Medicare For All – The Wrongologist

Saturday Soother – December 23, 2023

The Daily Escape:

Santa Christmas gondola regatta in Venice – December 2023 photo by Manuel Silvestri

Happy Saturday! Wrongo loves it when the days begin to get longer, if only by a fraction. It’s a hopeful sign of the return to more daylight and eventually, spring and summer. This may (or may not) be the last column until the New Year. If it is, Wrongo wants to end with some positive notes.

First, The Economist is out with its annual “Country of the Year” award. This year, it highlights the move back to moderation from conservative governments in three countries.

First, Brazil which swore in a center-left president, Luiz Inácio Lula da Silva, after four years of mendacious populism under Jair Bolsonaro:

“…who spread divisive conspiracy theories, coddled trigger-happy cops, supported rainforest-torching farmers, refused to accept electoral defeat and encouraged his devotees to attempt an insurrection.”

The new administration quickly restored normality—and reduced the pace of deforestation in the Amazon by nearly 50%. But since Lula likes Putin, Brazil didn’t get the award.

Second, Poland had a remarkable 2023: its economy withstood the shock of the war next door; it continued to host nearly 1 million Ukrainian refugees. It raised its defense spending to above 3% of GDP. The country’s biggest problem has been the dominance of the populist-nationalist Law and Justice (PiS) party, which has run the government for the past eight years, eroding the independence of the courts, stuffing state media with lackeys and nurturing crony capitalism:

“In October voters dumped PiS in favor of an array of opposition parties. It is early days for a new coalition government, led by Donald Tusk, a veteran centrist, but if it does a good job of mending the damage PiS did to democratic institutions, Poland will be a strong candidate for our prize next year.”

Tusk is a former president of the European Council.

But Greece won the prize. We all remember a few years ago when Greece was the economic basket case of Europe. Incomes had plunged, the social contract was fraying and extremist parties on the left and right were popular. The government turned to China and sold its main port, Piraeus, to a Chinese firm:

“But after years of painful restructuring, Greece topped our annual ranking of rich-world economies in 2023. Its center-right government was re-elected in June. Its foreign policy is pro-America, pro-EU and wary of Russia. Greece shows that from the verge of collapse it is possible to enact tough, sensible economic reforms, rebuild the social contract, exhibit restrained patriotism—and still win elections.”

The Economist closes with the thought that nearly half the world is due to vote in new governments in 2024, so democracy isn’t just on the line in America. It’s on the line everywhere.

Second, a piece of good domestic news. Charles Gaba at ACA Signups reports that, according to the Centers for Medicare & Medicaid Services (CMS):

“In 2022, the insured share of the population reached 92% (a historic high). Private health insurance enrollment increased by 2.9 million individuals and Medicaid enrollment increased by 6.1 million individuals.”

Another stunner from CMS: US healthcare spending as a percentage of the GDP was lower last year than it was 6 years earlier. More detail:

“With a lower rate of health care spending growth of 4.1% in 2022, the share of GDP devoted to health care fell to 17.3% in 2022, lower than both the 18.2% share in 2021 and the highest share in the history of the National Health Expenditure Accounts of 19.5% in 2020. During 2016-19 the average share was 17.5%.”

That’s all good news. Around the global headquarters of the Wrongologist, we’re starting to look toward next year. And even if it seems the news can’t get worse, it probably will. Think about Trump on trial, epic Supreme Court decisions, ongoing foreign policy crises and the most important election of at least Wrongo’s life.

2024 will be a long year that’s going to require emotional and intellectual strength to avoid despair when the media continues covering this election as they have been. It will be a lot to handle.

Here’s Wrongo’s wish that you find some comfort and joy over the next week. And please keep showing up around here in the New Year. Wrongo promises to keep trying to give you perspectives that hopefully make some sense of the world.

On to another out of the ordinary Christmas tune. Watch and listen to the Canadian singer-songwriter Loreena McKennitt perform the “Huron Carol”, written in 1642 by a Jesuit missionary, Jean de Brébeuf who lived among the Huron people. It is Canada’s oldest Christmas song. Brébeuf wrote the lyrics in the native language of the Huron/Wendat people. In December 2021, McKennitt sang it together with an ensemble. It’s superb and haunting:

How Can America Handle The Costs Of Elder Care?

