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Gillibrand and the Path to Universal Healthcare

[ 165 ] August 11, 2017 |

I attended the town hall held by noted neoliberal shill Kirsten Gillibrand this week. Mostly, she talked about her enduring reverence for Al D’Amato:

It would have been easy for Sen. Kirsten Gillibrand (D-N.Y.) to rest on her laurels at the town hall she held at Hudson Valley Community College in Troy, New York, on Wednesday. In the wake of the narrow defeat of the Republican “skinny repeal” of the Affordable Care Act, she received two standing ovations from a packed house before she even began to speak. (It seems unlikely that the senators who went down with Mitch McConnell’s ship, like Dean Heller and Jeff Flake, would get a similar reception.) But she had a more ambitious agenda in mind. Before taking questions, she celebrated the defeat of ACA repeal but quickly observed that it was not enough: Too many people still couldn’t afford insurance. And making a point she would return to repeatedly for the next hour, she identified her preferred solution: Medicare for all.

I have no idea if Gillibrand is running for president or what her chances of winning the Democratic nomination would be if she does run. But it is becoming increasingly clear that the 2020 Democratic nominee will support Medicare for all or a similar program as the ultimate goal for health-care reform, even if it’s not Gillibrand or longtime single-payer advocate Bernie Sanders. And on Wednesday Gillibrand made the case for the policy very effectively.

As a public speaker, Gillibrand’s effect is that of the happy warrior. She projects optimism and determination even when decrying the damage President Trump has done to American institutions or the many negative effects of Citizens United. There is a place for anger in political discourse, too, and I don’t know what the most effective tone for the next Democratic nominee would be. But in the context of defending Medicare for all, Gillibrand’s approach was very effective, making universal public insurance seem like common sense — which of course it is.

In her opening comments, Gillibrand identified the problem: A system based largely around for-profit insurance simply cannot provide access to health care that is both affordable and universal. It’s not a coincidence that the United States, which relies on the market for health insurance more than any other advanced liberal democracy, also spends far more money despite being the only system that does not provide universal coverage. The ACA’s historic expansion of Medicaid was a major step in the right direction, and the more regulated and subsidized insurance markets it established were a significant improvement on the status quo. But ultimately, health-care reform should build on the former rather than on the latter.

Some observers will take Gillibrand’s emphasis on Medicare for all as a sign she intends to run for president in 2020. She might, but, as she herself pointed out, her position isn’t new. Gillibrand also favored Medicare for all in her first House race in 2006, running in a congressional district George W. Bush had carried by 8 points two years earlier. Her support for Medicare for all wasn’t the reason she won in an electoral context that was unusually favorable to the Democratic Party, but it also suggests that there’s no reason to think the position would be a political liability for a Democratic presidential nominee either.

The details will vary, and the results will depend on part on what the hypothetical majorities look like, but 1)the next Democratic nominee will support Medicare For All or a similar program in principle and 2)the next Democratic Congress/White House will make a Medicare buy-in available to the largest class that is politically valuable, and possibly expand Medicaid as well.

 

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  • Assuming that the Democrats do not want to abandon the ACA, which they shouldn’t, how do we get from the ACA to Medicare for all, or something similar? That’s the path I think we should be talking about. Start with the ACA and then discuss what changes do we need to make to get to some form of universal coverage.

    • Frank Burns

      My guess would be making the public option available as a choice, which came fairly close to happening before.

      • randykhan

        That seems like the simplest way to go.

    • I’m no expert, but these seem to be a few steps down this path –

      1. make state Medicaid expansion mandatory
      2. add public option
      3. increase Medicaid eligibility

      • Timb116

        You can’t do 1

        • Lev

          True. You can federalize the program, though, which would make expansion easier. Which all Democrats should support.

        • Why not?

          • SNF

            Roberts re-wrote the law to make Medicaid expansion optional because he said mandatory expansion was unconstitutional. So you can’t just try the same thing again.

            Maybe we could address his concerns about coercing states if we made the expansion 100% free, instead of making them pay for a small percentage of the expansion’s costs, like the ACA did. Of course, that’s assuming that the concerns were really in good faith. After a couple Trump nominees are on the Court, it’s possible they may just make up new reasons why Medicaid expansion is unconstitutional.

            • malraux

              But if a law passed that was a removal of traditional medicaid, followed by an entirely new medicaid system (identical to the old one but with the expansion), then that would pass the weird robert’s rule.

              • Anthony Bruck

                Robert’s Rules of Disorder

        • malraux

          Why not? Yeah, SCOTUS nixed one method, but theres multiple ways too go about it.

          • Timb116

            No, there aren’t. You can’t make states take money they don’t want

        • Yixing’s Fluffer

          You can make it politically unfeasible to continue to refuse to take the pot of free money for your constituents, though.

      • awarre

        As a sub to number 1, what about expanding the Medicaid threshold to, say, 175% of the federal poverty level? Just ratchet that number up whenever politically feasible.

        • That’s kind of what I meant by #3, and also increasing the subsidy dollar amounts.

