bargain with the doctors for federal no-fault malpractice insurance and covering medical school tuition in favor of caps on billing.

      2. All employer health insurance spending on pay stub. Eh, I’m skeptical about this one being that effective.

      3. Reduced administrative costs. Well, I think #1 would help there – a lot of that administrative cost is fighting about who’s paying what for what. If we just standardize prices and payment methods, we could clear up a lot of that.

      4. I care a lot more about eliminating deductibles than I do about eliminating co-pays, as long as co-pays are put within a decent limit and/or subsidization so that people with chronic diseases don’t get screwed over. But then again, #1 also helps with that – a lot of people’s issues with co-pays stem from the fact that prescription drugs are way too expensive in the U.S.

      In terms of some other issues that still need to be addressed:

      1. universal coverage, because we’ve still got tens of millions of people without insurance.

      2. affordability, because the subsidies taper off pretty quickly and we want people getting silver or gold plans rather than defaulting to bronze because of price issues.

      3. quality of insurance. This is a big deal – the first plan I bought on an exchange gave me dental insurance that didn’t cover root canals unless it was necessary to save a bridge; I have friends who are on plans where the only mental health provider is a family and marriage counselor; getting doctors to take some of the more modest plans is a pain in the ass.

      • efc

        I would also add the need for a bargain with the doctors for federal no-fault malpractice insurance

        What would this mean? No fault as in any one injured gets paid without needing to find liability? Workers comp is no fault and there is still a lot of litigation as to the nature of the injury, the required treatments, etc. The doctors may have less at stake, but it won’t necessarily decrease litigation. And it won’t placate the insurance companies.They are trying to destroy workers comp and still have tort deform.
        https://www.propublica.org/series/workers-compensation

        Maybe that’s enough for doctors. The one big reason we have large medical malpractice awards in this country is because medical care is so expensive. The huge damage awards are commonly because of things like payments for future lifetime medical care. It’s a kind of chicken and the egg a bit. If doctors made less (and by extension health care was less expensive) malpractice awards would also be lower.

        I suppose the efficacy of the reform of our medical malpractice system isn’t material if the purpose of the change is mostly a bribe or bargaining chip to get rich doctors to accept being paid less.

    • pseudalicious

      We need to think through how to accomplish a big reduction in admin costs.

      Maybe this is a dumb thing to say, but HIPAA causes so much paperwork, even in a “paperless” office. I wonder if reforms to that law would cut down on admin stuff. Maybe that’s just a drop in the bucket, idk.

  • j_kay

    But Single Payer’s failed since FDR.

    And Obamacare still just done. Won’t you have to wait for a next FDR farther along the liberal wave, to bring it up?

    And jobs and the economy are more important.

    • Murc

      And jobs and the economy are more important.

      Nothing is more important than your health. You cannot hold a job if you are in ill health even if there are jobs to be had.

    • But Single Payer’s failed since FDR.

      “Single payer,” defined as “the attempt to implement single payer in one fell swoop,” has failed since FDR.

      On the other hand, the amount of health care and health insurance provided by the government has increased with each round of reform. Each of those bring us closer to single payer.

      It seems to me that the question “Single-payer or hybrid?” is of academic concern at this point. The answer that both sides should be giving is “More.” At what point will “More” not be the right answer? Let’s jump off that bridge when we come to it.

  • Were progressives just being humored because the larger Democratic Caucus needed their votes and knew that their bills were never going anywhere?

    I think the answer to that question is: Yes!

    I think one of the takeaways from this primary cycle is that the coalition of disgruntled liberal Democrats and independents is, in fact, rather large and they’re getting sick of being played by the establishment DLC types. They’re not as radicalized just yet as the Republican base, but I don’t think the Democratic establishment has as tight a hold as it thinks, either.

    • L2P

      No evidence for this at all…

      • Marc

        The age demographics of the Sanders voters are pretty good evidence that there will be a change in the ideological makeup of the Democratic electorate.

  • shah8

    One small thing that bugs me.

    Real change happens over the protests of people who think(or are) they’re comfortable today.

    This is true of incremental change. The outcome of the Civil War led to lasting, but incremental changes for the rights of ex-slaves. As bad as sharecropping and all of the other stuff of the 1880s were, they were still better than what it was like before.

    The ACA is incremental change, even though it was a fiscally necessary revolution. And we basically did it over people’s literally dead bodies. It’s continuing over people’s suffering and dying, state by state.