The Daily Escape:

The start of US Highway 6, outside of Bishop, CA – September 2023 photo by Steve Wolfe

(There will be no Saturday Soother this week. Wrongo is on the road.)

Millions of older Americans from the Silent Generation and the Baby Boomers are facing a dilemma as they “age in place.” They must figure out how to pay for increasingly complex medical care. The NYT quotes Richard W. Johnson, director of the program on retirement policy at the Urban Institute:

“People are exposed to the possibility of depleting almost all their wealth….”

The prospect of dying broke is an imminent threat for the Boomers. About 10,000 of them turn 65 every day between now and 2030. They’re expecting to live into their 80s and 90s at the same time as the price tag for long-term care (LTC) is exploding. Currently LTC expense is outpacing inflation and approaching a half-trillion dollars a year, according to federal researchers.

By 2050, the population of Americans 65 and older is projected to increase by more than 50% to 86 million. The number of people 85 or older will nearly triple to 19 million. The Times has a chart of how many of those who need long-term care will die broke:

Some older Americans have prepared for this possible future by purchasing LTC insurance back when it was still affordable. Since then they’ve paid the monthly premiums, even as those premiums continued to rise. But this isn’t the norm. Many adults have no plan at all or assume that Medicare, which kicks in at age 65, will cover their health costs. But Medicare doesn’t cover the kind of long-term daily care, whether in the home or in a full-time nursing facility, that millions of elderly Americans require.

For that, you either pay out-of-pocket or you spend down your assets until you have less than $2,000 in assets in order to qualify for Medicaid. Remember that Medicaid provides health care, including home health care, to more than 80 million low-income Americans.

And even if you qualify, the waiting list for home care assistance for those on Medicaid tops 800,000 people and has an average wait time of more than three years.

Here is a snapshot of how long-term care is paid for in the US:

Governments provide 71.4% of the total. The largest non-government source is people who pay out-of-pocket, and private insurance is becoming increasingly expensive. More from the NYT:

“The boomer generation is jogging and cycling into retirement, equipped with hip and knee replacements that have slowed their aging. And they are loath to enter the institutional setting of a nursing home. But they face major expenses for the in-between years: falling along a spectrum between good health and needing round-the-clock care in a nursing home.”

That has led them to enter assisted-living centers run by for-profit companies and private equity funds. The NYT says that about 850,000 people aged 65 or older now live in these facilities and when in them, they are largely ineligible for federal funds. Some facilities provide only basics like help getting dressed and taking medication while others offer luxury amenities like day trips, gourmet meals, and spas.

In either case, the bills can be staggering. More:

“Half of the nation’s assisted-living facilities cost at least $54,000 a year, according to Genworth, a long-term care insurer. That rises substantially in many metropolitan areas with lofty real estate prices. Specialized settings, like locked memory care units for those with dementia, can cost twice as much.”

Home care is costly, too. According to Genworth, agencies charge about $27 an hour for a home health aide. Hiring someone who spends six or seven hours a day cleaning and helping an older person get out of bed or take medications can add up to $60,000 a year.

It’s worse for people with dementia because they need more services. The number who are developing dementia has soared, as have their needs. Five million to seven million Americans over age 65 have dementia, and that’s expected to grow to nearly 12 million by 2040.

The financial threat posed by dementia also weighs heavily on adult children who in many cases become guardians of aged parents. The Times included this chart:

The reality is that families go broke either caring for, or finding care for their loved ones. The alternative: Women in the family give up their lives and jobs to care for their family members instead, which worsens the gender wage gap.

The NYT article makes it clear that older Americans receive far less government support than their peers in other countries. The “why” question is easily answered: It’s a combination of the concerted effort for any public support to be demonized as “welfare”. It’s also partly the result of our failed experiment with long term care insurance. The politicians’ idea was that “the market” would take care of it, so government help for retirees could be limited to Medicaid-paid nursing homes.

But, the LTC insurance industry has largely imploded. Insurers had little experience with the product and grossly overestimated the lapse rates. If a policyholder stops paying, the insurer gets to keep the money and use it to provide services to everyone remaining in the pool. The surprise was that very few people stopped paying. A second miscalculation was that people who held these policies were living longer than forecasted. Longer life equaled higher and larger payouts (insurers also benefit when customers die before they’ve used up all the policy benefits).

