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August 09, 2017 11:36 AM UTC

"Punching Hippies?" More Like "Barbarians At The Gate"

  • 32 Comments
  • by: Colorado Pols
Sen. Michael Bennet, former President Barack Obama.

The Denver Post has a story up today that is worth reading, despite a headline that some of our more aggressively liberal Democrats might find a bit incendiary–“At town hall that focused on health care, [Sen.] Michael Bennet says single-payer system isn’t best option.”

In a dialogue this week largely focused on defeating efforts to repeal and replace the Affordable Care Act, U.S. Sen. Michael Bennet dismissed another system elsewhere along the ideological spectrum: government-sponsored, or single-payer, health care.

Bennet, speaking Monday night at a town hall in Greeley, said the existing system should be the focus.

“I think we should have a discussion about how to expand Medicare, so that more people can be part of it or maybe be able to buy it and how to do the same with Medicaid.”

Bennet emphasized that his Democratic colleagues frequently debate a single-payer health care system, but that he was “in the early days of this, myself”. The senator also said he hoped the topic “won’t turn into a litmus test” for Democratic candidates.

Creating an option for individuals regardless of their income or age to buy into government-managed health insurance programs would restore one of the central objectives of the 2010 Affordable Care Act, one lost in the vain attempt to win Republican support for the bill: a “public option” that would regulate the cost of private insurance by forcing it to compete with a nonprofit model. There are good arguments for Democrats adopting a “Medicare for all” platform as part of a broader counterattack on health care leading into the 2018 elections–in addition to this being a way to build on the Affordable Care Act’s success in expanding coverage instead of trying to tear the existing law down.

At the same time, there is a significant percentage of voters on the left who have much more expansive designs for health care reform than reviving a public option, to include a single-payer model like the one proposed in Colorado last year via Amendment 69. This pressure comes despite the fact that Amendment 69 failed by nearly 80% of the vote.

There are a number of reasons why Amendment 69 failed as badly as it did, and not all of them have to do with a lack of support for single-payer health care in the abstract. Many Colorado Democrats who support going beyond the scope of Obamacare to address access to care in America still couldn’t support Amendment 69, believing that a nationwide solution was the only viable path forward–as other states who started down this road themselves discovered. There were also specific problems with the proposal as written that hadn’t been accounted for, costing it support from would-be allies. When you combine soft support on the left with the total wall of opposition from conservatives to anything that can be remotely considered “government health care,” Amendment 69’s fate was sealed. So much so, in fact, that it was more useful to Republicans as a wedge to drive within the Democratic coalition than as a rallying point for Democratic candidates in 2016.

And it has to be said: a radical change to health care like moving the entire nation to a single-payer system is politically no more viable a prospect today than it was in Colorado last year. Where the broader adoption of something Americans know and trust like Medicare could attract enough support to pass–especially after a big Democratic win in 2018–there remains a far too vast ideological chasm between the right and left to achieve more than that right now. Progressives face a years-long task of unwinding pervasive conservative messaging on this and so many other issues. They faced the same challenge in 2010, too, and the total blockade of Democratic policy priorities by Republicans since the passage of the Affordable Care Act raises legitimate questions about whether the highly compromised Affordable Care Act was worth the collateral damage. The combined objectives of policy gains and legislative majorities, in a nation that is as deeply divided as ours, makes this a far more difficult question than impatient ideologues want to admit.

The political reality of this is tough medicine for a left newly emboldened in opposition to President Trump, but it’s critical that Democrats understand the limits of their own political capital. In 2004, Colorado Democrats retook majorities in the state legislature not by proposing far-reaching “Hail Mary” progressive policy goals. They won by pledging to be more competent with the government the voters already knew.

That’s where it has to start today, too.

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32 thoughts on ““Punching Hippies?” More Like “Barbarians At The Gate””

  3. Nothingburger alert.  Even Bernie says that adding a public option would be an easy-peasy way to gradually move to single payer.  Changing to single-payer all at once is probably not even possible given the behemoth-ish nature of current healthcare.  Nothing to see here folks.  Let's just add the public option, work out the kinks, and let the single-payer thing happen organically without litmus tests, hand-wringing, or this silly talk of Hail-Mary progressives. 