    There’s a problematic subtext in a lot of discussions about incremental change, in which “superconsensus” is emphasized as both being more practical and more desirable, and the fact that you don’t get much is an acceptable outcome of that. Abuses of the concept of “If nobody was happy with the compromise, must have been a good one.” The reality though, is that you cannot lead a political party like this–everyone will eventually hate you. A political leader and a political regime has to accumulate victories. Victories are the basis of political agglomeration. Obama was never in trouble in 2012, and the focus on his successors has let the media mud slide from his clothes to the floor in recent months. That is because he has notches, incontrovertible notches on his stick. Where he won, and the bad guy lost. Compromise to seal your victory is good! Compromise to gain a few crumbs without complaint is bad!

    Hilary Clinton is already suffering from the appearance of nepotism (wife of ex-prez) and cronyism (eg all the bank speeches). She is on the spot, and will continue to be on the spot should she win. Everyone will look to see if she’s her own woman who has something to offer to the rest of us. The problem is that she has lots of plans, addressing lots of problems, but these plans neither attack the heart of our problems (the political and economic consequences of inequality), nor do they appeal to the heart of the public. And one thing I’ve grown very sick and tired of, is the use of Republicans to say that ambition is dead. Failure is failure, no matter what the excuses are for it. It’s alright to fail, but it’s a deadly sin for a leader to be without ambition for fear of failure. If Hilary Clinton cannot win any battles with Republicans, then she will be impeached. Pure and simple. Doesn’t take any good reasons for a non-rightwinger, just a lot of bullshit and high unpopularity.

    • random

      If Hilary Clinton cannot win any battles with Republicans, then she will be impeached. Pure and simple.

      Huh?

      • Hogan

        Because Brazil, that’s why.

  • Brien Jackson

    A couple of rejoinders:

    The first place I noticed this was the fight over UMass economist Gerald Friedman’s report on Bernie Sanders’ ambitious proposals for Keynesian stimulus, where Democratic Council of Economic Advisers Chairs Alan Krueger, Austan Goulsbee, and Christina Romer rhetorically kneecapped a report suggesting that Sanders’ proposals would significantly boost the economy, all in the name of evidence-driven policy.

    Now, this is a larger topic that deserves its own post, and one I’ll write when grading is over and I have a bit more time, but it was a noticeable attempt to boundary-police without being too public about why a policy that comes right out of the greatest hits of the Progressive Caucus was unacceptable to the party establishment. Are those ideas no longer acceptable within the Democratic Party? Were progressives just being humored because the larger Democratic Caucus needed their votes and knew that their bills were never going anywhere? I don’t know, because no one is actually talking about this – instead, we keep having oblique discussions about respectability politics.

    This is not my recollection of this whatsoever. The problem was that Friedman’s analysis was a total hack job that forecasted literally unprecedented levels of economic growth, and then a sustained 5% growth rate after that. People weren’t bashing the policies so much as the abject hackery.

    The second place where this came up was with single-payer, which I discussed in a previous post. As I said in that post, there are some major problems with the current debate which make it very difficult to have the conversation that Scott Lemieux wants us to be having about how to build on the Affordable Care Act to get to a European-style health system.

    Because when we look at an example like Colorado, signs are not very encouraging that the ACA is going to be used in that way, as opposed to being used as rhetorical cover for being opposed to further reform. It’s one thing to argue that gradualism is better than going for single-payer in one bite, but it’s another thing to openly campaign for the defeat of a single-payer initiative, to echo Republican attacks that single-payer will raise taxes and kill jobs, and to see Democratic consultants working for the vote no campaign.

    I’m…not sure what’s wrong with this?. Even putting aside the unique problems of trying to enact single payer on a state level, it really would necessitate much higher taxes (which I’m fine with but most Sanders supporters aren’t!) and would drastically shrink the size of the health insurance inudstry, meaning a bunch of jobs going up in smoke. I’m not sure why these are things signle payer uber alles types aren’t expected to have to address ever.

    • Davis X. Machina

      This is not my recollection of this whatsoever. The problem was that Friedman’s analysis was a total hack job that forecasted literally unprecedented levels of economic growth, and then a sustained 5% growth rate after that.

      That would have happened after the political revolution, though.

      Who knows what would happen? The fiscal multiplier could be, like 6 or something. There’s no way to know.