A final factor is the rising levels of dementia described above.

And since demand for support outside of family members exceeds the supply of beds, nursing homes and assisted living facilities that aren’t terrible want residents to join during the independent living phase (which requires very little care, so those fees subsidize intensive nursing home care). Many of these facilities require a $400,000-$500,000 buy-in, which may not be refundable at death, even if the resident is current on their monthly fees.

There’s got to be a better way. Medicaid can’t be the only option to pay for LTC. Congress needs to establish a better system for middle-class Americans to finance LTC.

How we handle the growing costs of long-term care is just another reminder that we get LITTLE for our tax dollars beyond a giant military. Americans are responsible for their own medical care, childcare, college tuition, retirement and nursing home care. Some or all of which are provided in other rich countries.

This is a loudly ticking time bomb, and the demographics of the problem won’t change for decades. And yet, the Republicans seem bent on making it worse. They’re actively trying to bring about their dream of privatizing Social Security and Medicare.

Wake up America! We have real problems to solve.

Biden’s Plan To Cut Drug Prices

The Daily Escape:

Mars on left, Earth on right – image by alofeed

The Biden administration released its list of 10 prescription medicines that will be subject to the first-ever price negotiations by Medicare. This is a big deal because Medicare covers 66 million older Americans, people who routinely take very expensive drugs.

Until recently it was illegal for Medicare to negotiate prices with drug companies. But the Inflation Reduction Act (IRA), passed last August, gives Medicare that power. It also forces companies to pay a rebate to Medicare if their drug prices rise faster than inflation. The Congressional Budget Office estimates that price-capping measures will reduce Medicare expenses (and the federal deficit) by $96 billion by 2031.

The list includes drugs for diabetes, arthritis, and Crohn’s disease, and could sharply lower medical costs for patients. Reuters says that the US Centers for Medicare & Medicaid Services (CMS) spent $50.5 billion between June 1, 2022 and May 31, 2023 on these 10 drugs. That was about 20% of the total cost of drugs in the Medicare prescription drug program known as Part D.

The WaPo had an opinion piece by David Goldhill, CEO of SesameCare.com, a digital marketplace for discounted health services: (brackets and emphasis by Wrongo)

“The pharmaceutical industry earns almost 50% of its worldwide revenue here [the US], as do medical information-technology firms. [Medical] Device makers earn 40% of their money in the US. And this understates things, because US revenue is generated from higher prices, so margins are greater. If the US accounts for half of a company’s revenue, it probably contributes at least 75% of its profits.”

This has always been the business plan for Big Pharma: Make your money in the US and take whatever scraps of profit you can get in other markets.

That market subsidy is paid by American taxpayers generally (through the funding of Medicare) and by US pill-takers specifically when they pay higher co-pay prices for the drugs that help with their chronic conditions. The Economist points out that prescription medicines in America cost two to three times more on average than in other wealthy countries:

The blue dots are the price paid in the US for brand name drugs. The grey dots are prices paid in the various countries for all US drugs sold in those countries. The comparison of brand name to generics shows how much greater the cost is to an American. It also follows that US patients’ out-of-pocket expenses, (the slice of drug costs not covered by insurance), are among the highest in the world.

It’s understandable why Biden’s move to start negotiations on some of the most expensive drugs has been fiercely opposed by the pharmaceutical industry. Essentially, high US drugs costs underwrite what amounts to a subsidy for buyers of the same drug sold when it’s outside the US.

Many of the Big Pharma have jumped on the legal bandwagon, challenging price-setting provisions in the IRA. More from the Economist:

“Since the law’s passage over 50 companies have blamed the IRA in earnings calls for clouding their prospects.”

A quick primer on drugs. Most medicines are either small-molecule drugs or large-molecule drugs. The former are the kind of pills that line our medicine cabinets. Large-molecule drugs, (also called biologics), are more complex and must be injected. The IRA grants biologics 13 years of pricing freedom after a drug is approved, while small-molecule drugs get only nine years post-approval before they must face Medicare’s bean counters. The industry estimates that small-molecule brands could lose between 25% and 40% in overall revenue due to the earlier cap on prices.

