Tag Archives: Bernie Sanders

Medicare For All? Or For All Who Want It?

Elizabeth Warren and Bernie Sanders have made “Medicare for All” a centerpiece of their campaigns. Pete Buttigieg has offered “Medicare for All Who Want It.” Both proposals have generated criticism, and in my opinion, most criticism of both is misplaced, because the discussion fails to distinguish between two very separate issues: 1) what would a sensible system look like, and 2) how do we get there?

I was prompted to revisit the issue because my cousin–the cardiologist I often cite on this blog–has done his own analysis of the current state of healthcare in this country, and concluded that a single-payer system is both preferable and inevitable. (Those who want to get “into the weeds” of that analysis should follow the link.)

In my most recent book, I also make the case for single-payer–and point out that a fully-implemented single-payer system would be much less costly than our current patchwork, dysfunctional approach. Virtually every economist who has analyzed the situation agrees. That doesn’t necessarily mean that taxes wouldn’t go up, but any increase would be more than offset by savings on premiums, co-pays and other costs currently borne by individuals and employers.

At any rate–I’m in full agreement that a single-payer system is needed. I depart from the “vote for me and I’ll change the system” approach being taken by Warren and Sanders because there is an enormous mountain to climb between where we are and where we need to be, and the suggestion that all we have to do to get a single-payer system is elect a Democratic president (or perhaps a Democratic president and Senate) is ludicrous.

It isn’t simply that politically powerful insurance and pharmaceutical  companies would throw everything they have into that debate. Voters rebel when they are told they will be forced into a new system, no matter how demonstrably better off they would be. Just getting the Affordable Care Act through Congress took enormous political capital, and that was after numerous (unfortunate but necessary) concessions.

In a recent column for the New York Times, political scientist Jacob Hatcher writes that we shouldn’t lose sight of what Ms. Warren is trying to do.

She’s making an evidence-based case for shifting the debate away from the perilous place it’s now in. Rather than “Will taxes go up?” or “Will private insurance be eliminated?” she wants us to ask a more basic question: How can we move from a broken system — a system that bankrupts even families who have insurance and produces subpar health outcomes despite exorbitant prices — to one that covers everyone, restrains prices and improves results?

I actually don’t see Warren asking (or answering) that very important question–she seems to be making the case for an immediate change that would eliminate all private insurers, and if my impression is correct, it is a politically fraught case.

Nevertheless, “how” is the most important question. As Hacker writes,

Getting to affordable universal care has always been a problem of politics, not economics. Given that the United States spends much more for much less complete coverage than any other rich democracy, it’s easy to come up with a health care design that’s much better than what we have. The problem is figuring out how to overcome three big political hurdles: financing a new system, reducing disruptions as you displace the old system and overcoming the backlash from those the old system makes rich.

Yep. And that brings me to an interesting paragraph in my cousin’s post. Dismissing the “public option” (which is what “Medicare for All Who Want It” really is), he writes,

Even now, given our current healthcare pricing, a medicare type program, operating with lower administrative costs, would be far cheaper than those offered by their private counterparts. This would allow employers to willingly relinquish expensive private plans in favor of the cheaper public option that would reduce the cost burden of extra employee benefits. This means that the public option would likely supplant the present private plans completely in short order. (Emphasis mine.)

Yes. That’s the point.

“Medicare for All Who Want It ‘ isn’t the answer to the “what” question. It’s the answer to the “how” question.

 

 

 

Hacker

 

Promises Promises…

Trump promised to revive coal mining. Bernie is once again promising to eliminate student debt. Bernie’s goal is a lot more attractive, but his strategy is equally delusional.

Trump, of course, is too dumb–and unconcerned–to know how energy markets work; he just throws red meat to his equally-uniformed base. Is that what Bernie is doing, too? Playing to his core voters without realizing how unrealistic/unworkable his promises are? I doubt that. Unlike Trump, he’s pretty smart–and he actually knows how government works.

And that’s worse, because it means he has to know his plan is an absolute non-starter.

Student debt is admittedly an enormous problem, both for the students who spend years burdened by it and for the economy, where it constitutes an enormous drag on consumer spending and economic growth. Policymakers definitely should do something to alleviate the burden, but the pertinent question is: what sorts of proposals make sense?

What would a workable solution look like?

Economists point out that simply canceling all student debt ends up helping high-income families most, which seems like a less-than-prudent use of tax dollars. Estimates are that the top 40 percent of earners would receive about two-thirds of the benefits.