      • The Lorax

        Maybe just have Medicare or Medicaid buy in instead of public option? And have it be available to all with generous subsidies.

        • aardvarkcheeselog

          The “public option” under discussion here is making Medicare buy-in available on the O’Care exchange. A mechanism to achieve your goal.

      • JKTH

        Sounds right…I’d also add make the subsidies for exchange plans more generous (linked to gold plans and extended up the income scale for example). A broad Medicare buy-in would also probably be part of it.

      • mattmcirvin

        1a. If you can’t do 1, at least make full ACA subsidies available to people who should be receiving expanded Medicaid, but aren’t (the only reason this isn’t the case today is that the law as written didn’t anticipate the SCOTUS case). That will apply to the public option when you do 2.

      • SNF

        4. Lower the Medicare age requirement.

      • Kanchou

        One easy way to get around Roberts’ ruling on Medicaid expansion is to just make all Medicaid Expansion into Enhanced Silver 94/87/74, aka Cost-sharing reduction subsidies for people under 150%/200%/250% of FPL.

        https://enhanced-silver.com/enhanced-silver-cost-sharing-reductions/

        Maybe just created a new Enhanced Silver 99.9 plan to replace Medicaid entirely. I am aware of case that people who are between 100% -150% of FPL deliberately over-estimated their incomes to be on Enhanced Silver 94. Most due to larger provider network, but also the truism that “Programs for the poors are poor programs.” So it’s better to just have a regular program for all with subsidies to the low-income people.

    • Thom

      Return to the idea of letting those over 60 buy in to Medicare?

    • Marduk Kur
    • AlexSaltzberg

      Ignoring expansion options (such as reducing the age for Medicare or expanding eligibility for Medicaid)…

      1. Allow people to buy into Medicare or Medicaid as a public option on the individual market.
      1a. Allow companies to buy into it as an employer option.

      2. Switch from a fine if someone does not have insurance to an opt-out policy where people are automatically enrolled.

    • Incontinentia Buttocks

      Why is the ACA an issue? Democrats should support the ACA so long as it’s the best politically possible system. It was in 2010 and it has been ever since. But there’s nothing sacred about it. If a truly universal system that isn’t based on the ACA presents itself as a political possibility, my hope would be that Democrats would happily abandon the ACA.

      • mattmcirvin

        Exactly right. What we shouldn’t support is trashing the ACA and replacing it with nothing, or with something worse, with the idea that it might bring the revolution–that is the worst kind of heighten-the-contradictions brocialism. But if we could replace the weakest elements of the ACA with a true universal system? Get on board.

        • aardvarkcheeselog

          I would definitely support a bill that totally repeals existing Medicare in one sentence and in the following paragraph re-enacts it under a new name, unmodified except for a provision that makes Medicaid expansion mandatory, preferably concluding with the sentence “Fuck you, John Roberts, you useless political hack in the guise of a judge.”

      • mattmcirvin

        (As I recall, this was also Barack Obama’s position when Congress talked about ACA repeal. Basically “Put up or shut up–if you have a concrete replacement that can cover more people, I’ll sign it.”)

    • TheBrett

      We expand either Medicare or Medicaid. Both have the seeds for a universal public insurance plan, although in Medicaid’s case you’d have to do some re-jiggering to get it past the Roberts Court’s stupid Sebellius ruling regarding federal funding.

      Make them true public options, either as the default unless you switch to a private plan, or offered on the exchanges (or both).

  • the largest class that is politically valuable

    I do hope that’s a typo for “viable”.

    • awarre

      That largest politically valuable class is everyone except those who point out typos on the internet.

  • Rob in CT

    Good. I think it’s right both policy-wise and politically at this time.

    I do wonder what new litmus test will arise from Our Leftist Betters (NHS or GTFO?) to replace the demand for single payer.

    I saw an article in Vox today arguing further Medicaid expansion might make more sense than Medicare for all, but honestly whatever. The details can be sorted out later.

    • Timb116

      Nothing will replace these Lefty Tea Partiers unless Bernie says it’s okay

      • Rob in CT

        Well, Bernie is on the Medicare for all train, so he will say ok to that (most likely the fault line will be over Wall St. instead).

        Plus, Bernie did ultimately fall in behind Hillary, and most of his voters did too. A vocal, minority did not, and some of them turned on him as part of that. So over them he may have limited influence.

      • AlexSaltzberg

        I have seen no indication that they care at all about what Sanders says.

        • jim, some guy in iowa

          this is why “dudebros” or “pink anarchist bunnies”- something that doesn’t reference Sanders- is a preferable term

          • Mac the Knife

            It seemed like there was a brief period last summer where the term “snowflake” was being used to describe such people (too special and unique to be part of a valuable, er, viable political movement) but it became a right-wing term of abuse immediately after the election.

            Am I remembering this correctly at all?

