Sober up, Democrats, or say goodbye to your dreams.

Updated 7/15/19

Sober up, Dems. I'll be putting my money in this presidential race on a  candidate with appeal in the key electoral states Democrats need to win or liberals can say goodbye to their dreams. What is becoming clear is that the Democrat's winning nominee must appeal to both blue-collar midwest and high African American turn out or Donald Trump will get his second term. What is at stake for Democrats and possible swing voters are policies fundamental to Democrats and independents. Should Trump gain a second term, it is bye, bye Roe v Wade as the Supreme Court gets more anti-Rove v Wade justices. A Trump second term would place in control more energy lobbyists and executives sabotaging climate change green goals., White nationalism would continue undermining meaningful protection of civil and minority voters rights. It means a veto pen in the White House sinking health care insurance, any expansion, more sabotage, if not completely ending any federal program like Obamacare. Trump's record is to kill affordable health care for millions of citizens and neither he nor the GOP has any feasible plan for a replacement. Democrats can quibble over totally replacing Obamacare with Medicare for All or making Medicare a public option and in debates lose any chance at either being implemented if they lose the electoral college vote.

The horse race White House winner is not determined by who gets the most popular votes. If we learned anything from 2016, Democrats won that race but they lost because of the electoral college that weights votes by each state in favor of smaller populated states and against mammoth blue New York and California. So far, the start of this presidential election cycle shows some hope for Democrats to win both the popular vote horse race and the electoral college vote. but it is not only early,  it is also marginal and iffy. In any recent popularity polls, Donald Trump has held onto his base of 42 to 44% losing to several leading Democratic contenders, but he has not expanded it, even with his job approval at 45 to 47%. Recent polls of demographic blocks, issues such as health care and immigration, swing states, and relative position of Democratic aspirants for their party's nomination provide a snapshot of where the race stands today, but as we have seen in these days of modern communication. much can happen quickly to change public opinion.

Early in the election cycle Joe Biden has shown the ability to appeal to win both key demographics and flip some states from red to blue, yet some of Democrats barking at his heels in the announced field have tried to take him down. Democrats should be wary of a circular firing squad of candidates attacking fellow aspirants to boost their own chances. Those lines of attacks could be used by the GOP to defeat them in a general election.

From a July 8 Washington Post email : The economy is the only major issue on which a majority of people approves of how Trump is doing. On foreign policy, it’s 40 percent. On taxes — remember, Republicans passed a tax bill in 2017 to try to get good marks here — it’s 42 percent. On health care — a potent issue Democrats championed to help them win back the House of Representatives last year — it’s 38 percent.

Voters would choose Trump over a socialist

Match-ups between Trump and most 2020 candidates are dead even (except for former vice president Joe Biden, who beats Trump by 10 points among registered voters in this poll). But the pendulum swings clearly toward Trump when voters are asked to choose between Trump and a “socialist." Trump is suddenly decisively ahead.

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Where the race stands now

In June, some polls show Biden beating Trump is key states Trump carried in 2016, including Wisconsin, Ohio, and Michigan, as well as Florida, North Carolina and Arizona. A major portion of the Democratic party is the African American vote. Their turnout and enthusiasm are key to determining who becomes the Democratic candidate.

After the first debate, Kamala Harris attacked Biden on not being favorable enough of busing a decades ago as a way to try to paint him as a person not supportive of the Black community. This worked to her advantage and Biden was caught off guard and fumbled the answer. He took a hit in his polls but maintained his lead and support in the African American community.

As of July 13, Biden maintained a 20 point lead among African American voters in spite of Harris' strategy. Biden's 40 years in high profile public office is less a bane and more of a boon when it comes to appealing to the Black community. Not only does he have a record of defending civil rights on many more issues, but he also served as vice president with Barack Obama, America's first African American president, who trusted him explicitly. He is a known quantity which makes Harris' attacks less effective. Biden's track record is a safe one based on years of trust. Harris, African American/Asian, has been under fire for past support of law enforcement issues opposed by African Americans when she was attorney general of California. Her debate strategy of attacking Biden on busing was a breakout moment for her, showing her political acumen and her debate skills that could take on Trump, moving her up the polling ladder.