      I’m not sure why these are things signle payer uber alles types aren’t expected to have to address ever.

      Everybody Knows that if you remove the profit incentive, and gain the economies of scale that comes with single-payer, the savings are such that the health-care delivery system becomes self-financing from present general federal revenue.

      I have the internet, so I know such things

      • efc

        Hahahahahaha! You are so funny! Oh my god! Please, no more, I can barely breathe!

      • The Lorax

        This is brilliant.

    • This is not my recollection of this whatsoever. The problem was that Friedman’s analysis was a total hack job that forecasted literally unprecedented levels of economic growth, and then a sustained 5% growth rate after that. People weren’t bashing the policies so much as the abject hackery.

      Except then it turned out the critics hadn’t read the analysis, thought the outputs were assumptions, and ended up with egg on their faces. Shocking that you don’t remember that part.

      A better example of a pose of technocratic authority in the service of boundary-patrolling it would be difficult to come up with.

      • sibusisodan

        I’m not sure I see where the egg comes from. The initial response of ‘this can’t be correct’ was, in fact correct.

        The initial failure to identify the actual problem in the analysis doesn’t signify all that much. It was a sub par piece of analysis, deserved the critique and isn’t worth defending.

  • louislouis

    Elephant in the room is she doesn’t want to expand the welfare state. She opposes single-payer and thinks Obamacare is as good as it gets. She is not trying to rock the boat that’s going to pay her $800k speeches when she gets out of office and current rewards her daughter to the tune of $600,000 for an interview with the Geico Gekko. She will be much more passive in the face of gridlock, get us into some more wars, and appoint Larry Fink to head treasury. Everyone here will thank their lucky stars a Republican isn’t in charge and the Clinton Foundation will be rolling in it until Chelsea’s run.

    • Murc

      My understanding is that Chelsea Clinton has little to no interest in holding public office. She’s nearly forty and has never so much as run for dog catcher. That’s not necessarily a firm bar for a political scion, W. got a late start too, but if she were at all interested in an office she’d presumably have done that by now.

      • Hogan

        After her eight years in the White House (ages 13 to 21), I’d run screaming in the other direction too.

      • Rob in CT

        I don’t think that’s the claim. The claim is: everything is rigged. In this rigged system, HRC, Chelsea, and people they know do great. So HRC won’t really challenge that system.

        I don’t think this is entirely wrong, but the idea that HRC “doesn’t want to expand the welfare state” looks transparently wrong. She has an actual record of working to expand the welfare state.

        • Fake Irishman

          … and a ton of proposals to do just that. But of course, no one anywhere wants to talk about those because policies are for losers (or maybe those “liberal wonks” that are apparently responsible for us losing all those elections.)

        • Murc

          I don’t think this is entirely wrong, but the idea that HRC “doesn’t want to expand the welfare state” looks transparently wrong. She has an actual record of working to expand the welfare state.

          To be fair, she also has a record of working to destroy parts of it. So, y’know.

          • DocAmazing

            “Ending welfare as we know it” has some inconvenient fingerprints on it.

        • Davis X. Machina

          She has an actual record of working to expand the welfare state.

          She didn’t mean it, though.

          I’m not interested in actions, I’m interested in unverifiable speculation about motives.

        • louislouis

          Wrong. She has always advocated for market-based solutions.

      • Denverite

        My spouse “had coffee” with her when she was campaigning in Denver a few months ago (my spouse was in the coffee shop and Chelsea’s advance team came in and said that Chelsea needed coffee and wanted to rub elbows with the hoi polloi). She said that Chelsea was very pregnant. I’d imagine any political run is a ways off given the small children.

      • louislouis

        The Clinton Foundation works by trading on members of the Clinton family’s gov’t ties. The whole thing falls apart if you don’t have a Clinton in office. So yeah, Chelsea will eventually run. Hillary wasn’t elected anything and went straight to Senator when she was over 50. With no diplomatic background she’s Secretary of State and an “expert” on foreign policy. These things move fast.

  • Fake Irishman

    As an aside to this whole conversation, isn’t interesting how we ascribed everything we wanted and hoped for to candidate Obama in 2008, even if we didn’t have a particularly good reason to do so?

    On the other hand, in 2016, we seem to ascribe everything we fear on to Candidate Clinton despite her running on Obama’s platform, with Obama’s coalition, and with a similar history of Obama’s wonkish way of crafting policy.