            • aardvarkcheeselog

              It’s noteworthy how rapidly the RWNM appropriates new phrases and redefines them in a way that makes them useless for their original purpose. There was a brief period right after the election, where “fake news” was a descriptive term for money-amplified nutjob nonsense masquerading as reporting or analysis. I think it took less than two weeks for Trump to repurpose it into its present meaning of “real world news that Donald didn’t like.”

        • aab84

          It’s a weird dynamic, I think. Some of the ones I’ve encountered online seem genuinely incredibly devoted to Bernie (not that there’s anything wrong with that). Others mostly seem interested in using the fact that he’s decided to call his form of liberalism “socialism” as a way to push actual, “the workers must control the means of production” socialism. I don’t know that it’s a monolith at all.

          • “Incredibly devoted to Bernie…not that there’a anything wrong with that”

            I actually think there is something wrong with it. I mean, I like Bernie, despite his flaws. But although he’s the politician whose ideas are probably closest to mine, he has his flaws, just as I have mine. We really don’t need any personality cults.

    • TheBrett

      Some of them will push supplier-side nationalization if we ever get single-payer, but judging by most health care systems in the rich countries it won’t happen. The UK was a special case, and even then it still has private hospitals/doctors and even private insurance.

      Actually letting the public plan set up and own hospitals and clinics wouldn’t be a bad idea, though.

    • Philip

      If a medica(id, are) for all system passes, the logical next step would be nationalizing health care infrastructure, yeah. Single payer is a compromise from the perspective of genuine leftists, after all. I don’t really get why it’s seen as a bad thing to shift your proposals closer to your actual policy preferences as the median citizen moves closer to supporting them, but that’s just me.

    • Technocrat

      When donuts and water are a mortal insult, I’m not sure policy details are going to drive the reactions of the Leftmost. For KG to get them on board, she’s going to have to do *something* to mitigate the accusation of being an Establishment Democrat (however you define that).

  • Yixing’s Fluffer

    I’m more in favor of allowing states to experiment with different programs like Medicaid buy-in while Congress focuses on other reforms, such as tackling drug pricing.

    • farin

      Quite a few states are only willing to experiment with new means of self-destruction, unfortunately. The floor for coverage needs to be raised before anything else.

  • CatCallOfCthulhu

    I’m not sure telling middle class people that they’re going to lose the employer provided insurance that they like, get something worse, and have the privilege of paying more taxes for it while losing a significant portion of their compensation is a political winner.

    What are you going to do when doctors say “no” to the Medicare fee schedule?

    I know it gets the progressive wing of the party pumped up, but I don’t feel like this has been thought all the way through.

    • aab84

      I do worry about the Harry and Louise ads. “You can keep your doctor” was probably the biggest lie Obama told during his presidency, but I completely get why he said it.

      • sanjait

        ACA caused a very small fraction of the population to have to change insurance plans due to increased market churn, and a fraction of those were unable to re-up at a good rate with the same insurer and provider networks.

        It really wasn’t that big a lie. Somehow it’s gotten blown up as such, but not IMO on the merits.

        • awarre

          “It really wasn’t that big a lie” and yet it really was the biggest lie he told. What a strange contrast to today.

          • sanjait

            Right. Just like how Obama trampled on the Constitution with things like exercise of prosecutorial discretion, and now half of GOP voters are ok with postponing the 2020 election if Trump says so.

        • ChrisS

          I don’t think lying matters anymore. Or at least until a democrat is elected again and suddenly there will be a call for that person to be unreasonably virtuous to “heal the nation … etc.”

        • Joe Paulson

          There is even less there if you spin it in a certain way —

          http://www.huffingtonpost.com/2013/10/30/if-you-like-your-plan-you-can-keep-it-_n_4175715.html

          I think it was something of a venial sin and the overheated blowback of the “give me a break, welcome to the real world” variety.

        • Eric K

          In marketing people make claims like “lowest cost of operation” for a $150 printer, everyone knows that means compared to other printers in the $100-200 range and of course something like a $20,000 professional printer has significantly lower cost of operation, but you still footnote the claim with all the supporting data.

          A typical “lie” from a Democrat is making a claim like that verbally without all the fine print supporting data, while having a website with all the details documented in thorough detail with every i dotted and t crossed.

          Every sane person knows what they meant, but the “neutral press” treats that as equal to a Republican saying “this $150 printer will cure cancer!”

          • Eric, I would like to buy that printer.

      • Rob in CT

        Another obvious angle of attack for opponents would be trying to scare seniors into believing that expanding the program would be done at their expense, like the lies the GOP told about the ACA.

      • AlexSaltzberg

        There was (and still is) a provision in the ACA that said that insurance companies had to keep people in on grandfathered plans.

        Turns out that not many people stayed on the same insurance plan in the time between passage of the law and the implantation. Especially when insurance companies offered them new, cheaper plans that would not be protected by the ACA grandfather clause.

    • The Lorax

      Indeed. I wish Bernie wouldn’t have conflated universal care and single payer. Though of Medicare for all means all can buy in if they don’t have private insurance, that’s good.