Trump and the GOP are banking on the white nationalist elements of their base. To solidify that support, they are launching extreme anti-immigrant and anti-minority policies, hyping fears of a large swath of voters, facing a future where whites will be a minority of voters. This month, Trump announced policies and actions to maintain his hate and fear bonafides, including ICE raids, Vice President Pence visited scary looking male migrants crammed into chain linked holding pens being treated badly. Pence did not visit the facilities housing children separated from parents. Trump announced he is planning to remove the ability of asylum seekers to reach US borders. by forcing them to remain in Mexico. He failed in his attempt to get a citizenship question on the 2020 census form as the SupremeCourt ruled against him, but his effort should at least keep his base happy. Trump media is attempting to paint four women Representatives of color who are outspokenly left of the rest of the Democratic caucus, as representative of all Democratic candidates, sending them "back" to where they came from. , The GOP is also attempting to brand all Democrats as being for open borders in spite of a difference among candidates on the issue of criminalization or decriminalization of undocumented migrants. or plans to secure and improve the immigration system. This may work for Trump, but Biden's 40-year history makes that a hard sell as an older white man with a known history and a reservoir of trust as a rational, thoughtful, public servant.

On health care, Biden has carved out the most moderate approach of the top four, whose position was announced July 13 as keeping Obamacare but providing a buy-in to Medicare, while permitting those who like their private, union, or employer-provided insurance to keep it. Advocates of the more extreme version of Medicare for All would do away with private insurance (except for supplementals) and move consumers into a single payer plan. The GOP's obvious strategy is to scare consumers away from any Democratic by charging them as socialists. Polls show that tagging any candidate as a socialist is a very effective strategy, with Trump beating any candidate branded with that term, fair or not. The tag of "socialism" is especially toxic to Democrats in swing states per an Axios poll. Biden's 40-year record makes sticking him with "socialist" a hard sell.

Obamacare was originally designed to have a public option, government-provided insurance plans like Medicare or one offered to federal employees, to provide competition that would force private insurers to become cheaper. Biden's plan for prescription drugs would be to permit Medicare to bargain with drug companies for the best price. Currently, drug companies and Medicare and Medicaid are forbidden by law to bargain, permitting drug companies to continue to gouge consumers with their own price setting. Biden would also allow consumers to get their prescriptions from providers abroad, giving US drug companies competition they do not have now. Both Sanders and Warren would eliminate private and employer insurance for a Medicare for All plan for everyone, a single payer system more like the Canadian model. Harris has supported legislation of both approaches, the public option, and the Sanders/Warren approach..

From a July 8 Washington Post email : The economy is the only major issue on which a majority of people approves of how Trump is doing. On foreign policy, it’s 40 percent. On taxes — remember, Republicans passed a tax bill in 2017 to try to get good marks here — it’s 42 percent. On health care — a potent issue Democrats championed to help them win back the House of Representatives last year — it’s 38 percent.

Voters would choose Trump over a socialist

Match-ups between Trump and most 2020 candidates are dead even (except for former vice president Joe Biden, who beats Trump by 10 points among registered voters in this poll). But the pendulum swings clearly toward Trump when voters are asked to choose between Trump and a “socialist." Trump is suddenly decisively ahead.

 https://www.cnn.com/2019/07/13/politics/joe-biden-leads-with-black-voters-analysis/index.html

https://www.nbcnews.com/politics/meet-the-press/trump-trails-biden-warren-sanders-new-nbc-news-wall-street-n1029646

https://www.axios.com/alexandria-ocasio-cortez-poll-democrats-2020-aeaa3771-f142-4059-b79e-1fed569dfdf9.html

https://thehill.com/policy/healthcare/451263-nixing-private-insurance-divides-medicare-for-all-candidates

https://www.cnbc.com/2019/07/15/biden-unveils-health-care-plan-to-expand-obamacare-hits-medicare-for-all.html

https://www.usatoday.com/story/news/politics/2019/07/15/donald-trump-says-house-democrats-he-insulted-should-apologize/1732314001/?csp=chromepush

POLITICO.COM

Biden invokes Obama to defend his civil rights record

The former vice president delivered a fiery response after Kamala Harris 
attacked his past stance on busing.