    Does this all come down to her vote on the Iraq war, or is there something else going on here?

    I wonder why this is.

    • Dilan Esper

      The fact that her foreign policy has been both immoral and incompetent (which extends beyond Iraq, btw), certainly drives a lot of it.

      In her defense, some of it is obviously sexism, too.

      • ColBatGuano

        Was Iraq her foreign policy?

        • so-in-so

          For that matter, did the Authorization pass by a single vote?

        • Denverite

          Who knows if they are accurate, but the general portrayals of her tenure as SoS paint her as being the most hawkish voice in the administration.

          • postmodulator

            There is copious, convincing evidence that she is hawkish by the standards of the Democratic Party mainstream. I think that’s probably established beyond debate.

            • sapient

              I think it would be useful to discuss “isolationist” versus “correct” versus “hawkish”. There are some foreign policy issues that might demand that some country offer military support. When is that appropriate? It seems to me that all the self-styled progressives have to offer is “Never.”

              • random

                I love how ‘hawk’ has been redefined to mean ‘thinks the military should ever be involved in anything ever’ by people who consider FDR and LBJ a template for their ideal President.

                • sapient

                  Yeah, I mean, it’s definitely important to discuss. But why isn’t anyone actually discussing it? In detail?

                • Well, I’m sure we’re all agreed that if Hillary wants to borrow Obama’s time machine to go back to 1940 and kill some Nazi’s, then more power to her!

                • As if It seems to me that all the self-styled progressives have to offer is “Never.” is “detail.

                  Sorry it seems like that to you. In the most relevant present case, Bernie Sanders voted for the Kosovo and 9/11 AUMFs, but against the Iraq War. He’s endorsed the use of drone strikes, but thinks the program should be curtailed.

                  And yet, it “seems” to you that it’s those self-styled progressives who fail to demonstrate nuance in their foreign policy thinking. I wonder why that is?

                • sapient

                  What about Libya, joe from lowell? I supported that, as did the UN. But the Berniebros are demonizing Clinton for that.

                  As to the Iraq vote from Clinton, that was a mistake. But we should discuss that mistake again in a separate thread. Or be real about the fact that Clinton was taking the approach that people such as Jessica Matthews endorsed, to give credibility to threats of military force behind inspections.

                  Trusting Bush to put forth that nuanced policy was a mistake, but get over it.

                • shah8

                  I supported the Libyan intervention, too. That was a mistake, and it’s plainly obvious that the West does not have a real interest in reconstructing viable states. So all interventions basically destroys the state, and winds up being worse than the Taliban or Quadaffi, etc, etc, etc…

                  I mean, we pushed Malliki out of power, right? And plenty of people were fine with that, because he was an asshole, but these sort of leadership shufflings usually put in place people with less capacity to do anything. And so Abadi is dealing with Parliament invasions in Iraq today.

                  We are just far too much in love with our power to reward and punish to parlay our resources with any skill such that permanent positive results happen.

                • The first thing I want to point out is that none of the people insisting that “BernieBro” isn’t HillShill campaign jargon are going to call you out for you demonstration of the most common usage.

                  What about Libya, joe from lowell? I supported that, as did the UN. But the Berniebros are demonizing Clinton for that.

                  And now Obama calls it a demonstration of the limits of intervention. Like him, I come down between Sanders and Clinton. So even on the level of this appeal-to-authority thinking, I don’t see how bringing up Libya helps you; it’s clearly not the slam-dunk example of an operation no one could credibly criticize. And, really, if this is how you discuss foreign policy, you might want to go light on the huffy complaints about a lack of detail.

                  As to the Iraq vote from Clinton, that was a mistake. But we should discuss that mistake again in a separate thread.

                  No, I think we should discuss it on this thread, because Sanders’ history of opposing some military actions strongly and supporting others really puts the lie to your claim that all the self-styled progressives have to offer is “Never.” My mention of Iraq seems to have inspired you to recite your prepared remarks about Hillary’s Iraq War vote, but a sharper eye might have noticed that I didn’t mention her vote. I brought up Sanders’ Iraq vote, and for a purpose wholly distinct the argument you’re prepared for. Rather, I was demonstrating the you are being inaccurate in your description of his foreign policy nuance.

                • I mean, even at the time, Obama was calling it a 51/49 question. It’s a strange example to use to show that an opponent is an absolutist.