    • Rob in CT

      Doctors will have less leverage against Medicare (for all) than they presently do. They may scream, but they’ll have to take a haircut (if we actually pass it).

      That said, it also makes sense to take steps to increase the supply of docs.

      • sanjait

        What alternative would docs have to accepting lower payments? Docs are smart and highly trained, but also highly specialized. Are we to believe there are employers out there just itching to hire former docs at salaries comparable to what they’d earn from Medicare reimbursements? Good luck with that.

        • Rob in CT

          Well, yeah, that’s what I was saying (though I didn’t say it quite so definitely – I do suspect Docs would be able to leverage public goodwill and some advertising $$ into goosing the reimbursement rates somewhat).

          • sanjait

            Yes, I meant it as a challenge to the original post in the thread rather than yours.

      • LeeEsq

        One of the few good Libertarian ideas for free market healthcare reform is ending the stranglehold that the AMA has on the creation of doctors in the United States. We should make it easier for doctors to immigrate to the United States and practice medicine.

        • farin

          I’m sure they’d be less enthusiastic about the proper replacement for the AMA, uniform standards enforced by the federal government.

          • mattmcirvin

            Considering they want the FDA abolished…

        • aardvarkcheeselog

          When I was a life sciences undergrad, thinking I would have a PhD and academic career someday, I hated no one except the pre-meds.
          They are present at most schools in far greater numbers than people who want to be scientists some day, and the absurd competition they’re in for a shot at a seat at med school gravely distorts the curriculum for people who want to learn stuff.

    • Joe Paulson

      How about the middle class people who lose the insurance they don’t really have much of an opinion of or think isn’t that great & get something as good or better while others get better health care and this helps everyone in the long run? Focusing on a narrow group, including those who might like imperfect plans or who just want theirs, at some point is of limited value.

      If we have some sort of Medicare for all system, I gather the rules in place now might be tweaked some. If it is the system will be “for all,” maybe saying “no” will be harder. And, as noted here in the past, the matter has been thought about & there isn’t one way to do this sort of thing. Since any program has to pass Congress, as we saw with Obama and ACA, what she supports will only be a generalized goal at any rate.

      • SatanicPanic

        I don’t think this is a great plan. I often mention this to my leftist betters that for all I care with my employer insurance I have something more or less as good as single payer. I would be fine switching that to single payer, but purely for ideological reasons. Other people in my position might not see the value in changing and the left is going to have to come up with some answers that will satisfy them.

        • Joe Paulson

          I’m open to various ideas & my bottom line is universal coverage, the details negotiable. Change always has people upset even when it’s overall good change. Not sure what is uniquely different about this. Sure, you have to sell it. She’s pretty good at that.

          As Scott’s article notes, she’s also flexible. For instance:

          What should Congress do if the votes in Congress for Medicare for all
          aren’t there yet? Gillibrand had a ready answer: “You get to
          single-payer by letting people buy in [to Medicare] now.”

    • stepped pyramids

      The Conyers “Medicare for all” plan is not based on the current plan called Medicare, so criticism of it based on the expectation it has the same benefits and fee schedule as Medicare is inaccurate.

    • TheBrett

      What are you going to do when doctors say “no” to the Medicare fee schedule?

      They mostly don’t do that now, and if we really are serious about “Medicare for All” (which translates into “a public insurance plan originally based off of Medicare and sharing the name for all”), then the rates are going to go up to converge more with average fees. The cost savings come from restraining growth in those rates over time going forward.

  • Ash

    Either the public option or gradually expanding medicaid so most everyone is covered (or both maybe?) are good paths towards universal healthcare.

    As a side note, Gillibrand is currently my personal favourite (if she ends up running) to be the Dem nominee. She seems both politically and policy savvy, and willing to listen to feedback.

  • Joe Paulson

    The Al D’Amato bit is a joke but she probably can relate to him to the degree she is comfortable playing the game of politics and getting stuff for her constituents. In her autobiography, e.g., she explained how excited she was to host a fundraising group for her mentor Hillary Clinton back when Clinton first was running for the Senate.

    I don’t know the story behind it, but seems fitting Gillibrand used to have a picture on her Twitter page with her meeting a family and a little girl was being given a few dollars. Maybe, the girl was going to donate it to Gillibrand’s campaign or some other cause. (I do wonder about the picture.)

    • DrS

      I do hope that pic is suppressed, lest it become evidence of ILLEGAL CAMPAIGN CONTRIBUTIONS

  • Brien Jackson

    A national public option and Medicare buy-in?!?! NEOLIBERAL SELLOUTS!!

    (no, really, this is the leftier than thou line now.)

    • sanjait

      Medicare has means tested premiums and lets private health insurers compete for beneficiaries.

      Did you ever stop and think about how Medicare is actually the neoliberal sellout program? Didja?

      • Rob in CT

        A fact that many would discover the minute Medicare for all was seriously under consideration.

        Though to be fair, I do think “Medicare for All” is shorthand for something that not only expands enrollment but also coverage. “Improved Medicare for All” basically.

