Category: Health Policy

Sunday Cartoon Blogging – January 26, 2020

A few random thoughts on Sunday:

  • Where Wrongo comes from, “take her out” means go on a date, or…something else. It has nothing to do with job termination.
  • The impeachment seems to be helping Trump so far. According to a Washington Post-ABC News poll, Trump’s approval rating has climbed to match the highest of his presidency.
    • Axios reports that Trump’s net approval numbers improved in 31 states between September and December, according to Morning Consult data.
    • They improved by at least 5 points in Iowa, Utah, Maine, Montana and New Mexico.
    • An incumbent president with a growing economy and a low unemployment rate 6-12 months before the election can be tough to beat, even presidents who are bad at their jobs.
    • America twice elected Andrew Jackson. It elected Fillmore, Pierce, and Buchanan to consecutive terms. And we also did the same with Harding and Coolidge.
  • Are you following the Coronavirus outbreak in China? The number of confirmed cases in China stands at around 1,300. The virus has also been reported in Thailand, Vietnam, Singapore, Japan, South Korea, Taiwan, Nepal, Malaysia, France, the US and Australia. The death toll in China from the Coronavirus outbreak jumped on Saturday to 41.
    • We don’t know how deadly the virus is. These outbreaks can range from low-to-highly contagious, and from low-to-highly deadly. There isn’t enough data so far to know where to place this virus on either the contagion, or the deadly axis.
    • An amazing development is the rapid and powerful response by global public health agencies. Modern transportation allows diseases to spread globally. But modern communications and effective government agencies can react as fast.
    • This could radically change the severity of epidemics. Modern communication plus modern technology makes the global response far more effective than in the past.
    • This is a bit of evidence that, in some ways, countries are working together to build a better world.
    • From Fabius Maximus:

“Extreme libertarians tell us that governments can’t do anything right, and that we should “starve the beast.” Conservatives also hate the UN. Here we see an example of strong government agencies – national and international – providing a vital service.”

On to cartoons. On Saturday, the GOP began their defense of Trump:

Some say the Senate could be doing something else:

The GOP’s impeachment strategy moves on:

Trump and Mitch both want America to eat mystery meat:

Country before Party: such a quaint idea:

Some kids can’t wait for recess:

 

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More About The Virtue of Exciting Candidates

The Daily Escape:

Mt. Assiniboine, Provincial Park, BC, CN – 2019 photo by Talhanazeer. Assiniboine is the pyramid-shaped mountain on the left.

When Wrongo thinks about the Democratic primary candidates, he feels a bit like when he was a breeder of Havanese dogs: “Don’t get too attached to any one of them–we’re only keeping one.”

At the end of the day, we’ll only have one candidate. The question is which is the keeper?

Yesterday we asked: which candidate excited you? Judging by crowd sizes in Iowa, Sanders, Warren and Buttigieg have generated excitement, while Biden has not:

“Mr. Biden has a lot to prove here. I’ve attended some of his town halls and rallies, and they’ve been lackluster, his speeches dull and meandering, and his crowds comparatively small. I’ve been to memorial services that are more exciting. I certainly hope mine is.”

That quote is from Robert Leonard, the news director for the Iowa radio stations KNIA and KRLS. More from Leonard:

“Who is going to get an enthusiastic turnout caucus night? Bernie Sanders will. His support is strong. We’ll see if he can increase it….

Elizabeth Warren has fallen in the polls, but she will have a big turnout caucus night. Her on-the-ground organizing is terrific and her supporters unwavering…..

Pete Buttigieg will also have a big turnout. Watching his several-blocks-long parade of supporters file into the Liberty and Justice Dinner last fall in Des Moines gave me goose bumps…..”

Leonard finishes with this:

“On caucus night, given the soft support I see, if the weather is bad Mr. Biden’s supporters might not come out. It might also depend on what’s on TV….For the other candidates, if their supporters walked outside, slipped on the ice and broke a leg, they still would crawl through snow and ice to caucus.”

He’s alluding to the x-factor, the charisma, the excitement that a candidate creates in voters, and claims that in Iowa at least, Sanders, Warren, and Mayor Pete are showing some of that.