    1. My main beef with Amendment 69 was that if it passed, my state taxes would have tripled or quadrupled, with no benefit accruing to me. 

      I agree: fix the existing system first before even considering single-payer.

      1. I hope the debate can be centered on not if we can get a public option, but rather on how it would be implemented.

        Either a pure "anyone that wants to buy into medicare", opening up competition vs. the profit-driven insurance companies, vs. a blanket lowering of medicare to say, 55 years and above, which would place the most expensive users into medicare, leaving the highly profitable younger, healthier customers for the insurance industry to harvest.

        Gee, I wonder which one the insurance industry would prefer?

  4. The nugget of doubt embedded in the next to last paragraph regarding whether the collateral damage from Republican viciousness since 2010 was worth the fight for affordable health care is worth a comment.  My two cents is that Republicans would have vehemently opposed anything else that person of color president would have done.  In personal terms, many many people have benefited from receiving health care coverage and it has exposed how shallow and mean spirited Republicans really are.  The long game hasn't been played out yet Pols.

  5. Negotiations 101: Never discard your most extreme position prior to beginning negotiations.

    Never say, "We would never strike" to an employer.

    Never say, "Anyone who advocates for single payer is a barbarian at the gate, and we would never do that. We're reasonable people. "

    Michael Bennet, recipient of at least $362,000 from the insurance, health, and pharma industries, is, not shockingly, not an advocate for a proposal which would limit the profitability of these industries.

    This does not mean that he is right. Nor is it at all smart to discard the "single payer option" prior to negotiating whatever compromise agreements get hammered out with Republicans in the interim. 

    We have to at least keep expanded Medicaid, if not lowering the age for Medicare, and put some well-considered "fixes" in place on Obamacare.

    We have zero chance of getting that done if we discard the threat of the single payer boogeyman.

    Sanders is coming out with a "Medicare for All" bill next month. It would behoove Pols, as well as everyone else, to wait and see what is actually in the policy before saying that Congress should never go there, that it's impossible, or that people who advocate for it are "aggressive" liberals, "hippies", or "barbarians". 

    It won't make Republicans like you any better, or work with you any more congenially  to indulge in name-calling and undercutting your strongest options.

    1. "Never discard your most extreme position prior to beginning negotiations" is how unskilled negotiators negotiate. Skilled negotiators know that the other side (or sides, in a multilateral negotiation) will accurately assess what the parties' real interests are.

      Right now, the paramount interest is in not letting Trump blow up the ACA, so either Congress has to appropriate the CSRs or a court has to order their payment. Pretending that a single-payer plan is a viable alternative to not funding CSRs–i.e., that there is a Democrat who would not vote to protect CSRs–is ludicrous.

      1.  Skilled negotiators know that the other side (or sides, in a multilateral negotiation) will accurately assess what the parties' real interests are. 

        Really? Would you care to elaborate on that point? What makes that a reliable dynamic in a negotiation? I am just not sure what you are trying to say.

        1. Remember the archery rule– AIm higher than your real target .  My slogan was "Come in screaming for Red revolution and settle for improvements in the pension plan."

          1. To waist your time, try this pear crisp recipe:

            Ingredients

            • 1/2 cup all-purpose flour
            • 1/3 cup quick-cooking oats
            • 1/3 cup packed brown sugar
            • 1 teaspoon ground cinnamon, divided
            • 3 tablespoons cold reduced-fat stick margarine, cut into pieces
            • 4 cups sliced peeled pears (about 2 pounds)
            • 2 tablespoons sugar
            • 1 tablespoon lemon juice
            • 1 teaspoon grated lemon peel
            • 1/2 teaspoon ground ginger

            Directions

            In a bowl, combine the flour, oats, brown sugar and 1/2 teaspoon cinnamon. Cut in margarine until coarse crumbs form; set aside.