        • stepped pyramids

          Yeah, the Conyers bill is titled the “Expanded and Improved Medicare For All Act” and it’s a completely different beast than Medicare as we know it.

          • sanjait

            Hmm. Well, Medicare is already the world’s most expensive single payer system, in terms of per service cost structure.

            Making it more generous, like by expanding coverage and reducing copays and such, would make it still more expensive.

            That’s not to say we shouldn’t do those things, but it further undercuts the argument that Medicare for All will be cheaper because everyone else’s single payer is cheaper.

  • Whirrlaway

    it will be a lot easier to get to beneficial health care now that the Great Pumpkin has punched up the insurance companies. Eased their way out of the business, so to speak.

  • “Medicare for all” is a good slogan to promote the idea of making public insurance available to all. It needn’t mean abolishing all private insurance, and I don’t think that proposal would fly, at least not now. If you look at the big picture, Canada’s Medicare for All does achieve universal coverage and better health outcomes overall at a significantly lower cost. But on the personal level a lot of people have worse coverage than they would in the American system. That is partly because once health care is mainly paid for publicly services are rationed through budget controls, since health care now accounts for a huge chunk of government budgets.

    • Nym w/o Qualities

      Yes, the breed of “single payer” that probably suits the U.S. is a combination of (1) a “single-payer floor” of universal Medicare/Medicaid, probably with insurance companies and HMOs acting as fiscal managers as they do today, plus (2) a wide-open supplemental insurance market, which companies would probably continue to use for employee benefits. It would still be unfair, richer people would still have better plans, but it would be way better than now.

      • Steve LaBonne

        That’s exactly where I am.

      • DrS

        “It would still be unfair, richer people would still have better plans, but it would be way better than now.”
        Which is also the case in every industrialized nation that has some form of universal coverage.

      • Eric K

        Yeah, most middle class and wealthy seniors have private plans to supplement Medicare.

        Would it be fairer if that were unnecessary and Medicare provided better coverage?

        Sure but we have our voting population not Norway’s.

        We need to keep pushing for the best we can get, the ACA is better than what we had before, and Medicare as a baseline coverage for everyone with supplemental coverage for those that can afford it will be better than the ACA.

    • lulymay

      And don’t forget that as long as we have governments that lean more ‘right’ than maintain what was once normal, a ‘middle of the road approach’, both health care and education budgets face continual rationing. Pharmaceuticals are still playing a huge role in the cost of health care and Mulroney’s favour to these companies by extending the number of years’ patent protection did nothing to help those requiring meds on a regular basis. Still, we are in much better shape than most in the USA because of bulk pricing. Single payer did not mean the loss of employer sponsored medical coverage because prices were still based on a set price, just that the employer cover 1/2 of a monthly fee. However, more and more corporations are dropping that employee benefit in favour of higher profits.

  • sibusisodan

    To what extent would it be feasible to push the idea of the Democrats as ‘the party of healthcare’?

    That fits what I’m seeing – Democrats endlessly moving the ball forward for better healthcare. Republicans don’t care and have got nothing. Is that becoming electorally salient?

    • aab84

      The problem is that voters have tended to hate all changes to healthcare, whatever those changes are. Democrats got killed with that for the last 8 years, and Republicans are now. Electorally, Dems are probably better off as “the party that will keep Republicans from letting you die” than “the party that will make healthcare better.”

      • TopsyJane

        That’s because for many, changes to healthcare coverage are associated
        with loss, not gain. For a sizable number, the system still works. They
        have stable jobs with a good health care plan or their spouses do and
        they don’t want to lose what they have for something that may well be
        worse.

        • Steve LaBonne

          ACA was carefully crafted to do that almost to the maximum extent possible, and that didn’t prevent a violent backlash.

          • TopsyJane

            As already noted in this thread, it’ll be nothing compared to the backlash if you take away something good that people have and replace it with something not as good (and raise their taxes to do it).

        • Scott P.

          Plus people tend to get sicker over time, so it follows they will be less satisfied with their healthcare now than in the past, in general.

    • sanjait

      My impression is Dems are falling into that identity by default.

      Though they would be wise to make it explicit and own it though consistent, clear and deliberate messaging.

      I mean, is there not a single non-evil Frank Luntz type person the Dems could hire to manage the word- and message-craft?

      • Steve LaBonne

        Not much chance, many of them think Lakoff is a brilliant messager, FSM help us.

        • Anna in PDX

          Ha, we must have cross posted. So he is not good at it after all? Again, I never know whether what speaks to me is a good message to everybody else, or not.

          • Steve LaBonne

            I personally think he has not the first clue about effective campaigning (of course he’s never actually done any.). But that’s just my opinion, and we all know everybody has one…

            • … mine is the same as yours. He’d be the ideal campaign director for Michael Lerner, maybe (http://www.tikkun.org/nextgen/overcoming-trump-ism-a-new-strategy-for-progressives).

              And his harping on how different it is that he’s saying “brain” instead of “mind” to show that he’s a good materialist but not a mechanistic materialist who cares how stuff actually works is also tedious.