The first thing that most of us want is relief from the Trump assault. In the general election, that starts with telling people the damage assessment, and a plan of repair. The nominee has to say that our government and democracy are in tatters and need to be stitched back together. Constitutional checks and balances have been nearly destroyed by the Republicans.

Maybe we need Medicare for all, free college tuition, and the rest of the progressive agenda, but first, we need to triage our democracy.

To win the presidency, we need to take back Pennsylvania, Michigan and Wisconsin. Are the voters in those three critical swing states ready to sign on to rebuild our social safety net, reform health insurance, and raise taxes on the rich and corporations? Hell yes.

Trump’s 2020 plan is to pump up the Dow while keeping unemployment at historic lows. He’s done that with a $1.5 trillion tax cut without any plan to pay for it. He’ll tout his new “trade deal” with China. He’ll mock and belittle the Democrats and their nominee. Meanwhile, Trump has no health plan at all!

Mitch McConnell’s plan is to make sure Trump is acquitted at all costs, to continue packing the courts, and blocking any meaningful legislation coming out of the House.

What’s the Democratic Party’s 2020 plan? The proposals by the progressive Democratic candidates have merit. Their goals are the right ones for the country and the planet. But, those plans will take several administrations to fully implement. Few voters fully understand the details of how to pay for Medicare for all. Moreover, they absolutely are worried about having their private health insurance taken away. That’s what most Americans have, so that has to be a big concern for Democrats in 2020.

Which of the current flock of Democratic candidates have what it takes to unite and lead the Party to a 2020 victory? Which nominee will have coattails to swing the Senate, hold the House and add to the Party’s roster of statehouses?

The 2020 election will turn on whether individual voters see the Democratic Party’s nominee as a heroic savior of the country, or less of a leader than the execrable Trump.

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Which Democrat Nominee Excites You?

The Daily Escape:

Keyhole Arch, Pfeiffer Beach, Big Sur, CA – 2020 photo by jtmess. For a few weeks every winter, starting with the Winter Solstice, sunset lines up with the hole in Keyhole Arch.

Someone told Adlai Stevenson when he was running for president in 1952 (or ‘56): “Every thinking person in America will be voting for you.” Stevenson replied, “I’m afraid that won’t do—I need a majority.” (Via)

It’s time that Americans recognize that the most important global event in 2020 will be the US presidential election. The reason is blindingly obvious. It’s questionable if the world can be brought back from four more years of Donald Trump. That’s doubly true for the US. That means historic voter turn-out is required.

And if that’s the case, it’s important that the best person challenge Trump in November. Last night’s debate didn’t move us any closer to knowing who that should be. This, from Deborah Long is a useful take:

Three Democratic candidates for president walk into a bar.

The first one says, “I’m going to beat Donald Trump by re-starting the Bolshevik Revolution”.

The second one says, “I’m going to beat Donald Trump by breaking up the big banks and sticking it to the man.”

The third one says, “I’ll be in my trailer. Call me on the horn when they’re ready for my cameo in ‘The Way We Were’.

Her underlying point is that the current Democratic candidates show no unifying message. That partly explains why the top four are polling at close to the same numbers. Democrats need to answer the question: Who can deliver a knockout punch to Donald Trump, and repudiate what the Republican Party currently stands for?

Wrongo posted about Economic Dignity last spring. It’s from an article by Gene Sperling, Obama’s Director of the National Economic Council. His take is that the Fed and Congress should implement a full employment monetary and fiscal policy that enables tight labor markets.

Sperling says that implementing the idea of economic dignity would lead to higher wages, and give employers greater incentive to provide advanced training to their employees. And, high demand for labor would give more workers more of the “take this job and shove it” leverage that’s lacking today.

We’ll need more: America needs a return to what Paul Collier calls the “cornerstones of belonging”— family, workplace, and nation, all of which are threatened by today’s market-driven capitalism.