PhRMA, the pharma Industry’s lobbyist argues (and Republicans back them) that high US prices reflect the high cost of drug development. The pharmaceutical manufacturers are, of course, suing to stop the price negotiations. They say that allowing the government to negotiate lower bulk prices for drugs will stifle innovation, and will cut funds for research.

One thing that Big Pharma wants to avoid showing us is that they rely on smaller, more agile biotech firms for ideas. Between 2015 and 2021, 65% of the 138 new drugs launched by Big Pharma originated mostly from smaller firms. So, while innovation isn’t totally gone from the big firms, what they’re mostly doing is marketing the intellectual property of small pharmaceutical firms.

It didn’t take long for Republicans to jump on the decision to allow Medicare to negotiate drug prices. From Politico:

“Piggybacking on the pharmaceutical industry’s strategy, Republicans are working to persuade Americans that the Biden plan will stifle innovation and lead to price controls.”

Politico quotes Joel White, a Republican health care strategist:

“The price control is a huge departure from where we have been as a country….It gets politicians and bureaucrats right into your medicine cabinet.”

Politico says that the GOP effort to reframe the drug price debate may hurt them, since they plan largely to run on inflation, while the Biden plan will lower drug prices. Also they quote a new poll from the Kaiser Family Foundation (KFF) that shows 58% of independent voters trust Democrats to lower drug costs compared with 39% of Republicans.

Our politicians and pundits have bleated at us for years about being an “exceptional nation” – but what we really are is exceptionally gullible. As long as the large healthcare and pharmaceutical companies insist on standing between American consumers and their health needs, maximizing their profit will always come first.

We also continue to elect leaders who lobby for keeping corporations unleashed so that they can make as much profit as possible, while saying that the “market” will decide where the public good is prioritized. This keeps us hopelessly mired in a grossly expensive, and often ineffective healthcare system.

We continue to let ourselves be convinced by corporations and our politicians that reforming healthcare is impossible. That the solutions and methodologies used by other developed nations are substandard, and/or somehow immoral.

The Hill reported that the 14 leading US drug companies paid out more in stock buybacks and dividends from 2016 to 2020 than they spent on research and development. Those firms spent $577 billion from 2016 to 2020 on stock buybacks and dividends, $56 billion more than the $521 billion they spent on R&D. So, it’s oblivious how Big Pharma could easily fund their R&D with lower drugs prices.

It is also useful to remember that America has more healthcare billionaires AND healthcare bankruptcies than any other country. Those two things are inextricably linked.

As long as the pharmaceutical companies can maximize profits by buying politicians rather than by charging higher prices in other countries – the American people are the ones who will continue to get screwed.

Monday Wake Up Call – January 31, 2022

The Daily Escape:

Mount Saint Nicholas, Glacier NP, MT – January 2022 photo by Jack Bell Photography

Anyone else thinking that our national party bus is about to stall out in the slow lane on America’s Boulevard of Broken Dreams?

Here’s an under-the-radar story: In 2020, the Trump administration hatched a plan to gradually transition traditional Medicare over to private firms. It’s called Direct Contracting (DC) and is operated by Direct Contracting Entities (DCEs). Currently, there are 53 of them in Phase One of an experimental program operated by the Centers for Medicare and Medicaid Services (CMS).

Under the program, the DCEs receive a fixed amount of money annually to cover care for each traditional Medicare enrollee whose primary care doctor (or group) has signed up with that DCE. The DCEs must pay for all of the care of those people assigned to them. To date, the CMS has auto-assigned hundreds of thousands of people to DCEs.

Since no one on Medicare has voluntarily signed up to work with a DCE, it’s unlikely they know of, nor understand what’s happening. And the CMS doesn’t require DCEs to tell people that they have the right to opt-out.

The idea behind DCEs is to shift a portion of the financial risk of the elderly’s medical care away from traditional Medicare by capping the payments to a third party that’s responsible to pay for it. This is the latest in many efforts by CMS and Congress to control the rising costs of healthcare.

Wrongo and Ms. Right have recently noticed a blizzard of direct mail offers to convert our traditional Medicare to an all-in insurance program. It’s probable that some of these are from DCEs.