              • Anna in PDX

                My mom is a huge Lerner fan and every time I try (dutifully) to read one of his articles I just want to shake him, he desperately needs editing down.

      • Anna in PDX

        The “framing” guy, Lakoff? Seems like he wants to be involved in Dem messaging. I am NOT GOOD at messaging myself, actually I am absolutely horrible at guessing at what makes a powerful / good slogan / message, but defer to those who are, do people think he is good at it?

        • sanjait

          I’m not familiar. A quick search shows me stuff that says he is a cognitive scientist, which I think is an interesting field but delves into theoretical space where what we need is just practical and data-driven.

          Trump had the Brietbart people, who, for all their evil, know how to use things like media monitoring and A/B testing to figure out messaging. One article I read described the high level process as monitoring rightwingnut radio and internet, seeing what people were saying, parroting it, and seeing what sticks. Trump himself bragged how he just would say stuff in speeches and see what got people cheering.

          Point is, “messaging” in this context is only a little bit theory and creativity, and a whole lot of testing. Luntz is a focus group guy, which is actually old-fashioned at this point. The internet makes testing fairly easy, so what is needed is someone who is only genius enough to know how to utilize it strategically.

          • Steve LaBonne

            Exactly! The last thing we need is people who won’t let ugly facts destroy their beautiful theories. And there’s too much of that on the segment of the left that believes or claims to believe 80% of people are socialists without knowing it.

            • Anna in PDX

              I love that Rochefoucauld quote, it’s my new favorite thing.

  • randykhan

    If I didn’t already like her because she’s willing to swear in public, this would get me on board.

    • Rob in CT

      It also helps that one can point to her 2006 commitment to this idea so a certain sort can’t claim that she says it but doesn’t really mean it.

      • Hogan

        I think the line will be “she was a Blue Dog, so Medicare for All must the the neoliberal sellout plan.”

        • Rob in CT

          An easily rebuttable line, though, IMO.

          • Hogan

            Oh sure. I don’t think they have anything that will actually work except among themselves.

        • Joe Paulson

          With “blue” so tied to “Democratic” these days, how much is the term “blue dog” even used in the context of “conservative Democrat” these days?

      • JMP

        Look, is she The Savior, The One and The Light? No, therefore she is a neoliberal shill who must be defeated; all Democrats who are not The Messiah are the enemy, particularly those who dare to enter politics while not having a penis or with dark-hued skin!

        • Ithaqua

          Launching a pre-emptive strike against a couple of Commenters Who Must Not Be Named, are we?

    • LeeEsq

      Seeing her debate Trump would be great.

      • Steve LaBonne

        I thought seeing Hillary annihilate him by any sane standard WAS great. Didn’t work out so well, though.

        • mattmcirvin

          The debates ended too early in the cycle.

    • Joe Paulson
      • Steve LaBonne

        That’s Kirsten FUCKING Gillibrand to you.

      • Adam King

        Senator Gillibrand if you’re nasty.

  • Incontinentia Buttocks

    I know that it will take years to achieve, but a concrete plan for universal, affordable, quality healthcare is a litmus-test issue for me. I will not support a Democratic presidential candidate in the primaries who doesn’t have such a plan. Vague, theoretical belief in universal access is no longer enough.

  • TheBrett

    2)the next Democratic Congress/White House will make a Medicare buy-in
    available to the largest class that is politically valuable, and
    possibly expand Medicaid as well.

    I hope they do more than that. It’d be easier just to modify Medicare (or Medicaid) to make it the default secondary insurance for everyone in the US, and a public health insurance plan in its own right (I doubt we’ll get outright single-payer with private insurance banned or restricted – not even England with the NHS does that).

    Incidentally, it looks like all this progressive talk is starting to scare the Blue Dog wannabes crawling out of the woodwork after getting annihilated in 2010 and 2014. Just read a Politico that was all “the future for the party victory runs through the exurbs and suburbs” – i.e. white upper-middle-class suburbanite conservatives – etc, etc ad nauseum.

  • Steve LaBonne

    I hope she does run. I believe she has the political skills and the dynamic, upbeat persona to be a formidable candidate. In those respects I think only Booker, of the frequently mentioned candidates, is possibly her equal, but while I would have no trouble supporting him in the general, I trust her more at the policy level, though I continue to think that “Medicare for all” is a slogan fraught with a lot more pitfalls in detail and implementation than its proponents are willing to acknowledge. (I feel confident that she understands it to be something that, at best, could not be achieved overnight and would be careful not to over-promise.)

  • Bill Altreuter

    Gillibrand has been a happy surprise. Poor David Paterson– he got roasted for her appointment, but he was no fool

    • stepped pyramids

      It is extraordinary to me that people were suggesting he should have appointed Caroline Kennedy, who has never given the impression of having anything more substantial to offer than a name.

      ETA: Boy, this Maureen Dowd column aged well.