That’s a unifying message for Dems. Hidden behind that message is the idea that America has to return to the ethics of the New Deal. Joseph Stiglitz, Nobel laureate in economics, says: (parenthesis and emphasis by Wrongo)

“Over the past half-century, Chicago School economists, (including Milton Friedman) acting on the assumption that markets are generally competitive, narrowed the focus of competition policy solely to economic efficiency, rather than broader concerns about power and inequality. The irony is that this assumption became dominant in policymaking circles just when economists were beginning to reveal its flaws.”

Stiglitz says we’ll need new policies to better manage capitalism. That means:

  • Dealing with the inequities in health care
  • Paying workers more
  • Rebuilding public assets like roads
  • Passing higher taxes on corporate profits and the incomes of the wealthy

The unifying message is that Democrats will provide Americans with a legal and political framework that allows people to provide better opportunity for their families.

Better opportunity is something all of America wants to believe in.

So, if the Democrats want to win big enough to silence the GOP, the 2020 Democratic Party nominee for president must excite Americans by showing them a path to a better future for their families. Emphasis on the “excite”.

We’re not going to get there by marching with pitchforks. We’re not going to get there with Biden’s nostalgia. We’re going to get there by speaking directly to the needs of America’s families, workplaces and nation.

Not by continuing the tiresome, wonkish recitation of “my policy is slightly better than yours”.

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The Future: Will It Be Just More of The Past?

The Daily Escape:

Wrongo said he wouldn’t look back, but has reconsidered. It’s time to declare war on those who refuse to use facts or science. Think about what these true believers in either faith or ideology have brought us:

Will we continue on this road, or will we make a turn for the better? Will 2020 usher in a better decade than the one we just closed? Doubtful, unless each of us stand up and do what we can to make a difference.

Those who think Trumpism is so new and novel should remember that Norman Lear made a hit TV show about it in the early 1970s. Since then, many American white people have taken a dark turn: They would rather have Trump’s government enforce a whites only voting policy than put in the work required to make our system benefit everyone equally, while decreasing the cut taken by the corporate class.

Building this better society requires hard cognitive work. So far, Americans aren’t up to thinking about solutions beyond “Build that wall!”

Another example: 50% of white people are actively against government bureaucrats making their health care decisions. They insist that something that important should only be decided by employer HR departments and multinational insurance companies.

They’re perfectly fine casting their fates with insurance bureaucrats. Even if those corporate bureaucrats deny their care most of the time. Worse, they’re told by the media that they shouldn’t pay any more damn TAXES for health care when they could be paying twice as much in premiums to insurance corporations.

Remember the song In the year 2525? “If man is still alive…”

That’s 505 years from now. What do you think the odds are that we’re still here?

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Warren’s Mistake on Single Payer

The Daily Escape:

Mount Shasta, CA – November 2019 photo by pkeller001

Wrongo wonders if Elizabeth Warren has made a big mistake in her policy for Medicare for All. She started out running to reform capitalism, but through the debate process, she’s evolved towards single payer health insurance as a main policy. Months ago, she was an increasingly skilled campaigner whose laundry list of policy proposals made her stand out from the pack. Now she’s for nationalizing health insurance, which doesn’t seem to be on brand.

Two of her main rivals, Biden and Buttigieg, essentially want to extend Obamacare while leaving the 170 million Americans covered by private insurance with their current plans. While on her left, her other main opponent, Bernie Sanders, also wants to nationalize health insurance.

The latest New York Times/Siena College poll of Iowa Democrats shows Warren, Sanders, Buttigieg, and Biden bunched within a 5-point range. And while Warren leads, the poll found more sentiment among primary voters for improving the private health insurance system than for scrapping it in favor of single-payer.

Worse for Warren, she and Sanders are both sufficiently well-funded and popular that neither can easily emerge from Iowa or beyond as the candidate on the left. It’s similar on the moderate side: Neither Biden nor Buttigieg are going away after Iowa either.

Buttigieg is a gifted politician. He’s correctly discerned that the path to marginalizing Biden lies not in attacking him, but in confronting Warren on single payer, which he did in the last debate. He would rather that Sanders was the front-running lefty heading into Super Tuesday, than have to confront Warren.

A few more debates, and Mayor Pete may be the last standing moderate alternative to Warren and Sanders, assuming Bloomberg doesn’t get traction along the way.