      • dm

        Her time as Secretary of State illustrates clearly that her foreign policy ideas and policies will lead to disaster. I am not sure she had all that much influence on the Iraq conflict but she did directly get involved with Syria and Honduras. Her own diplomat called the overthrow of the democratically elected government in Honduras a coup but she would not admit that because … reasons? The result of her position was that the country has become a centre for drug trafficking, corporate abuses, environmental destruction and terrible repression of dissent. People are fleeing because the situation is intolerable. Sometimes they can only send their kids off in a desperate attempt to seek safety. But she doesn’t even want to welcome those refugees which were put into that situation because of her lack of leadership. That’s the kind of president she will be.

        I decided there is a silver lining to her possible election. She is so disliked and her policies so hateful that people may be inspired to actually organize, push back and insist on meaningful progress.

        • Brien Jackson

          I enjoy how this fauxgressive cirtique has so reached the mindlessness stage that we can’t even keep Syria and Libya straight anymore.

        • Interestingly, Clinton did call it an illegal coup at the time. Her recent statement

          “The legislature, the national legislature in Honduras and the national judiciary actually followed the law in removing President Zelaya. Now I didn’t like the way it looked or the way they did it but they had a very strong argument that they had followed the constitution and the legal precedence.”

          is a departure (perhaps an “evolution?”) from what the administration was saying at the time.

          • From more of the interview:

            Clinton: Well, let me again try to put this in context. The legislature, the national legislature in Honduras and the national judiciary actually followed the law in removing President Zelaya. Now I didn’t like the way it looked or the way they did it but they had a very strong argument that they had followed the constitution and the legal precedence. And as you know, they really undercut their argument by spiriting him out of the country in his pajamas, where they sent the military to take him out of his bed and get him out of the country. So this began as a very mixed and difficult situation.

            If the United States government declares a coup, you immediately have to shut off all aid including humanitarian aid, the Agency for International Development aid, the support that we were providing at that time for a lot of very poor people, and that triggers a legal necessity. There’s no way to get around it. So our assessment was, we will just make the situation worse by punishing the Honduran people if we declare a coup and we immediately have to stop all aid for the people, but we should slow walk and try to stop anything that the government could take advantage of without calling it a coup.

            So you’re right. I worked very hard with leaders in the region and got Oscar Arias, the Nobel Prize winner, to take the lead on trying to broker a resolution. Without bloodshed. And that was very important to us that… Zelaya had friends and allies not just in Honduras but in some of the neighboring countries like Nicaragua, and that we could have had a terrible civil war that would have been just terrifying in its loss of life.

            She saying that it was partly tactical.

            • shah8

              And I’ve never found that particularly convincing.

              • sapient

                Why?

                • shah8

                  1) The way people talk about coups that do not have actual tanks in the field, but does have lethal backing if people don’t go quietly–the way people talk about it as if it weren’t a coup. A soft coup. Come on. In Egypt, that “soft coup” had massacres following it. These are coups, with real consequences for the further perpetuation of democracy and for the rights of the citizens of that country.

                  2) Zelaya had no such network of dead-enders who would prosecute a guerrilla war. If he did, like as not, no removal would have happened as a matter of balance of power.

                  3) The poor, in actuality, suffered for the fact that Zelaya was gone. Not only in the hindsight of massive crime waves and reduction of public services, but in ways that could be foreseen. He basically consolidated power by delivering good and services to those poor that Clinton was bemoaning about. So any coup, like the one in Brazil, would reverse such gains they got. A concern for Honduras’ poor is laughable. The law was the way it was, because the US, as a moral agent, probably shouldn’t ignore such things. And it’s not as if pretending that no coup has happened has led to positive results in either Honduras or Egypt.

              • I really don’t know, but I thought the full context I was interesting. It’s sort of consistent with some of her statements on Iran.

            • Part of what she was saying is that it was tactical. That doesn’t alter the other part, which is about its legality.

              • Well, there’s also the “they undercut their argument for legality” bit.

                • …which was about image, not substance:

                  Now I didn’t like the way it looked or the way they did it but they had a very strong argument that they had followed the constitution and the legal precedence. And as you know, they really undercut their argument by spiriting him out of the country in his pajamas, where they sent the military to take him out of his bed and get him out of the country.

                  She’s saying they made themselves look bad, and even then, “but they had a very strong argument that they had followed the constitution and legal precedent.”