      • FlipYrWhig

        That whole kerfuffle, along with the “Sherrod Brown is an establishment sellout for running against Paul Hackett!” one, enlightened me to the bizarre way 21st-century wannabe leftier-than-thous think. There’s always a late-breaking litmus test to fail.

      • david spikes

        MoDo was, is, and always will be a truly awful person.
        I’m sure she’s already pulled her old hate Hillary columns out of the freezer and is defrosting them to get ready to replace Hillary with Kirsten.

    • Steve LaBonne

      And I don’t want to hear Berniebots roasting her for changing her stance on guns after she ceased to represent a rural congressional district, because guns are one of Bernie’s biggest weak points.

      • randykhan

        Not to worry. They don’t actually care about gun control.

        • Wojciech

          And they’ll find something else to go all purity pony over, bank on it.

    • Steve LaBonne

      I’d take him over Cuomo’s evil spawn every day and twice on Sunday.

    • Drew

      It all comes back to penis. The dicks of two New York Jews that helped profoundly shape American politics. Anthony Wiener’s wiener helped get us Trump, and Eliot Spitzer’s wiener helped get us Gillibrand. The schlong giveth, the schlong taketh away.

  • Bloix

    I hope Warren runs, but I would be happy to get behind Gillibrand if she doesn’t.

    • Steve LaBonne

      I feel able to engage in age discrimination because I’m entering old fart territory myself- I want somebody younger. Also I don’t think she has anything like Gillibrand’s political chops.

  • Mike in DC

    1. Repair the ACA(short term)
    2. Medicare buy-in for those 50+(medium term)
    3. Medicare for all, in stages (5 years younger per stage, every 2 years, until you get down to 25)

    • Steve LaBonne

      But I would clarify, for all as an option .

      • But “Medicare Option For All” doesn’t destroy the Evil Capitalist Insurance Industry, which is the actual stated goal of many single payer advocates.

  • Terok Nor

    To return to a point I made previously, what would Medicare For All do about covering what current Medicare doesn’t? I imagine an imperfect but adequate solution can be found, but not without acknowledging that there is a problem, and not by magical thinking and slogan-chanting.

    • Nym w/o Qualities

      You’re right, but “Medicare” is mostly just a name and a part of the HHS bureaucracy that people are familiar with. “Medicare for All” wouldn’t need to resemble “Medicare” much at all. The contents of a basic “MFA” plan would be hashed out in Congress, as the ACA plans were.

  • NicknotNick

    I don’t know if this is relevant to the debate in Yankland, but up here in Canada employer-based health insurance is quite common — it covers dental and vision services, pharmaceutical discounts, and sometimes tops up normal hospital coverage with things like payment for a private room, etc. Since a lot of the discussion in the US is about people who are made nervous by the prospect of losing their employment-based insurance, why not consider this model as a possible option? Offer as wide and basic a public option as is possible, but then support insurance companies in developing supplementary offerings. The bonus of this is that these would be a lot cheaper for the people who buy them, and I would bet that they would be profitable for the companies (as cream-skimming, making money off of easily-predictable, low-level health care).

    • NicknotNick

      I think the biggest challenge for any real reworking of the American health care system will be dealing with the deluge of articles from butthurt upper-middle-class professionals who have to wait more than 30 minutes to get their knees scoped. About three seconds after one of these valuable specimens is told “I’m afraid we won’t have any spaces until 7 weeks from now” the Internet will be swamped with enough rage to melt whatever remains of the polar icecaps.

      • Steve LaBonne

        That’s why I think that politically we’re going to have to live with the special affluent snowflakes keeping pricey private insurance and thereby getting preferential access to elective care. It’s annoying but unimportant compared to making sure that all people have access to high-quality care when they need it, quickly being guaranteed only when it’s urgent.

        • NicknotNick

          Yes, I agree — I’ve never thought about it before, but most public health care systems exist in countries with less inequality than the US has, and were instituted at a time when this was substantially less than today. I wonder if there are any examples of oligarchic societies that successfully instituted one?

          In Canada, public health care begin in Saskatchewan and Alberta in the 1940s and 50s, societies that were less stratified and with an ethic of communal support. Some basic crumbs for the proles might be the best that the US can do, at this moment in time.

          • Steve LaBonne

            Medicaid works and patients (as opposed to providers since it pays a lot less than private insurers) really like it. It’s a lot better than crumbs.

          • Bruce Baugh

            Taiwan, maybe? I don’t actually know how much inequality it had in the ’90s, when it made the switch, though.

    • Murc

      it covers dental and vision services,

      This brings up another thing that Democrats should get behind that would be a big deal: removing the completely arbitrary distinction between “medical” and “dental.”

      Even in the People’s Republic of Canada, this is a distinction they largely maintain, and it’s fucking nuts. It means that poor people often receive significantly worse treatment when it comes to their teeth and gums, often at great cost to their overall, because at some point in the past we decided that caring for your mouth didn’t fucking count as “medical care.”

      No more of that. No more “dental insurance.” If you have medical insurance, it covers medical care, and dental care is medical care, period. That should be a big policy initiative the next time we get a bite at health care reform.