Sanders has made a similar proposal before, and David Honig, a friend (who is an exceptional lawyer), took a “deep dive” into that previous plan. I am appending his analysis. It’s long, and it’s legalistic/technical, but it also demonstrates why political promises sound so much better when they aren’t closely examined.

I’ve bolded language that I think is particularly important…Here’s David’s summary.

________________________–
Time for a breakdown. Here we go:

TITLE I—FEDERAL-STATE PARTNERSHIP TO ELIMINATE TUITION

SEC. 101. GRANT PROGRAM TO ELIMINATE TUITION AND REQUIRED FEES AT PUBLIC INSTITUTIONS OF HIGHER EDUCATION.

That’s our first title, and what it tells you is that this isn’t a Federal program alone, it’s a State and Federal program. In turn, that means that States have to sign on. The King v. Burwell precedent from the ACA litigation is going to still control, and that means we’re not talking about free tuition everywhere, just in blue States.
 
(a) Program Authorized.—
(1) GRANTS AUTHORIZED.—From amounts appropriated under subsection (f), the Secretary of Education (referred to in this section as the “Secretary”) shall award grants, from allotments under subsection (b), to States having applications approved under subsection (d), to enable the States to eliminate tuition and required fees at public institutions of higher education.
(2) MATCHING FUNDS REQUIREMENT.—Each State that receives a grant under this section shall provide matching funds for a fiscal year in an amount that is equal to one half the amount received under this section for the fiscal year toward the cost of reducing the cost of attendance at public institutions of higher education in the State.

That’s your formula — 2/3 Fed, 1/3 State. So if Sanders’ own estimate is right, that the cost to the Feds is $750B over 10 years, that means the States are going to have to come up with $375B, and they can’t tax Wall Street.

So how much do they get? Well, that’s interesting, and the legislation quite clearly institutionalizes the vast differences in education spending from State to State:

(b) Determination Of Allotment.—

This is how the dollars are determined.

(1) INITIAL ALLOTMENT.—For fiscal year 2016, the Secretary shall allot to each eligible State that submits an application under this section an amount that is equal to 67 percent of the total revenue received by the State’s public system of higher education in the form of tuition and related fees for fiscal year 2016. For each of fiscal years 2017 through 2019, the Secretary shall allot to each eligible State that submits an application under this section—
(A) an amount equal to the allotment the State received for fiscal year 2016, plus
(B) if the State provides additional funds toward the cost of reducing the cost of attendance at public institutions of higher education in the State for any of such fiscal years that is more than the matching funds requirement under subsection (a)(2), an amount equal to such additional funding provided by the State, which amount provided by the Secretary may be used for the activities described in subsection (e)(2).

Ummm, wow. So the State gets 2/3 of the revenue it received in the form of tuition and related fees? That, by the plain language of the statute, would exclude money spent by the State from general funds, lottery funds, special education funds, etc., and include only tuition and related fees. So States that subsidized education the most would get the least? That’s how it reads. If so, this is a total non-starter, and the legislation is a complete sham —  a promise written in unrealistic numbers to make it seem possible. If that is really what is intended, kill it now. Just forget it, and stop even pretending it was realistic.

But, in the interest of fairness, let’s assume it doesn’t really mean what it says, and that what it is really intended to do is replace all State spending on higher education. Okay? Is that fair, at least for the sake of discussion?

Even under that reasoning, there are problems. California’s budget is $10.5B, while Vermont’s is $84M. More important, New Hampshire is $104/capita, while Wyoming is $606/capita. So we start with that spending (assuming it’s not really tuition, which would make the whole thing a farce), and see right away that the new Federal program would instantly endorse unequal spending decisions made State-by-State, and pay for those decisions with Federal money. How long do you think that would last without challenge, either in Congress or in the courts? Yeah, not very long. If the money is coming from DC, paid via New York, what justification is there to spend so much less in one State than another?

And for years after 2016, while the States can increase their spending, they only get a one-to-one match in Federal funds, rather than the initial two-to-one match, making future State spending far more expensive than past State spending.

(2) SUBSEQUENT ALLOTMENTS.—Beginning in fiscal year 2020, the Secretary shall determine the median allotment per full-time equivalent student made to all eligible States under this section for fiscal year 2019 and incrementally reduce allotments made to States under this section such that by fiscal year 2025, no State receives an allotment under this section per full-time equivalent student that exceeds the median allotment per full-time equivalent student made under this section for fiscal year 2019.

Oh look, starting in 2020 there is an “evening out” of the money. Except, it comes down, instead of going up. So a State that was spending a lot of money on education gets a whole lot less, dropping the median, while a State that was spending less doesn’t get more. The median just keeps dropping to the lowest common denominator.