Let me choose: An American trait

A version of this was published on line by the Sky Hi News February 27, 2019
https://www.skyhinews.com/news/opinion-muftic-let-me-choose-an-american-trait/

Two very hot controversial public policy issues, one appealing to the right and the other to the left, share something in common. Americans prefer to be free to choose among alternatives, especially when their personal lives and health are directly affected.   What first comes to mind is the issue of abortion.  However, for Democrats choice is a value that cannot be ignored when they shape health insurance legislation, either   Democrats will have a winning hand if they support keeping choice in health care insurance and women’s control over their own bodies.

A Wall Street Journal/NBC 2018 poll showed 71% (and 52% Republicans) do not want Roe v Wade overturned.  They want to make their own decisions about their bodies. An overwhelming majority does not want someone else’s moral and religious views or government to tell them what they cannot do in these most personal gut-wrenching decisions. 

The issue of a woman’s right to choose is a cultural, religious, health,  and moral matter, but health insurance is a quality of life, health, and pocketbook issues.   Permitting consumers a choice between private and public insurance providers, and the ability to keep their current insurance and doctor are the keys to strong public support of proposals for health insurance reform.

Over 60% polled in mid-2018 liked Medicare for All (half of Republicans and majorities of independents and Democrats), but when asked if they want to end their choice of private insurers, only 10% approved, as the Kaiser Family Foundation discovered. KFF also found, “nearly half of Republicans and majority of independents and Democrats favor an optional Medicare-for-All play. Public support for Medicare-for-All shifts significantly when people hear arguments about potential tax increases or delays in medical tests and treatment and recent polling also shows many people falsely assume they would be able to keep their current health insurance under a single-payer plan...

Another survey, reported by the Hill in early 2019 found 70% support for Medicare for All, but if a plan would eliminate private insurers ( called single payer), support dropped to 13%. 

The two issues that almost scuttled Obamacare were opposition to the mandate that required everyone to have health insurance and subscribers finding they did not get to keep their doctor as they were promised.  

There is also an ideological pushback to any national health plan.  It is a tradition ingrained in the GOP psyche. The Grand Old Party is following a Grand Old Tradition, a historically long held ideology, opposing Social Security, Medicare, and Medicaid tooth and nail and they are beginning to invoke an ideologically based opposition argument again. 

 Any public program that distributes resources from those better off to those who cannot afford basic living expenses is one definition of socialism.  In some quarters, any publicly funded program that supplants private business is also considered socialist. Republicans are already beating the drum that anything proposed by any Democratic candidate is that awfully feared word “socialism.”  It will fail as it has in the past as a political slogan when the needs for quality of life and life itself are unmet to such an extent that it is more important to individuals and families than adhering to some ideological ideal. Those current polls are evidence we have reached that point. FYI. Not all kinds of public health insurance plans eliminate private insurers as the fear mongers on the right want you to believe.

Price and costs are still a very large part of the conversation. Here is the rub. The counter-argument against allowing consumers to have a choice of whether to participate or not is expensive.    The larger the subscriber pool mix of high users and low users, the cheaper the system is for the average patient. Providing every choice consumers desire comes with it a higher price tag. There are so many variations of degrees of government involvement in health care, that the tradeoff becomes which one can we as taxpayers afford vs. what we feel we need and want.

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Obamacare was based on a conservative think tank plan to save the private insurance industry. They feared the adoption of single-payer national health would eliminate private insurance. Obamacare was structured to use private insurers. and it also provided the mechanism to provide a subsidy only to those who could not afford private health insurance.  Medicare also allows the use of private insurers and a great deal of choice of providers. Obamacare also provides consumers a choice of nonprofit and for-profit insurance plans providing various levels of coverage and out of pocket expenses.  It saw some impact with the removal of the mandate Trump engineered through executive order, but it has managed to keep its head above water in spite of it.

The objection by consumers of Obamacare was they did not get to keep the doctor if their choice because the choices did not include the network or provider they once had.  This was likely based on experience with employer-provided insurance.  Employers frequently changed the choice of insurance providers as they got better deals for their employees and their company’s bottom line, causing employees to find a new doctor or network. Job changes also often require a choice of different providers in employer-provided plans. 