                • That seems unnecessarily charitable. Not liking how it looked equally means, I though there was something odd or wrong in spite of the prima facile justification” and she says in the end, “So this began as a very mixed and difficult situation.” I take that to mean that there was an argument for legal removal but it was executed illegally.

                  That’s all substance. She might have been wrong and shah8’s points might be absolutely right, but I don’t think that what she’s saying is that it was a legal thing that looked bad, but that it was a mixed thing that complicated the response.

                • Uncharitable. Unnecessarily uncharitable.

                • I don’t think so, Bijan. They “actually followed the law.” The equivocation doesn’t appear in her opinion on the law – she’s forthright about that. Her words set up some equivocation, all right, but it’s between its legality and how it looked.

                • It can undercut their strong legal argument without damaging the legality.

                  Your reading really feels forced. Even if the readings were equally natural,
                  Charity dictates mine.

                • Close reading and syntax dictate mine.

                  Look at how the sentences are set up. Map them out as a logical thread. What is being contrasted? There’s an “one the one hand, on the other hand” argument being made.

              • dm

                Besides her own diplomat the UN and OAS also called it a coup. It is damning that what sounded like a brag in the hard cover version of her book was deleted in the soft cover version. The original version paints Zelaya as inconvenient and the new regime as preferable. She may describe her response as being tactical and somehow in line with a desire for peace but it looks a whole lot more like destabilization which tends to be good for American business. A lot like the kind of action Kissinger would suggest ….

    • On the other hand, in 2016, we seem to ascribe everything we fear on to Candidate Clinton despite her running on Obama’s platform, with Obama’s coalition, and with a similar history of Obama’s wonkish way of crafting policy.

      She’s running pretty far from Obama on foreign policy, actually. She’s been distancing herself from him the entire campaign season, from supporting additional sanctions on Iran, to her restorationist AIPAC speech, to saying it was a mistake not to into Syria early and big, to continuing to rumble at Iran.

      On domestic policy, Clinton has certainly been hugging Obama. Perhaps the reason “we” find fault with her foreign policy is because “we” have been paying attention to the role she played at the hawkish end of the administration’s foreign policy team, and to the substance of the foreign policy she’s been running on.

  • AMK

    At the very least, I’d like to see some genuine plans from pro-ACA folks about how we build from the status quo to a European-style system, because without that….there’s very little evidence that there’s intent to build in the first place.

    No shit. It’s called the “Affordable Care Act” not the “Universal Care Act.” The overarching economic, political and moral imperative was to make care more affordable for middle-class people and reign in the most egregious coverage-denial practices, as well as to serve as a vehicle for cost cutting mechanisms and related white-shoe think-tankery. The Medicaid expansion was tacked on to help more of the poor, but the center of gravity in the Democratic Party circa 2010 had zero interest in building from the status quo to a “European system” on the national level.

    As to where we go from here, I think the Sandersites who think even a Congress of 535 Democrats would nationalize the healthcare industry are out of their minds.

    • Denverite

      Oh come on. It imposed a mandate on individuals to purchase insurance, employers to offer insurance, it subsidized middle-income-and-lower individuals to help them buy insurance, and it expanded the Medicaid safety net from something that helped some really poor people to something that helped all poor and almost-not-poor people (pre-NFIB). It doesn’t matter what it was called. It was designed (in part) to provide health insurance or coverage to the vast majority of previosuly uninsured.

      • AMK

        And those are all good reasons to support the ACA—I certainly do. But the question was “are the people behind the ACA serious about moving to an American NHS model?” and I think the answer is obviously no.

        Personally, I think the part of the system most in need of reform now is not the payment system–single payer vs regulated private intermediaries–but the pharma market itself. We need some type of drug price control mechanisms in place, otherwise the kind of universal healthcare system we have won’t matter. Subsidies and taxes and legal guarantees to pay the costs of care with no price controls wlll end up looking alot like the college tuition trainwreck, where a student-loan system originally intended to ensure everyone can afford college is now relentlessly exploited by colleges to charge whatever they want.

      • It was designed to not quite be universal, and it was made even more not-universal upon implementation.

        IOW, we’re not there. That’s not a slam on Obama or the ACA; it’s just a fact. We’re not there yet.

    • Oy, the full name is The Patient Protection and Affordable Care Act (PPACA), and the first bit encompasses closing in on universal coverage.