Do people really think this is a good idea?

(c) State Eligibility Requirements.—In order to be eligible to receive an allotment under this section for a fiscal year, a State shall—

Okay, so what does a State have to do to stay in the system?

ensure that public institutions of higher education in the State maintain per-pupil expenditures on instruction at levels that meet or exceed the expenditures for the previous fiscal year;

You have got to be kidding me! So one-half of the States, the ones actually trying to fund their higher education, get less starting in 2020, but the State has to keep paying just as much? So now the funding will go down from 2-1 to perhaps 1-1, or even less? This is insane. In the meantime, they have to do just as much with even less than they had before? So the University of California system is going to have funding from the feds that matches funding to Missouri, but has to put just as much California money into it, while trying to maintain their standards? Interesting.

ensure that tuition and required fees for in-State undergraduate students in the State’s public higher education system are eliminated;

Hey guys, we get less money, but we can’t charge tuition. Terrific!

(3) maintain State operating expenditures for public institutions of higher education, excluding the amount of funds provided for a fiscal year under this section, at a level that meets or exceeds the level of such support for fiscal year 2015;

Okay, this one’s not a big deal. Except, it hints that when it said “tuition” up above, it really meant “tuition.” And that’s nuts.

(4) maintain State expenditures on need-based financial aid programs for enrollment in public institutions of higher education in the State at a level that meets or exceeds the level of such support for fiscal year 2015;
(5) ensure public institutions of higher education in the State maintain funding for institutional need-based student financial aid in an amount that is equal to or exceeds the level of such funding for the previous fiscal year;

Huh? Why do they have to spend just as much on need-based student financial aid if students don’t have to pay tuition? Somebody please explain this one.
 
(6) provide an assurance that not later than 5 years after the date of enactment of this Act, not less than 75 percent of instruction at public institutions of higher education in the State is provided by tenured or tenure-track faculty;

A lovely goal, but the money just dropped through the floor for the highest-paying half of the States in the country.

(7) require that public institutions of higher education in the State provide, for each student enrolled at the institution who receives for the maximum Federal Pell Grant award under subpart 1 of part A of title IV of the Higher Education Act of 1965 (20 U.S.C. 1070a et seq.), institutional student financial aid in an amount equal to 100 percent of the difference between—
(A) the cost of attendance at such institution (as determined in accordance with section 472 of the Higher Education Act of 1965 (20 U.S.C. 1087ll)), and
(B) the sum of—
(i) the amount of the maximum Federal Pell Grant award; and
(ii) the student’s expected family contribution

So in addition to the funding discussion above, now they have to make up the difference between costs and Pell grant money? This is starting to sound like a whole lot of new unfunded mandates, the kind the Supreme Court doesn’t like.
 
and
(8) ensure that public institutions of higher education in the State not adopt policies to reduce enrollment.

Same enrollment, less money.

(d) Submission And Contents Of Application.—For each fiscal year for which a State desires a grant under this section, the State agency with jurisdiction over higher education, or another agency designated by the Governor or chief executive of the State to administer the program under this section, shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.

Only States that want to participate will need to submit applications. Guess which States will want to participate? The Democratic States that spend low amounts of money on higher education. The higher-paying States, even if they’re blue as blue can be, won’t want any part of it, for the reasons noted above. 
 
(e) Use Of Funds.—

How do they get to use the money?

(1) IN GENERAL.—A State that receives a grant under this section shall use the grant funds and the matching funds required under this section to eliminate tuition and required fees for students at public institutions of higher education in the State.

First, reduce tuition. Okay, got it.

(2) ADDITIONAL FUNDING.—Once tuition and required fees have been eliminated pursuant to paragraph (1), a State that receives a grant under this section shall use any remaining grant funds and matching funds required under this section to increase the quality of instruction and student support services by carrying out the following:
(A) Expanding academic course offerings to students.
(B) Increasing the number and percentage of full-time instructional faculty.
(C) Providing all faculty with professional supports to help students succeed, such as professional development opportunities, office space, and shared governance in the institution.
(D) Compensating part-time faculty for work done outside of the classroom relating to instruction, such as holding office hours.
(E) Strengthening and ensuring all students have access to student support services such as academic advising, counseling, and tutoring.
(F) Any other additional activities that improve instructional quality and academic outcomes for students as approved by the Secretary through a peer review process.

Second, you have to put any additional money back into education. Savings may not be spent elsewhere. Not even State money. So the Feds are now controlling the State use of its budget, even if the State is meeting all its obligations. Interesting. How long do you think that will last in court?