            Place pears in a large bowl. Sprinkle with sugar, lemon juice, lemon peel, ginger and remaining cinnamon; toss to coat. Transfer to an 8-in. square baking dish coated with cooking spray. Sprinkle with crumb mixture. Bake at 350° for 45-50 minutes or until pears are tender. Yield: 9 servings.

             

            Originally published as Fresh Pear Crisp in Light & Tasty August/September 2003, p23

             

             

            Nutritional Facts

            1 cup: 130 calories, 3g fat (0 saturated fat), 0 cholesterol, 43mg sodium, 28g carbohydrate (0 sugars, 2g fiber), 1g protein. Diabetic Exchanges: 1 starch, 1 fruit.

            2. Looks good! What is the source of all the sodium? I'm on that crazy no/low sugar/carb diet, would need to substitute the brown and other sugar with Stevia, might not make as tasty. I'll let you know if I can get authorization from my wife to cheat on the carbs and sugar.smiley

        3. It means that taking an extreme position when it is clear that your real interest is more modest is silly because a skilled negotiator will discern the difference between your position and your interests.

          Democrats may have good reasons to support a single payer/Medicare for all/public option–for example, to protect from a primary challenge from the left–but it is an empty gesture as negotiating tactic because it is clear that their actual interest is in stabilizing the ACA marketplaces.

          There may be some merit to staking out an extreme position when the other side's interests are not clear, in which case taking an extreme position is a temporizing measure. But it is likely to be more effective to simply avoid taking any position at all and instead take the time to investigate the other side's interests. But this is not the case in the current healthcare debate, where the Democratic position is clearly to improve upon the ACA by ensuring payments for CSRs.

          1. Where you're wrong, old time, is in assuming negotiators have total freedom.  In reality, when I negotiated for my union, I represented a wide array of members interests.  Some of the more extreme ones were, of course, eventually discarded, but you at least owed your members the courtesy of presenting them.

            You seem to be advocating a kind of Boulwareism, where you make only one offer and refuse to budge from it.  I actually knew Dick Boulware, Lemuel's nephew, but I'm afraid his tactic doesn't work.

          2. Sanders may be the one doing the negotiating in the Senate…he is the "amendment king", after all. He's been really effective as a legislator for a really long time. John Conyers, also an old, "Have no f*cks to give, been introducing single payer every year since '03" is reintroducing single payer in the House. So your assumption that only mild-mannered moderates who have already sold out to the insurance companies (cough*bennet*cough) will be negotiating is probably not accurate.

            You wrote: "There may be some merit to staking out an extreme position when the other side's interests are not clear, in which case taking an extreme position is a temporizing measure."

            Could there be anything more unclear than the GOP position on healthcare? 5 versions of a health care bill, no hearings, no discussion, no expert testimony, just "throw it at the wall and see if it sticks".

            Congress has to keep Medicare for All on the table. Even if it's just, "Negotiate with us on fixing the ACA, or negotiate with the SINGLE PAYER BARBARIANS!"

      2. "Not funding CSRs" would be ludicrous. Yes, not funding cost sharing reductions, which allow individuals to purchase insurance subsidized by Medicare, would indeed be ludicrous. That's why I didn't suggest it.

        If you look at the WaPo article I linked to, "Nine Ways to Really Fix Obamacare", you'll see some well-considered ways to actually lower costs and pay for the CSRs.

        Far from being an "impatient ideologue", a "barbarian at the gates", or a "hippie", as Pols infers in their condescending original post, I'm interested in any and all fixes to the ACA.

        Probably, in the interim, some kind of compromise bipartisan solution  (funding CSRs and implementing the cost cutters in the WaPo article) can be found, if only Republicans feel backed into a corner enough to pass something that they can't pass with GOP votes.

        I'm in the demographic that would benefit from lowering the eligible Medicare age to 55, or allowing me to buy into it as an alternative to my employer-sponsored health care.  Those are also viable short-term fixes.

        Part of backing GOPS into a corner to preserve access to health care for Americans is keeping "Medicare for All" on the table. Again, a good negotiator never wants to start off by taking their scariest option off the table.