Sanders is a much better candidate than he was in 2016. He’s making inroads among African-Americans and Hispanics. AOC, a very popular symbol of youth and progressivism, supports him. Sanders is doing well enough with young progressives to keep Warren from now moving closer to the center on single payer.

She went from cautious on single payer to all-in. First, she allowed that there were multiple paths to universal coverage. In an attempt to simplify during one of the debates, she said: “I’m with Bernie”, without having a firm plan.

When pressed by Biden and Buttigieg to specify how she would pay for her vague plan without raising taxes on the middle class, she dodged the question, saying that overall health insurance costs to the middle class would go down. She finally produced a white paper that described a 10-year $20.5 trillion plan to fund Medicare for All without raising taxes on the middle class.

Her opponents are using her proposal to define Warren to their own advantage: Biden and Buttigieg say it’s too radical and too expensive; Sanders says it’s inferior to his plan. While single-payer is popular among Democratic primary voters, several polls of swing state voters suggest that the majority favor a more moderate health insurance plan.

That would seem to be an invitation to embrace positions most Democrats actually prefer.

Warren’s problem is that she seems married to a health insurance program which leaks votes and positions her in a fight for the left of the primary electorate. However, we’re in a time when a coalition of minorities, suburban swing voters, and persuadable blue-collar whites are what’s needed to win states like Pennsylvania, Michigan, and Wisconsin.

Warren should return to her roots of tax and capitalism reform. These are popular policies with Democrats, even with those who are against mandatory single payer health insurance. The continuing rise in inequality requires us to do something to narrow it.

And Warren’s wealth tax could do just that, and finance more robust social programs and spending on infrastructure. The US mostly taxes individuals on the income earned from their jobs and investments, while a wealth tax would levy taxes on assets like stocks, yachts, artworks and vacation homes.

Both Sanders and Warren have an asset tax plan. In Warren’s plan, all net worth under $50 million is exempted, compared to $32 million for the Sanders plan. Business Insider says the Sanders plan would bring in $4 trillion in government tax dollars over a decade. And, Warren’s version would total $500 billion less in the same period.

During this primary season, moderates and progressives will have to understand clearly why they are Democrats, and how they will bridge their differences by November 2020 and deliver massive turnout.

Both wings need to remember that it isn’t enough to win the White House. Legislative gridlock must end.

It wouldn’t hurt if Warren did some thinking about her single payer plan, too.

 

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Sunday Cartoon Blogging – November 10, 2019

Bill Gates is the second-richest person in the world, with a net worth of $106.2 Billion. Here’s what Bill Gates said about Elizabeth Warren’s tax plan:

“I’m all for super-progressive tax systems….I’ve paid over $10 billion in taxes. I’ve paid more than anyone in taxes. If I had to pay $20 billion, it’s fine. But when you say I should pay $100 billion, then I’m starting to do a little math about what I have left over….You really want the incentive system to be there without threatening that.”

Here’s what would actually happen to Gates under Elizabeth Warren’s tax plan: (emphasis by Wrongo)

“The Warren campaign calculates that under Ms. Warren’s plan, Mr. Gates would owe $6.379 billion in taxes next year. Notably, that is less than Mr. Gates earned from his investments last year. Even under Ms. Warren’s plan, there’s a good chance Mr. Gates would get richer.”

Gates won’t have to pay as much as he thinks. The fundamental question is whether it’s ok for a billionaire to add 6% less to his massive fortune under Warren’s plan? Can billionaires still be successful executives if they don’t pocket every last penny they can lay their hands on?

Billionaire Michael Bloomberg doesn’t think the current Democratic presidential field is sufficiently deferential to the rich, so he’s running to make sure we get there.

When you think about it, two billionaires, Bloomberg and Steyer are running as Democrats. A third, Howard Schultz, billionaire behind Starbucks, tried to run as an independent. All wanting the job of billionaire Donald Trump.

Billionaire Mark Zuckerberg has said he would fight the Warren’s taxes on billionaires. Tim Perkins, a billionaire venture capitalist compared the “progressive war on the American one percent” to the Kristallnacht and anti-Semitism in Nazi Germany.