(3) PROHIBITION.—A State that receives a grant under this section may not use grant funds or matching funds required under this section—
(A) for the construction of non-academic facilities, such as student centers or stadiums;
(B) for merit-based student financial aid; or
(C) to pay the salaries or benefits of school administrators.
 
Oh for ____’s sake! Do we really think school administrators, the people who enroll students, who handle disciplinary issues, who manage dormitories, and a thousand other things, aren’t part of running a successful university? Is there some imaginary university where the kindly professor meets the students under the ol’ oak tree to impart knowledge, while they nibble their brown-bag lunches?
 
(f) Authorization And Appropriation.—There are authorized to be appropriated to carry out this section $47,000,000,000 for fiscal year 2016, and such sums as may be necessary for each of the fiscal years 2017 through 2025.

And the cost? $47B the first year, and whatever is necessary for the years to follow.

Conclusion

There you go. That’s Sanders “free college” plan.

It doesn’t sound quite as great to me when you look at the details as when you put it on a bumper sticker.

That reminds me–how are all those new coal mines doing?

 

We’ve Heard This Song Before

Trump’s bigoted diatribes against Latinos, Muslims and (nonwhite) immigrants received a considerable amount of attention during the campaign, as did his reprehensible attitudes  about and behavior toward women.

The torrents of anti-Semitism he unleashed received less coverage by mainstream media sources, but not because that anti-Semitism was less pronounced. Anti-Semitic posts surged on Twitter; and as the Atlantic reported,

This was the year that anti-Semitism went mainstream again. On Tuesday, American Jews will have a chance to register their vote about a presidential candidate whose campaign has trafficked in anti-Semitic rhetoric, symbols, and organizations unlike any other seen in recent years.

Reporters who are Jewish–or who just have Jewish-sounding names–were subjected to vile diatribes employing words that weren’t part of public conversations back in “political correctness” days.

Those of us who are Jewish tend to be sensitive to eruptions of this sort, and the extent of ancient “Jew hatred” tropes and the emergence of old anti-Semitic stereotypes was chilling.

This ugly reality is one reason I get so annoyed when naive and disappointed progressives insist that Bernie Sanders would have beaten Trump. They point to polls taken during the primaries, which any pollster will concede are so early as to be meaningless. (Actually, polls taken during the campaign weren’t so meaningful either–just ask Hillary Clinton.) Had Bernie emerged as the nominee, he would have been subjected to the full ferocity of Republican campaign attacks, and as a commenter on this blog previously noted, there was plenty to work with. (That’s not a slam on Bernie; most people who have been in public positions a long time, and actually done things, have baggage or a history that can be twisted and made to look like baggage.) Given his attacks on the 1%, and his economic positions, there would have been enormous amounts of money pouring in from the Koch brothers and their ilk to fuel those attacks.

But that’s not the only reason Bernie couldn’t have won, no matter how much his message might have resonated with voters who actually wanted change. And let’s be honest. The ugly truth is that the majority of Trump voters weren’t voting for change–at least, not in the sense most people mean.

They were voting to repudiate social change and (especially) a black President.

They were voting to take America back to the way things were when no one spoke Spanish, gays were in the closet, Muslim-Americans were rare or non-existent, Jews and blacks were just barely second-class citizens, and women knew their place. And in the pantheon of their hatreds, Jews rank high.

Bernie Sanders is Jewish. The voters who thrilled to Trump’s nativism and White nationalism were never, ever going to vote for Bernie.

There’s a lot of debate over whether Donald Trump is anti-Semitic himself, or whether he was simply willing to pander to David Duke and the rest of the KKK and Nazis who endorsed him, but it really doesn’t matter. He did pander to them, he did encourage their virulent anti-Semitism, and if he ever effectively disavowed the Klan’s support, they (and I) didn’t notice.

Instead of wasting time with fantasies of what might have been, all of us who oppose Trump need to resist his agenda as forcefully as we can; we also need to begin looking now for progressive candidates who can run for the House and Senate in 2018, and for a transformative candidate who is electable in 2020. (Assuming the country is still here and in one piece in 2020. But that’s a blog for another day…)

A New Age of Activism?

A number of recent columns have “post-mortemed” (if that’s a word) the Presidential primaries. One such, in the New York Times, considered the ongoing influence of Senator Bernie Sanders’ campaign. Sanders has yet to fully concede, although he has said he intends to vote for Clinton, and he is likely to remain a force in American politics for the foreseeable future.

Sanders’ ability to engage young voters was surprising, at least to me; a crusty 74-year-old self-described “Democratic Socialist” would seem to be an unlikely hero to twenty-somethings. Yet he clearly evoked a passionate response from young people.