      • NicknotNick

        Yeah, it doesn’t make any sense at all, literally none or perhaps less-than-none, considering dental disease is a gateway condition that leads to many grave chronic problems. Here in Alberta there is a provincial program that makes sure kids under 18 have access to basic preventative services for teeth and vision, but it sure isn’t in the main health package for adults.

      • FlipYrWhig

        “Bite,” I get it.

      • Cosign.

        Dental is a place where routine care and early intervention make huge differences in health and quality of life. It’s bonkers to short change it.

        And the EU (esp the U.K.) need to get on board on water fluoridation. I mean, really.

        • Murc

          Holy shit, you guys don’t fluoridate your water over there?

          • Nope! And the people here are all Strangelovian about it. I had conversations with people with PhDs about it that were absurd.

            Manchester defeated a referendum to fluoridate.

            But it’s EU wide nonsense.

      • Daniel

        Yeah, I was surprised when I first learned that other countries’ healthcare systems consider dental care to be some luxury.

        In Germany, dentures are the one expensive item you have to pay out of pocket. I don’t need dentures yet, so my out-of-pocket dental care payments have been to date exactly 0 €. That includes regular check-ups, lots of fillings, one or two root canals, and the removal of my wisdom teeth.

        My insurer is one of the run-of-the-mill quasi-public ones. (There is very little difference from one to another.)

      • Lurking Canadian

        Never mind dental, our provincial heath plan doesn’tcover drugs. The meeting with the doctor where she says you need to take a course of these or you’ll die, is free. The bottle of life-sustaining pills, you have to pay for.

        (Provinces have means-tested programs to make sure lower-income citizens have their medicine paid for and for most others it’s covered by employer-supplied insurance.)

        As a result, it took me a long time to adjust to the ACA debate about mandatory birth control coverage. Canadians aren’t even entitled to free penicillin.

    • Adam King

      We need insurance to cover hearing aids as well.

  • she’s fine. i’ll vote for her.

    now what about 2028?

    • Eric K

      Her VP one of the Castro brothers? Or someone else not even on the radar yet?

      • Steve LaBonne

        Obama certainly wasn’t on the radar in 1997- when he started his career in the Illinois Legislature.

        • Eric K

          Exactly, 11 years out is an eternity in politics

      • SatanicPanic

        Chelsea Clinton, obviously.

  • sk7326

    It’s got to be a true blue public option – and one that employers are allowed to purchase for employees. Do those things and private for-profit insurance simply cannot compete.

  • Adam King

    She has my vote. To be sure, any Democrat has my vote. But from what I’ve seen of her so far, Gillibrand has my happy vote.

  • ethel

    What does she say about the Hyde Amendment? Currently federal funds can’t be used to cover abortion. If we waved a wand and switched to a federal single-payer plan overnight without considering the Hyde Amendment, we’d lose all abortion coverage in one swell foop.

    • Steve LaBonne

      Even if that were taken care of at the outset I wouldn’t trust that to last. Which is why this is one of my biggest objections to the idea that a Canada-like system is a good idea for the US.

    • Paul Thomas

      There’s nothing about single-payer that would prevent people from purchasing supplemental insurance policies that would cover abortion. Those sorts of gap-filler policies are prevalent in other single-payer countries.

      It’s already the case that ACA subsidies can’t be used to purchase plans that cover abortion. So it’s confusing why you think that Medicare-for-all would make anything worse than it already is.

      • ethel

        “Private insurance carriers may offer a plan in the state Marketplace
        that includes coverage of abortions beyond those permitted by federal
        law as long as they comply with the requirement to segregate federal
        funds.” https://www.forbes.com/sites/theapothecary/2015/10/02/are-american-taxpayers-paying-for-abortion/#64b18deb6a4b

        • Paul Thomas

          That article is grist for my mill, not yours. It says the state plans essentially have to collect a separate premium payment for the abortion coverage, making that “coverage” effectively its own (unsubsidized) risk pool. Again, nothing in an extension of Medicare would prevent the sale of supplemental insurance to cover a similar unsubsidized risk pool.

          The author of that article estimates that the equivalent of only about 1/1000 abortions are actually paid for by federal funds, essentially all of which are rape/incest/life-threatening condition abortions that would remain covered anyway.

          • ethel

            But it’s NOT true that you have to give up any possibility of abortion coverage if you need ACA subsidies to buy a plan, which is what you were implying. And all kinds of people keep trying to chip away at those exceptions.

  • JamesWimberley

    The third leg is surely children: maternity care, parental leave, childcare at work, the usual. The USA is IIRC the only rich country in which maternal death rates have gone up recently.

  • Paul Thomas

    This is odd; I've been reliably informed that single-payer is a spectacularly unpopular policy that would result in massive tax increases.

  • There’s something about Kirsten… Maybe the on-the-record F bombs. I forgive her for all her failings endemic to being a Dem pol. I am forever smitten (*sigh*)