Billionaire Stephen Schwarzman, Chairman of Blackstone, compared a tax increase for people like him to Hitler’s invasion of Poland.

Why does anyone care about the tax concerns of these people? They never have to think about money, and neither will their heirs. It’s a familiar story, the astronomically rich are willing to donate large portions of their wealth, so long as interfering with their cozy power relationship with politicians is off the table.

On to cartoons. No plan goes unpunished:

America has a difference of opinion on health insurance:

Bill Barr waves his God flag:

GOP wants to take a few shots at the whistle blower:

Trump misunderstood which turkey could do him a favor:

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Wrongo’s Hot Take On The Debate

The Daily Escape:

Autumn at Lovers Leap, New Milford CT – 2017 photo by Mike Jacquemin

It’s kind of crazy that Bernie Sanders has a heart attack, and comes back looking stronger than ever. Sanders directly addressed the charged but pertinent question about his health. It was a nice touch by Sanders thanking everyone for their well wishes. It turned the tables on the negative connotation of the health question. Sure, Bernie had a heart attack, but he appeared to be on his game. He shouted less, he was coherent. It looked like all of his neurons were firing.

Not so for Joe Biden. He was better, but Wrongo thought he’s showing some cognitive deficits of aging. He misused words, having several lapses when the wrong word came out, like when he said “epedentially”, whatever that means. He occasionally lost the thread of his argument. And Sanders zinged him, saying the campaign was all about the future. Biden’s the only candidate who is older than Wrongo, and these slips suggest the normal effects of aging.

Warren spoke the longest, about 6.5 minutes longer than Biden. That seemed to be a byproduct of the many attacks she faced. She didn’t escape unscathed, but the sheer number of punches she took underscores the fact that she’s now viewed by her opponents as a frontrunner. With an opportunity to expand on policy details, Warren was explicitly pressed for the 4th straight debate on whether Medicare for All (M4A) would result in higher taxes for the middle class, and she didn’t answer it directly. She should answer that taxes will go up while total health care costs will be lower by enough to make up the lost tax expense. Sanders freely admitted that it will require taxes to go up on everybody, including the middle class. Here’s CNN’s chart on talk time:

It was fun to watch Beto, version 2.0 (that would be Mayor Pete Buttigieg) fight it out with the original Beto on the question of how to get semi-automatic weapons off the streets. Mayor Pete also came out swinging against Sanders and Warren regarding Medicare for All. Wrongo is kind of with Mayor Pete on Medicare for All, where he says it should be for all who want it, and that people who already have insurance can stay on their plans.

The sad part of this Democratic food fight on universal health care is that it’s achievable through the back door of a public option. America doesn’t have to eat the apple in a single bite. So many Democrats turn up their noses to anything less than total victory over the insurance companies. Medicare is a good example of how M4A could work. There is no doubt the government’s administration will expand to meet the need, but that may take a little time.

Several of the middle-tier candidates, like Buttigieg, Booker, Castro and Yang had some very good moments, but the field must be cut to five by November. Harris, who started out the year looking like the most formidable candidate, is floundering. Beto, Steyer, Tulsi, Klobachar, and the rest, should retire from the competition.

Warren looks like the class of the field to Wrongo, followed by Mayor Pete. Bernie showed that he still has zest for the fight, and is a worthy opponent. Biden alternated between longing for the old days and getting hot under the collar, pounding his fist on the lectern. Wrongo only heard “get off my lawn”.

But one thing’s for sure, no one on that Ohio stage looked to Wrongo like a sure winner against Trump.

Is it possible that someone who isn’t part of the field will emerge and scoop the nomination?

Maybe, but Hillary isn’t the answer for Democrats.

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Sunday Cartoon Blogging – October 13, 2019

Trump suffered another legal setback in the federal courts on Friday over his plan to declare refugees and poor immigrants as “public charges”. The plan was to justify refusing them public services like heath care, and use that as a basis for deporting them.

“Judge George B. Daniels, of the US District Court in Manhattan, ordered preliminary injunctions Friday afternoon in two related cases against the administration’s new “public charge” rule that could have denied legal permanent residency and other forms of legal status to many immigrants in the country who are deemed likely to use public assistance.”