  • Fake Irishman

    In answer to Stephen’s original question about getting from ACA to universal coverage/access, I think Single Payer is fine on the merits, but I think that it’s impossible to get to from the current node of a well-established private system in a veto-player laden political system. As Balloon Juice’s (and occasional commentator here) Richard Mayhew has noted repeatedly and John McDonough has discussed exhaustively in his book “Inside Health Reform,” the ACA was the best we could do to get 218, 60, 1 and (mostly) 5 in our political system. The ACA managed to pay off/threaten enough players (e.g. providers, pharma) to get us major reforms in both care delivery and expansion of insurance access.

    The goal isn’t “single payer” it’s universal access to health care.

    So how do we get to affordable universal coverage from here? Well, one thing we can do is build on the newly functioning individual market to expand coverage and reduce premiums further. We can extend the subsidy level up to 500 percent of the poverty line and make premium subsidies more generous as well (Clinton proposes to do the latter) We can also expand the scope and size of CSR to 300 percent FPL instead of the current 250 percent, and expand Medicaid up to 150 FPL instead of 138. A public option ensures access to insurance and market competition. Having the federal government become an active purchaser should keep an individual insurer from “spamming” the exchange with very similar yet confusing plans.

    Improving outreach efforts to get everyone signed up who wants to be (Clinton has proposed this).

    Extending some forms of exchange plans and subsidies to undocumented immigrants (Clinton has proposed this too)

    Continuing to increase the medical loss ratio requirements on insurance plans.

    We need to have stricter rules about in and out of network billing so a reasonably diligent consumer can stay in network and not have to worry about an assistant surgeon coming in who’s “out of network while you’re unconscious.”

    That gets us to something like Switzerland on the way to Germany or Austria.

    On the provider side, continuing to the ACA’s experiments in cost control and ramping up the most effective ones.

    Getting the IPB up and running to keep Medicare costs under control.

    Cut the time period of drug and device patents.

    Help set up public manufacturing lines for government-defined critical generic drugs that have come off patent.

    Working with techniques like global budgeting and reference pricing.

    In general adopting best techniques from states.

    How’s that for starters? Some of these things require national laws, some require executive action, some merely require winning a state and pushing an experiment there. Any one of them is worth a push.

    • Brien Jackson

      I continue to contend that single payer would have little staying power in the American political economy even if you could pass it, as well.

    • Ronan

      Thanks for this comment, which is pretty informative, and the John McDonough reference. Have you read ezekiel emanuels”the reinvention of American health care”? If so, what are your thoughts on his “six megatrends” in the last chapter ?

  • sapient

    Honestly, the pie in the sky is that you go to the doctor, get fixed, go home. “Government” pays for that.

    If someone showed us the taxpayer bill for that, we could decide. Too bad there’s not a national referendum for that plan. Because that’s what people picture as “single-payer”. Also, it might be interesting to see how many jobs in the insurance industry would be lost (or not).

    I would love a system like that, by the way. It would be like having parents again.

    • That’s pretty much how the NHS works and that part of totally fantastic. I love it. I have a fair bit of health care needs (I’ve had arthritis since I was 30) and it just makes the whole thing easier.

      I’m sure there are people who, without cost sharing, would overuse health care, but I sure as hell don’t understand them. If I could be well enough never to go to the doctors office again, I would be ecstatic. I probably still under seek care. (Eg I delayed getting checked out for a coupe, of infections because my GP is a bit of a pita about appointments and I though I could tough it out. But then enough was enough and boom, awesome antibiotics that made me feel a ton better right away. I’m kicking myself for not going earlier.)

      • sapient

        Thanks, Bijan. I wouldn’t overuse health care either, knowing that that the third largest cause of death is medical mistakes. But I would definitely have my sore foot looked at.

        • I’m sorry about your foot and hope you can get it looked at (or it just gets better) soon.