        Especially if the scariest option is also the one that makes the most sense.

         

        1. CSRs do not "allow individuals to purchase insurance subsidized by Medicare." They are payments to insurance companies to allow lower-income purchasers of a silver-level plan on an exchange to qualify for lower deductibles and co-payments.

          My response to your prior post was a criticism of the statement that it is a basic negotiating tactic to put forth extreme positions (which you reiterate in this post). It might be common, but it is not effective.

          The ACA will be fixed if some Republicans defect and join with Democrats to ensure payment of CSRs and whatever minor tweaks they can agree on. How, exactly, will "keeping 'Medicare for All' on the table"–when Democrats have absolutely zero chance of achieving that goal–enable that solution?

          Pick up any serious book on negotiating (and I don't mean "Art of the Deal") and you'll see what I mean.

    2. Negotiations 101: Never discard your most extreme position prior to beginning negotiations.

      That's why voters continue to walk away from the Democratic Party.

      2. Pfruitti's Favorite Wish Sandwich Recipe:

        • Two slices of bread (Pfruit prefers white — duh!)

        • Wish you had some meat a brain.

        Enjoy!

          1. LOL!  Besides all those great recipes, if it weren't for Jake & Elwood, I may not have ever gotten turned onto Taj Mahal! . . .

            . . . or Wilson Pickett, or Brother Solomon Burke, or . . .

            (Which led to Albert Collins, which led to Hounddog Taylor, which led to Luther Alison, which led to Melvin Taylor, which led to Delbert McClinton, which led to Theresa James, which led to Proffesor Longhair, which led to Diana Washington, which led to Buckwheat Zydeco, which led to Beau Jacque, which led to the Subdudes, which led to Keb mo’, which led to Robert Randolph (next Thursday @ the Gothic , btw), which led to John Mahall, which led to Trombone Shorty (next Wednesday @ Red Rocks, btw) , which led to The Gourds, which led to . . . but, I digress

            . . . damn, I’m hungry

            . . . I wish I had a sandwich!!!)

    3. Pols should clarify, but I don't think they are calling liberals "barbarians." I think that's a reference to Republicans who want to destroy Obamacare instead of fix it. I think they're defending themselves from "punching hippies" by reminding liberals that the "barbarians are at the gates."

      Hello Guvs? You could clear this up easily I think.

  6. Other than cutting out the for-profit insurance companies (I'm sure, the main sticking-point), would someone kindly explain to me why single-payer is such a terrible idea? Medicare, Medicaid, the military, all federal employees are on "government health care". I wouldn't be here without it. If you add all of those people up, it seems more people get their care that way than though for-profit companies. Why do they kick so hard about it?
    ***
    Actually, I just did the arithmetic, based on another Polster’s numbers, and 40% of people are on “government healthcare”. that’s a lot of people. Are they suffering from it? As I said, I wouldn’t be here without my late father’s military healthcare.

  7. Single payer is not a terrible idea. In fact, it remains the least expensive and most effective way to provide health care for the people of a nation – as the New York Times, 60% of US doctors, and 58 other countries can attest.

    So there's that. They "kick so hard about it" because switching to universal health care would bring change. Euphemistically called "job churn", it means that people who now work in the for-profit model – pharma reps, advertisers, actuaries, people whose job it is to deny care and limit costs – would have to switch over to working in a non-profit model.

    They would have to fairly negotiate medication and treatment costs instead of charging what the market will bear, calculate risk based on medical efficacy instead of profit margin, think about how to provide care while keeping costs low – and this change would also put some really powerful insurance CEO millionaires out of work.

     

    1. Exactly…

      As a young man (20s) I worked in the insurance industry for about 3 years. I know something of it..you are dead on.  ..It is that last one that is the biggest bone in their craw.That's the one that hires the lobbyists and buys the electeds.

      Well…there's that dividend thing to keep shareholders in line, but the 6 to 8 figure salaries of the upper brass will be hard to take down..

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