More thoughts in a discussion from a reader who thinks national health will not work like it does in Europe because the US population is so much larger.  He would rather reform the old, pre-Obamacare system and keep the government out. Here is my answer: "Government out of medicine worked so badly and so many could not afford treatment or insurance, that is why Obamacare happened and the midterms went the way they went. . However, I am not sure how you deduced that just because a system scales up to size it de facto will not work. Medicare works so well and it is applied to the entire US that to touch it is the third rail of US politics.. Why can't it work if more subscribe to it. In fact, it should work better because the pool would include younger, healthier members, not just old people near the end of life. Ps Tort reform would have little impact..since much of it has already been done state by state. That is a fantasy and the CBO already scored it as having little impact. Agree on the lower drug costs; Obamacare permits cross state lines compacts but no one has done it because there are problems with private provider networks and the state by state control of insurance commissioners. Good luck in rocking that turf boat that has grown up with private insurance.. I am in favor of a system that preserves consumers right to choose between a private insurance plan and a Medicare based buy in.... that leaves no one out without ability to get the health care they can afford. It is not the cheapest way to go, but it fits the American psyche. that likes choice.."

https://www.nbcnews.com/politics/first-read/nbc-wsj-poll-support-roe-v-wade-hits-new-high-n893806

https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/

https://khn.org/morning-breakout/support-for-medicare-for-all-plummets-if-it-means-getting-rid-of-private-insurance-system-poll-finds/

https://thehill.com/hilltv/what-americas-thinking/428958-poll-voters-want-the-government-to-provide-healthcare-for

Introducing America's new health care system: Trumpcare

Updated 10/15/17 A version of this was published in the Sky Hi News, Oct 18, 2017 http://www.skyhinews.com/news/muftic-welcome-your-new-health-system-trumpcare/
Introducing America’s new healthcare system: Trumpcare.  Donald Trump just  broke the old one; he owns the new one.   He can no longer blame Congress that  also tried to break it and failed.  He is the one who broke it all  by himself with his own executive orders. It gives some the choice of cheaper policies, but their new choice is between bad, worse and useless. All premiums in and out of exchanges will rise. The financial impact will be felt immediately in everyone’s pockets. Trump has opposed any  suggested fixes that would make his orders unnecessary.

However, facing 2018  Congressional elections, he claims he is ready to make a deal with Democrats , it appears . No wonder. The political repercussions will be felt in time for the 2018 midterms when the  millions of lower income and middle class voters will feel the pain in their pockebooks and realize  in real time  they  just  been taken to the cleaners by Trumpcare. Given insurance policies fine print, most will only learn the consequences when they get sticker shock, paying full price for needed services not covered by terms, deductibles, and lifetime and annual caps. The most affected are red states that use more of the subsidies he just halted and who voted for Trump Alternatives such as single payer and Medicare for All will begin to look better and better to more. If Trump blames greedy insurance companies, then single payer solves that problem: it cuts out private health insurance participation.  Congressional  Democrats in the short term are united in support of fixing Obamacare in contrast to Trumpcare. Deal with Trump? Chuck and Nancy have already been bitten with DACA's deal with him over that. They were double crossed later . Don't blame them if they do not take him up with his offer.

Trump’s  threats to stop payments to insurance companies who help low income pay insurance premiums (not to prop up their stock prices as Trump claims)  have already caused exchange premium prices  to rise 20-25% in some states since  insurers anticipated his move. October 12 he made good on that threat with his order.  Per a recent Congressional Budget Office score , the impact on all  premiums  of the payment stop will  be an average increase of  20-25%..  An estimated seven million who buy insurance through the insurance exchanges  will find premiums hiked, but so will the subsidies increased to help them pay.  This order   will raise the deficit by $194 billion over ten years since the government will make up the difference in subsidies and insurance companies will pas on costs to everyone else in higher premiums, or the insurance companies will just drop out of the program.