      • Ronan

        Oh, having someone in my family with a similar condition, I’m glad youre finding good care in the UK.
        (Tangential Anecdotes to.follow, so take with a grain of salt) I’ve heard from a number of people who have had serious long term engagement with the NHS that compared to the irish health service it really provides excellent care. One or two specifically who (due to on going health issues) say that it’s the main factor that would prevent them ever moving back to Ireland. (Also, interestingly, I’ve heard similar things from friends who have moved from the irish health service to the NHS (primarily nurses); that what they value most from it, as professionals rather than patients, is that there are much more opportunities for advancement in their careers. Many more opportunity for further training, moving into different specializations, considerably less hierarchy within the system. The irish government are going through one of their cyclical freakouts about “plugging the brain drain” and bringing ’em home, with the usual solution (tax cuts, higher wages) top of the agenda, which seems to completely miss what incentivises a lot of this movement)
        Of course the irish health service is a bit of a mediocre outlier for northern European health care systems, so this doesn’t say much about the NHS in comparison to continental systems (I would like to see the irish system move towards the French model. We don’t seem to have a consistent enough revenue stream or the institutional capacity to run an NHS type system)

  • shah8

    man, just read up on the Matt Bruenig situation.

    It really sucks that he got fired.

    I don’t really like him, but I don’t necessarily like Joan Walsh, either. And their dispute on Twitter is freakin’ kiddy stuff, and I think the insult bar is way too low for getting fired. Then again, Bruenig has a history, which is why I don’t like him.

    Also, black people aren’t part of your tug of war, whether we were for Clinton or Sanders.

    • There’s a gofundme that seems to be doing well:

      https://www.gofundme.com/259kuchp

      The incidents seems like pretty poor judgment on his part. I’ve not read him in a while. Still, sucks to be out of work.

    • Brett

      I’m sad about it too. The guy could be a real asshole on Twitter with some trollish tendencies, but none of it really escalated too much (at least from him*) – the stuff that got him fired was about the worst of it.

      Meanwhile, his writings at Demos and his own personal blog were excellent stuff. Maybe if he’d been willing to cool his jets on Twitter for a few weeks . . .

      * Unfortunately, there are worse assholes who tended to swarm anyone whom he criticized harshly if they were women.

      • geniecoefficient

        * Unfortunately, there are worse assholes who tended to swarm anyone whom he criticized harshly if they were women

        They were complete assholes, swooping in to accuse him of “attacking women” or “harassing women”, as though his attacks had anything to do with the gender of the target. Totally dishonest. It’s infuriating.

    • geniecoefficient

      His scuffle with Tanden seems to have triggered the firing, but I don’t understand insinuations that Tanden acted to influence Demos’s decision. To be fair, in the past she may have complained about him publicly via Demos’s twitter. If you look at the exchange between them, it’s clear he lost it over AFDC, but that’s quite understandable given where he was coming from. The anguish that a parent and child on AFDC would have felt in 1996 is almost unimaginable. And he blames her (apparently incorrectly) for yanking it. Considering what he thinks she stands for, his flare-up is totally forgivable.

      • Ronan

        No, not her fault, but the press release issued by demos said they had been contacted by others over his Twitter behaviour. This would imply people with some degree of influence, probably peers of Tanden though, acting on their own volition . All in all a storm in a teacup, but another unfortunate example of a progressive institution putting little value in job security and being overly willing to bow to.the mob.

    • Ronan

      I’m not sure who these “black people” are, or why you claim to speak for them. Looking through the mentions there seemed to be all sorts getting involved. Every creed, colour, class and gender was throwing in their tuppence worth.

  • azumbrunn

    Two things about this:

    1. This debate you want to have should have a forum other than a Presidential primary campaign–which is by definition about who it the best person to be President. This debate ought to be taking place within the party at all times. It is unfair to criticize Hillary and her supporters for “blocking” it. They are trying to convince people of the quality of their candidate, not of policy preferences. If it has to be part of election campaign it belongs into legislative elections. Those people would afterwards ending up with the job of having to legislate after all.
    2. I hear too much assigning bad will to the other side. Especially inside the party we have to operate from a basis of assuming everybody has sincere convictions. This tendency of the left (this is more a fault of the left than of the centrists–they have other faults) is a way to shut down the dialog, not to get it going. Ironically: If Bernie had been elected President he would have been on the receiving end of this sort of rhetoric from the left within weeks–simply because the job requires any President to compromise (or sell out to use the technical term on the left).

  • Ronan

    Noted, just so people can put this particular talking point to bed

    https://mobile.twitter.com/Taniel/status/733433076777422849

    • I think the correct default is, of course, that the party will come together.

      However, this doesn’t speak to missed opportunities and wasted resources.

  • rmadson12

    I hadn’t seen anyone mention this piece from a few months ago in VOX about how an old bill put together by former rep Pete Stark might be the way to go in transitioning from ACA to single payer.

    http://www.vox.com/2016/2/3/10899790/single-payer-americare

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