The anticipated advantage of the DCE experiment is that Medicare’s out-of-pocket costs will be capped. The DCEs contract with CMS is for an agreed-upon annual payment. They have to pay for care and also make a profit based on that fixed revenue amount from the government. In addition to the normal profits from providing services, DCEs can keep as much as 40% of the money they don’t spend on care.

But there’s no such thing as a free lunch, and it seems to Wrongo that this creates yet another financial incentive to deny otherwise necessary treatments. It’s possible that the DCEs could pay doctors to steer patients away from specialty care. This means that someone enrolled in a DCE has reason to worry that their primary care doctor might limit their access to more costly care.

Direct contracting is supposed to be a pilot program, yet Medicare has no plans to limit the number of people it enrolls in these new plans. Instead, Medicare has announced plans to enroll 100% of traditional Medicare members into DCE-like programs by 2030.

Congress did not authorize the wholesale overhaul of traditional Medicare, so why is this happening? And so far, the Biden administration appears to be willing to continue playing Trump’s cards.

Many of the DCEs are owned by Private Equity (PE) firms. It doesn’t take a chess master to see that the PE firms will ultimately sell out to the insurance industry. And it wouldn’t be a big leap from that to fully privatize Medicare.

Time to wake up America! Did we elect Biden to privatize Medicare? The word “privatize” should scare the hell out of Americans. But unfortunately they’ve been fooled into believing that by some magic miracle of economics, it’s to their benefit.

To help you wake up, today we spend a few minutes with Neil Young. Wrongo appreciates Neil Young saying he wanted his music removed from Spotify if Joe Rogan is allowed to continue spewing his anti-Vaxx trash there.

This was an easy business decision for Spotify. They picked the popular podcaster Rogan with the $100 million-plus exclusive deal, over the cranky 76-year-old rocker whose last gold album was nearly two decades ago. Someone who hasn’t been on the Billboard charts since 1982.

Joni Mitchell and Dave Grohl have now said they will follow Young in leaving Spotify.

Let’s watch and listen to Neil Young playing “Hey Hey, My My” at Farm Aid in Champaign, Illinois on September, 1985. Young is a co-founder and board member of Farm Aid, along with Willie Nelson and John Mellencamp:

Neil won’t burn out or fade away.

Sample Lyric:
Out of the blue
and into the black
You pay for this,
but they give you that
And once you’re gone,
you can’t come back
When you’re out of the blue
and into the black.

“You pay for this, and they give you that”. Listen up Medicare!

Americans Die Earlier Than Europeans

The Daily Escape:

The Barber Pole, Vermillion Cliffs National Monument, AZ – May 2021 photo by Dave Coppedge

Derek Thompson in The Atlantic says that America has a death problem:

“According to a new working paper released by the National Bureau of Economic Research, Americans now die earlier than their European counterparts, no matter what age you’re looking at.”

Covid deaths are excluded from the study.

Before the 1990s, average life expectancy in the US was not much different than it was in Germany, the United Kingdom, or France. But since the 1990s, American life spans leveled off, and then fell behind those in similarly wealthy European countries.

We started hearing about America’s declining longevity when Anne Case’s and Angus Deaton’s 2015 study showed that White mortality in the US was rising. They called the new trend “deaths of despair”, caused by increased deaths by suicide, drug overdose and liver disease associated with alcohol.

Now, the bad trend has spread to all Americans:

“Compared with Europeans, American babies are more likely to die before they turn 5, American teens are more likely to die before they turn 20, and American adults are more likely to die before they turn 65. At every age, living in the United States carries a higher risk of mortality.”

The study collected data on American life spans by ethnicity and by income at the county level, and compared the data to those of European countries, locality by locality, allowing for direct comparisons. It explodes the myth about America having the best medical outcomes.

Sunday Cartoon Blogging – March 7, 2021

With the Senate’s passage of the Covid relief bill along Party lines, Wrongo is certain that given the chance, the GOP will do to Biden precisely what they did to Obama: Obstruct nearly everything in the hope that it will help them return to control of House and/or the Senate in 2022.

There may be agreement on an infrastructure bill, but if the filibuster remains in place, that will be the only other thing that Democrats achieve before the 2022 midterms.