Trump’s order includes a creation of a parallel system of  cheap association plans. There  will be no  requirements for  them  to cover anything so essential to many: prescription drugs, hospitalization, low co pays or affordable deductions, maternity care, cancer screenings including prostate and mammograms,  annual physicals,  pre-existing conditions, mental health care and drug rehab. Consumers buying into association plans  wanting  to make up the the unanticipated loss of uncovered benefits  would pay extra  from their pockets at  full  market price or go without. That is Trump's definition of "great care".

Currently fourteen million buy their insurance through the exchanges. The only ones who benefit from Trumpcare will be the two million  buying  insurance through the exchanges who make too much money now  to get subsidies. Even then, Trumpcare  will  bait and switch them  to accept his "great care"  association plans that resemble  a hamburger with   two buns but with  little meat and condiments .

The eventual   financial failure  of Obamacare is not the death spiral caused by Obamacare,  but it a death spiral engineered by the Trump administration on purpose as part of their plan to de facto repeal  it.  In time, the entire  Obamacare private insurance  based exchange system will collapse as the  parallel  association system will destroy the ACA’s “pool” comprised of  both those  with the healthy  who lightly place claims and  those with pre-existing conditions or with health problems.The  healthy will be  lured into cheaper stripped down plans. The result will be virtual high risk pools left to the sicker who   will see their premiums soar to become unaffordable.

This executive order  is such a fundamental change to the intent and financing of Obamacare, that it is the mother of all executive overreach.  resulting in court challenges which will further drag out uncertainties and  will cause continued premium increases  for everyone as the market is destabilized.

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Footnotes: A bipartisan "fix" to the subsidies has emerged from a Senate committee, but its fate is unknown.  GOP Senate leadership may refuse to bring it to the floor. Then it must pass the Senate and go to the House and require the President's signature.  Trump has issued various conflicting views on his support. http://www.cnn.com/2017/10/17/politics/health-care-csr-payments-deal-reached/index.html

Trump  may want to pay attention to the following impact on his core base of supporters and red states:

Criteria: access, quality, numbers applied for financial aid to afford health care in a recent study revealing 15 worst states to get health care. https://www.cheatsheet.com/culture/worst-states-live-want-decent-health-care.html/

All but one (Nevada) voted for Trump in 2016. The 5 worst: in order of the worst first
Arkansas, Mississippi, Oklahoma, Alabama. W. Virginia.

According to the Associated Press. Nearly 70 percent of those benefiting from the so-called cost-sharing subsidies to insurance companies live in states Trump won last November. https://twitter.com/AP/statuses/919246698081288192

https://www.forbes.com/sites/brucejapsen/2017/10/08/how-narrow-networks-doom-trumps-insurance-sales-across-state-lines/#7e4ea38a35f9.

http://www.npr.org/sections/health-shots/2017/08/15/543714171/cbo-predicts-rise-in-deficit-if-trump-cuts-payments-to-insurance-companies

"Blog posting: 9/271/17 Heads up: GOP's Repeal/replace Obamacare is a cat with 9 lives
ies https://www.pbs.org/newshour/amp/bb/trump-ending-obamacare-subsidies-health-insurers-heres-ends-paying

http://www.chicagotribune.com/news/nationworld/politics/ct-trump-health-care-executive-order-20171012-story.html

https://www.yahoo.com/news/pro-trump-states-most-affected-health-care-decision-134810734.html

https://www.usatoday.com/story/news/politics/2017/10/12/trumps-health-insurance-order-pushes-association-plans-drive-down-costs-some/752816001/

https://www.washingtonpost.com/powerpost/key-senators-reach-bipartisan-health-care-subsidy-deal-and-trump-expresses-support/2017/10/17

The GOP's problem with Obamacare replacement, failure to recognize: shifting sands of public opinion

A version of this was published in the Sky Hi News Sept. 27, 2017

Listening to GOP apologists on TV , their explanation for the unpopularity of their replacement plan for Obamacare is "people do not like change" or "they like the devil they know better than the devil they do not know". The latter is probably more true than the former except the public knows both devils and understands the difference. The GOP in Congress has underestimated the intelligence of the public in general and they failed to understand that there has been a dramatic shift in public opinion since the election. Promises made then have not taken that into account.The GOP's stubborn pursuit of keeping campaign promises as the singular motivation and strategy shaping their bills fails to realize that public opinion had shifted under their feet.