Daniels wrote that he found cause to grant the motion because the plaintiffs had sufficiently demonstrated that they would suffer irreparable harm if the rule went into effect:

“Overnight, the Rule will expose individuals to economic insecurity, health instability, denial of their path to citizenship, and potential deportation….It is a rule that will punish individuals for their receipt of benefits provided by our government, and discourages them from lawfully receiving available assistance intended to aid them in becoming contributing members of our society…”

Separately, the fourth Homeland Security Director resigned on Saturday. The entire DHS needs to be rethought and reformed from the ground up. On to cartoons.

This was the DHS’s “public charge” argument:

How did Rudy fall so far?

Trump’s brain trust circles the wagons:

Both sides try using platitudes to help make decisions:

His strategery rarely works out:

Another of this week’s best decisions was facilitated by Erdogan:

 

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Saturday Soother – September 14, 2019

The Daily Escape:

Denali NP, Alaska – 2019 photo by Alaskaty

Wrongo and Ms. Right watched the Democratic debate on Thursday night. Winning a debate comes down to connecting with voters, seeing who is the most likeable, the most sincere, who had the best delivery. Oh, and a few good ideas.

Wrongo thought the winners were Warren and Booker. The losers were Harris and Castro, for totally different reasons. Harris’s tactic was to attack Trump, while avoiding direct answers to direct questions. She has not lived up to the promise she showed in the first debate. Castro attacked Biden successfully, but it becomes more and more difficult to see him as a top-tier candidate.

Klobachar and Yang didn’t hurt themselves, but gained no ground. Biden, Bernie, Buttigieg and Beto had moments, but didn’t truly differentiate themselves from the pack. Bernie’s voice failed him, and his hoarseness gave him a difficult time connecting. As the debate wore on, he became a caricature of himself.

Biden got off to a strong start, but around the 2-hour mark, he became barely intelligible. His biggest applause line of the night was when he praised O’Rourke’s response to the El Paso shooting. He shouldn’t think that big applause for Beto was a good sign for Biden. Beto had a good night, mostly because he just said out loud about AR-15s what a whole lot of people believe on this issue.

There is a major problem with allowing TV network news types to conduct these debates. And who needed to hear a third hour where the media tried to dissect the health insurance policy differences between the ten Democrats?  Generally, their positions fall into either expanding Obamacare, or moving quickly to implementing Medicare for All.

Yes, some policy positions are different and consequential, but why did George Stephanopoulos try to gotcha Bernie and Warren about whether taxes would go up if MFA was initiated? Everyone knows that taxes would go up, while annual family health insurance costs would go away.

Amanda Marcotte, on twitter:

Maybe it’s simple: These Spinnerati work for the media, and the media is part of corporate America. Their charge is to bend things so that the choice you’re presented with isn’t a choice at all.

And, in three hours, the moderators asked no questions about the economy. They didn’t manage talk time well; Sanders was shorted. Here’s a breakdown of the candidates’ shares of talk time:

Looking ahead, Wrongo thinks the class of this field is Elizabeth Warren, and here’s why: Harvard professor Marshall Ganz teaches what he calls “the art of public narrative”. According to Ganz, successful and persuasive public narrative is the ability to tell, and to link together, “the story of self, the story of us, and the story of now”.

That seems to be a major part of Warren’s success to date. She’s done a good job creating a public narrative that connects with Democratic primary voters. She has leaned into her Oklahoma “ragged edge of the middle class” childhood, and her struggles as a young adult. She weaves that into a story of who we are as Americans, and she talks about the challenges we face today and how she (and we) can address them.

Her closest current challengers (Bernie and Biden) have noticeably weaker public narratives: Sanders is reticent about his own story, and how it made him the man that he is. He hits his policies, and vaguely links his policies to us and now. Biden has a great “story of self”, but his “story of now” is out of sync with today’s Democrats. He seems particularly bad on the story of now, and that is likely to torpedo his presidential chances.

We’ll see. The candidates have until next spring to hone their “public narratives”.