It’s important to remember that a family of four that makes $13.25/hour is living at the poverty level if they are working a 40-hour week. Few of those workers receive retirement, health benefits, or paid vacations.

Yet America is willing to provide many school-age children in this socio-economic segment three meals a day, often when school isn’t in session. It’s analogous to America failing to provide health care to the neediest, while letting the most critically ill into a local emergency room. The case for increasing the minimum wage is overwhelming.

Rome is burning. We should be willing to overpay for more fire extinguishers. That means end the filibuster. On to cartoons.

Opinions differ based on viewpoints:

Elephant plans to update Seuss:

People are starting to think we might get back to normal:

But not in Texas:

Two presidents compared:

Cuomo looks to the future:

Saturday Soother – June 27, 2020

The Daily Escape:

Mt. Rainer from the Whiteriver campground – 2020 photo by np2fast

Good morning fellow disease vectors!

Now that Florida and Texas have again closed their bars, you’re probably wondering: “Can Joe Biden’s lead in the polls get any bigger”?

Here’s your answer. On Thursday, the Trump administration asked the Supreme Court to invalidate the Affordable Care Act. They did this without any plan for replacing it, at what appears to be the height of new cases of the COVID pandemic. From Charlie Pierce:

“Imagine, for a moment, you’re a Republican. You already know that your party has hitched its wagon to the biggest ass in the history of American politics, and that he has proceeded to bungle a response to the worst public health crisis in a century, touching off a deep recession in the bargain….Perhaps you’re thinking to yourself this morning, y’know, maybe this isn’t the best historical moment to take healthcare away from tens of millions of Americans.”

Political gurus say that timing is everything.

Trump is doing this despite the fact that 487,000 new people signed up with HealthCare.gov last month after losing their company-provided health insurance coverage because of the pandemic-induced recession. That was an increase of 46% in sign-ups compared to the same month last year.

And Trump’s trying this stunt in the week when the US hit a new record for the highest daily total of reported COVID-19 cases – more than 45,500! He’s picked the perfect time to try again to throw an estimated 20 million Americans off of their insurance coverage.

This has been the GOP plan all along: we’re trimming the rolls of people on entitlement programs. We’re doing it through the courts, through legislation and by allowing the COVID-19 infection to spread.

It’s no longer clear which is the greater threat to lives in America: The Coronavirus, or Donald Trump.

This should remind all of us that we need to make Medicare for All, or another form of single payer insurance, a top priority after the November election.

Biden said it all in a speech this week: (brackets by Wrongo)

“Amazingly, he [Trump] still hasn’t grasped the most basic fact of this [COVID] crisis: to fix the economy we have to get control over the virus. He’s like a child who can’t believe this has happened to him. All his whining & self-pity…his job is to do something about it.”

We desperately need new leadership. Maybe we’ll get it next January.

Now it’s time to forget the Sahara Dust storm for a few minutes. You should also ignore the fact that the Dixie Chicks changed their name to “The Chicks”. How exactly does THAT rebranding improve our world, or their career?

Time to take our masks off, sit at an appropriate physical distance, and kick back: It’s time for our Saturday Soother.

Let’s start by brewing up a huge mug of Ethiopia Nano Genji Agaro Gera coffee ($21.00/12oz.) from Sacramento CA’s Temple Coffee roasters. The roaster says you will experience notes of nectarine and apricot with your first sip.

Now find a comfortable lawn chair, and settle in to listen to “Summertime”, written by George and Ira Gershwin, and Dubose Edwin Heyward, in 1935. It’s performed here by George Winston from his album “Restless Wind”:

It was also memorably performed by the late, great Sam Cooke in 1957, released as the B-side on the single of Cooke’s big hit, “You Send Me”.

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

Biden Isn’t FDR, But FDR’s 1932 Strategy Could Work

The Daily Escape:

Sunset, Poudre River trail, Fort Collins, CO – May 2020 photo by Dariusva07. Looks like a painting.

Livia Gershon has an article in JSTOR Daily, “One Parallel for the Coronavirus Crisis? The Great Depression”. She focuses on the question of whether America is already in a depression, or if are we sitting in the equivalent of 1928 or 1929? From Gershon:

“Today’s soaring unemployment, small business failures, and uncertainty about the future are like nothing most of us have seen in our lifetimes. If there’s any useful historical parallel, it might be the Great Depression.”