In conversations I had with more than a dozen Sanders supporters, many of them told me they were either disillusioned with or apathetic toward politics before this campaign. Mr. Sanders, a 74-year-old democratic socialist from Vermont, energized them unlike any candidate before. Now, they’ll either resign themselves to voting for Hillary Clinton, redirect their efforts to local campaigns or drop out again.

The article includes a number of comments from young Sanders supporters, and describes the issues that resonated with them. Perhaps the most perceptive observations, however, came from an activist named Winnie Wong.

This month, after the primaries are all over, some Sanders supporters will try to answer the question of what’s next at an event called the People’s Summit in Chicago. The mission of this gathering: to figure out how to turn Mr. Sanders’s momentum into lasting change. One of the attendees will be a digital strategist named Winnie Wong. After working with the Occupy Wall Street movement, she helped start the grass-roots group People for Bernie, and has been credited with coining the hashtag #FeelTheBern. She said she saw a connection between the Occupy movement and the Sanders campaign.

“This is a movement,” she said. “It is not about Bernie Sanders. He’s a part of this movement.” And, according to Mr. Sanders’s most ardent supporters, that movement isn’t going anywhere.

After teaching public affairs for nearly twenty years, and consistently bemoaning the anemic participation of college students in the political process, I get really hopeful when I read about the increased youth engagement described in this and many other articles.

Wong is correct that the increase isn’t limited to the Bernie phenomenon. A number of social indicators suggest America may be at one of those “turning points,” one of the cyclical swings in political/cultural opinion that have characterized our nation’s history. If I am reading those indicators correctly (and I know I may just be engaging in wishful thinking), Sanders great contribution is that he helped focus a relatively amorphous and simmering discontent on the need to engage with and reform the political process.

You don’t have to embrace the specifics of Sanders’ proposals to recognize the importance of that achievement.

The fact that the movement Sanders sparked is progressive is especially important at a time when nostalgia and reactionary impulses have given us Brexit and Trump and their hollow promises to take the world back to a time that never was.

Virtually everyone agrees that it’s time for a change in American politics. We can argue about the nature and pace of that change, but if Bernie has sparked a new youth movement with “legs,” a movement with staying power, he will have won something that is arguably more important than the Presidency.

How Gerrymandering Gave us Donald Trump (And Bernie, too)

Last night was another Republican debate, this time minus “The Donald.” It’s difficult to believe that this assortment of wannabes is the best a once-serious political party can muster.

How have we come to this?

David Brooks, the conservative columnist for the New York Times, is a thoughtful observer of the American scene, and while (in my opinion) he often misses with his analysis, he also often contributes to our understanding of the America we inhabit.

In a recent column, Brooks honed in on the public’s pervasive feelings of powerlessness:

The Republican establishment thinks the grass roots have the power but the grass roots think the reverse. The unions think the corporations have the power but the corporations think the start-ups do. Regulators think Wall Street has the power but Wall Street thinks the regulators do. The Pew Research Center asked Americans, “Would you say your side has been winning or losing more?” Sixty-four percent of Americans, with majorities of both parties, believe their side has been losing more.

These days people seem to underestimate their own power or suffer from what Giridharadas calls the “anxiety of impotence.”…

There are, as Brooks points out, many reasons for these perceptions of powerlessness, and certainly not all of them are political. That said, however, a case can be made that one of the great frustrations fueling the palpable anger in today’s electorate is the realization by so many citizens that their votes don’t count.

The American message has always been that we have political choice. If we don’t approve of the behavior of our political representatives, we can vote them out. Increasingly, that’s not true; gerrymandering has produced Congressional districts that would re-elect dead people if they ran with the correct political label.

At the federal level, the House of Representatives is unrepresentative of the American public, and likely to remain that way. In the last Congressional cycle, Democrats garnered a million more votes than the Republicans who nevertheless remain firmly in control—and, thanks to checks and balances—able to obstruct and defeat policies favored by a popularly-elected President.

I’ve written previously about the lack of competitiveness that gerrymandering produces, and about other deleterious consequences of the practice. Brooks points to one I omitted: the frustration experienced by citizens who feel—with considerable justification—that they have no voice.

Plagued by the anxiety of impotence many voters are drawn to leaders who pretend that our problems could be solved by defeating some villain. Donald Trump says stupid elites are the problem. Ted Cruz says it’s the Washington cartel. Bernie Sanders says it’s Wall Street.

When voters feel powerless, they are vulnerable to simple messages, identifiable villains, and candidates who channel their anger.

If history is any guide, that has never turned out well.