Polls have shown that voters' approval of the GOP replacement plans are approved by a measly 17 to 24% of voters.(May to November 2016, country was somewhat evenly split) The cost of health care is a fundamental pocket book , a quality of life , or even a life and death issue for those families who have low to average income. If their incomes were high enough to cover the costs of health care, there would be no issue. It does not; that is reality. Illness and disease hit families where it hurts or could hurt. They may gripe about Obamacare, but they know it would be worse if they did not have it .The opponents of the GOP plan, ranging from every stakeholder, from insurance companies to patient and disease related advocates to every facet of providers, have verified that their fears are justified, that the GOP plan would hurt them, their families, and their fundamental economic well-being.. .. The expression of their fears in marches, protests, sit ins and other contacts with their Senators and Congresspeople, may not have moved every GOP representative in Congress, but the message these actions convey has served to educate everyone else.

The public has also been educated to know that there are a variety of choices besides the take it or leave it GOP bills. The menu ranges from credible ways to fix and improve Obamacare to Medicare for All . They do not have to make the choice just between Obamacare and the bitter lemon of the GOP bills. There are other ways to save and improve their health care coverage.

Sarah Huckabee Sanders, the press spokesperson for Pres. Trump, made a broad statement recently that called Medicare for All, a single payer system being promoted by Bernie Sanders, a "terrible" idea. I distinctly remember early in the Tea Party movement angry older persons parading, protesting, and holding signs reading "Don't let government take my Medicare away from me". This big bit of ignorance that Medicare was a government program, was was put to rest as those Tea Party folks realized that. What most of the public has not yet realized is that both Medicaid and Medicare are single payer systems, but nonetheless support for those programs is driving the opposition to the GOP plan to cut Medicaid by large amounts. That Medicare will have financial difficulties in the future is true. Like Obamacare, there are fixes. Obamacare had cut the cost of health care enough so that costs did not increase as projected before Obamacare, so that twelve years were added to Medicare's solvency. . So popular is Medicare, Trump pledged not to touch that program during the campaign. However, he also pledged to replace Obamacare with something better , a promise he has not kept. He has supported the truly "horrible" GOP plans to leave 30 million without affordable insurance.

What is true is that there is no free lunch in health care, and if Medicare for All is too expensive to be self funding, tax payers will have to make up the difference. On the other hand, there is a tradeoff with lower out of family and individual out of pocket costs. There is a realization that the US is needlessly paying two and a half times more than other countries in the world who have embraced single payer programs. That is a debate worth having. It should be held in public and in Congress. That process is called "regular order". It should not be rammed down throats without knowing the impact as the GOP just tried to do with their Graham/Cassidy bill..

Medicare for All may not win out in that debate. Switzerland has a system similar to Obamacare , subsidizing private insurance to make it affordable. It differs from the US in big ways, though, since it takes the place of Medicare retiree and employer plans and it mandates all to have insurance through their system. They have strict price controls, too. Recently, when the Swiss had a chance to adopt a single payer system. they voted to keep the private insurance based status quo, even though their costs are the highest in Europe.

https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html?_r=0

https://www.yahoo.com/finance/news/fatal-flaw-new-obamacare-repeal-bill-180318871.html

http://news.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx?g_source=position4&g_medium=related&g_campaign=tiles

http://abcnews.go.com/Politics/public-prefers-obamacare-graham-cassidy-56-33-poll/story?id=50031499

http://www.kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-august-2017-the-politics-of-aca-repeal-and-replace-efforts/

https://www.usatoday.com/story/news/politics/2017/06/28/suffolk-poll-obamacare-trump-senate-health-care-plan/103249346/

https://www.forbes.com/sites/theapothecary/2014/10/01/landslide-in-referendum-swiss-voters-reject-single-payer-health-care-62-38/2/#473012922f2c

https://www.forbes.com/sites/brucejapsen/2017/09/20/blue-cross-plans-come-out-against-graham-cassidy-trumpcare-bill/#e77866c1c08e

http://www.denverpost.com/2017/09/19/hickenlooper-kasich-graham-cassidy/

https://www.vox.com/policy-and-politics/2017/9/21/16340066/health-group-statements-graham-cassidy-bill