Let’s forget debates, John Bolton’s mustache, and Trump’s gutting of clean water regulations so that we can focus on starting our Saturday with a Soother. Start by brewing up a yuuge mug of Kayon Mountain Ethiopian ($21/12oz.) coffee from Lexington Coffee, an award-winning artisan roasting company based in Virginia. The roaster says it is richly sweet with a crisp, syrupy mouthfeel.

Sit back with your hot brew, and think about how fall is coming, and how you have no plans to prepare for it. Now watch Yo Yo Ma and James Taylor have fun while performing in August at Tanglewood Music Festival:

Those who read the Wrongologist in email can view the video here.

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Last Night’s Debate and Medicare For All

The Daily Escape:

Dix Pond from the Dix Mountain trail, Adirondacks, NY – July 2019 photo by Shelley VK

A few thoughts about last night’s Democratic debate. Tom Sullivan captured Wrongo’s thinking:

“Watching Part One of the second Democratic debate was an endurance contest. CNN’s 30-second response format was a disaster, barely giving candidates time to formulate a sentence before being cut off. Questions from CNN moderators seemed designed not to probe policy issues, but to get candidates to snipe at each other.”

And snipe they did. The fringe and vanity candidates tried very hard to tell us which policies wouldn’t work. They were enabled by CNN’s question-askers, who mostly asked gotcha questions designed to provide sound bites for Republican attack ads down the road.

Elizabeth Warren won the night by responding to a poor-mouthed critique from Republican-lite John Delaney about health care:

“I genuinely do not understand why anyone would go to all the trouble of running for president just to get up on this stage and talk about what’s not possible. #DemDebate pic.twitter.com/cOCz5TS3AF”

— Elizabeth Warren (@ewarren) July 31, 2019

But, let’s take a moment to talk about the topic that took about most of the first hour of the debate: Medicare for All (M4A). Wrongo wants to remind everyone about an Upshot article on Monday in the NYT by Austin Frakt and Elsa Pearson. It asks, “What Would Medicare for All Cover?” From the article:

You can divide current Medicare coverage into two layers.

The first is relatively transparent. Traditional Medicare does not cover certain classes of care, including eyeglasses, hearing aids, dental or long-term care. When the classes of things it covers changes, or is under debate, there’s a big, bruising fight with a lot of public comment. The most recent battle added prescription drug coverage through legislation that passed in 2003.

So the authors say that a Medicare for all program that excluded all private insurance coverage, and that resembled today’s traditional Medicare would leave Americans with significant coverage gaps. And therefore, we should have a debate about what M4A would cover.

The writers go on:

…there is a second layer of coverage that receives less attention. Which specific treatments does Medicare pay for within its classes of coverage? For instance, Medicare covers hospital and doctor visits associated with cancer care — but which specific cancer treatments?

The devil is always in the details.

Although Medicare is a national program, most coverage determinations are local. Private contractors that are authorized to process Medicare claims decide what treatments to reimburse in each of 16 regions of the country:

What people are covered for in, say, Miami can be different from what people are covered for in Seattle. Many treatments and services are covered automatically because they already have standard billing codes that Medicare recognizes and accepts. For treatments lacking such codes, Medicare makes coverage determinations in one of two ways: nationally or locally…..There are more than 2,000 local coverage determinations….National coverage decisions, which apply to the entire country, are rarer, with only about 300 on the books.

Wrongo wasn’t aware of these differences in coverage, and that is something to talk about if/when M4A is seriously discussed in Congress.

It seems that what should be covered by any health insurance program is an evolving target, informed by changes in treatments and their reported efficacy.  The issue isn’t unique to Medicare. Wrongo prefers the decision to include or exclude a treatment not be made by an insurance company that can make more profit based on what forms of healthcare are offered.

For example, in many private plans, cataract surgery isn’t covered, while Medicare does provide coverage for a basic lens replacement.

And we shouldn’t allow the perfect to be the enemy of the good. In this country, tens of millions of people have no coverage, and tens of millions more are either under-insured, or face very high deductible plans. By contrast, throughout all other developed countries, every person is covered for all medical needs.

A few things to think about between here and the 2020 election.

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