The cliff that our economy just dove off is different from what America experienced in the Great Depression. From 1920 through 1933, America had Prohibition. The 1920’s were a time of unbridled capitalism, and many working class Americans were hurting financially.

In 2020, COVID-19 has hit us fast and hard. Today’s economic crisis is the result of deliberate choices by governments and individuals to restrict commercial activity. However, the results look about the same: Businesses shuttered, families worried about where their next rent payment is coming from, long lines at food banks. And the 100,000+ deaths.

In 1929, life in America was already awful for a lot of people: Businesses had few regulations to constrain their activities. The rich got much richer. Pro-worker policies had little political traction. That all changed after the Depression. By the 1940s, the country’s unions were stronger than they’d ever been and Congress had passed unprecedented economic policies to support workers.

It didn’t happen quickly or easily. FDR beat Hoover in a landslide in 1932. Hoover had won over 58% of the popular vote in the 1928 presidential election, but in 1932, his share of the popular vote declined to about 40%. Democrats kept control of the House, and gained control of the Senate, bringing 12 years of Republican Congressional leadership to an end.

Erik Loomis, a labor historian at the University of Rhode Island and blogger at Lawyers, Guns & Money, offered Gershon historical perspective:

“A lot of Roosevelt’s campaign in ’32 is ‘I’m not Herbert Hoover’….It’s not policy-driven, not about organizing the masses…..In fact, if FDR had been a left-wing figure, he couldn’t possibly have won the nomination of the 1932 Democratic Party, which, like the Republican Party, was deeply beholden to big corporations.”

And today we see Biden, with his man cave presidential campaign, running as “I’m not Trump”. And while he’s not policy-free, his Democratic party is still beholden to big business, much like FDR’s.

Many Democrats worry about Biden’s ability to stand up to Trump on the campaign trail. FDR, despite his polio disability, deliberately chose to present himself vigorously, including breaking precedent by flying to Chicago during the 1932 convention. His campaign song, “Happy Days Are Here Again” remains one of the most popular in American political history.

Biden may also need to consider breaking a few precedents, possibly by running a throwback front porch type of campaign, one that ignores Donald Trump. James A. Garfield, Benjamin Harrison, and William McKinley all ran successful front porch campaigns.

Returning to FDR’s efforts to turn the country around, Gershon says:

“…the major New Deal programs—including public hiring through the Works Progress Administration, Social Security’s old age and unemployment insurance, the NLRA, and progressive taxes—largely followed ideas that had been brewing on the liberal side of mainstream political conversations for decades. To many policymakers, relief for workers was a way of supporting capitalism. It powered the economy by encouraging consumer spending.”

She further quotes Loomis:

“When those measures are passed in the ‘30s, the left considers them all sell-out measures…FDR is heavily criticized on the left.”

In the 1930s, as today, the left wanted more radical pro-worker, and pro-family policies that were a bridge too far for FDR. Today is similar to the 1930’s. As much as Democrats want to run on policy, the candidate (and who the opponent is) are at least as important as policy.

Biden can run on a message of “I’m not Trump. He’s failing. And I won’t fail“. He and the Party can mostly save the details for after the election. For example: Running on some variant of Medicare for all (M4A) isn’t necessary. All Biden must drive home is that COVID-19 has proven that the current private insurance-powered healthcare system has failed us, and that we need reform.

Then impress on voters that the GOP vehemently supports the failed current health insurance model.

Once elected, Biden could push for M4A, assuming he has the Senate.

2020 isn’t 1932, and Biden certainly isn’t FDR. But there are political lessons to be learned from taking a look back in time.

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:

A slow-rolling climate holocaust
A new Gilded Age
Sustained income inequality
Re-emergence of global Fascism
Donald Trump
Re-emergence of racism in America
Anti-vaxx’ers
Facebook and Fake News
Charter schools
And this week, Even Trump’s appointees to an EPA science board complain that Trump is ignoring science

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?

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.

The Wrongologist

Geopolitics, Power and Political Economy

Category: Medicare For All

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