Kamala Harris has already backtracked on her support for Medicare for All, making it hard to have confidence she will fight for such a plan should she be elected.
Wendell Potter recently warned why such tweaks short of Medicare for All will not work:
I spent 20 years as a health insurance executive before leaving my job as a vice president at Cigna. I can tell you firsthand that by focusing on a half-baked measure like a Medicare buy-in, Democrats would hand a huge gift to the private insurance industry while doing less than the bare minimum to help struggling businesses, workers, families and patients.
When the next Congress starts in January, House Democrats should use their new majority introduce, debate and vote on significant legislation that would assure universal coverage, protect taxpayers, and dramatically transform our health care system: Medicare for All.
The Higgins plan to let people aged 50-64 to buy Medicare coverage does nothing to restrict the ability of insurers to profit from our fragmented coverage system. It would allow insurance companies to continue to control prices for almost everyone under 50, while pushing many of their most expensive-to-insure patients out of their risk pool and into Medicare’s — which shifts the cost onto taxpayers…
It’s time for Democrats to stop proposing health care reform that relies on insurance companies to play fair. After two decades in the for-profit health insurance industry, I can assure you they never will. They have no interest in doing anything that might in any way jeopardize profits. Their only interest is delivering profits to their shareholders. From that perspective, the status quo is very profitable. For everyone else, not so much.
Harris should have been prepared for push back on Medicare for All–both from people concerned about such a major change, and from attacks from the insurance industry. She handled this quite poorly. That said, her flip flopping on Medicare for All is hardly my biggest objection to Harris.
The goal this year must not only be to elect candidates to oppose Trump, but to also reform the Democratic Party (which is responsible for the situation in 2016 which enabled Trump to be elected president). Tuesday provides an opportunity for another progressive upset in Michigan, but it will be a challenge due to the presence of both a real progressive (Abdul El-Sayed) and a faux progressive (Shri Thanedar) who will divide the vote against establishment candidate Gretchen Whitmer.
El-Sayed is running on a platform similar to that of Bernie Sanders. Sanders has endorsed El-Sayed, and came to Michigan to campaign for him on Sunday. The previous weekend, Alexandria Ocasio-Cortez, who was responsible for a major upset over the Democratic establishment, came to campaign for El-Sayed. He was also recently endorsed by The Nation and previously received endorsements from groups including Justice Democrats, Our Revolution, The People for Bernie, Our Revolution, the Progressive Caucus of the Michigan Democratic Party, and Democracy for America.
El-Sayed is behind in the polls, but victory might be within reach. Progressives are encouraged by the greater enthusiasm seen for his campaign as compared to his opponents. Progressives are also encouraged by the memories of Bernie Sanders coming back from twenty-points behind just prior to the Michigan Democratic primary in 2016 to upset Hillary Clinton. The polls missed support for a progressive alternative to the Democratic establishment then, and could be doing so again.
The front runner, Gretchen Whitmer, is the daughter of a former president and CEO of Blue Cross Blue Shield of Michigan, and the recipient of their money. She is also the only Democratic candidate who opposes single payer health care. She has also benefited from dark money contributions, which has become an issue in the race. When she twisted the facts to respond to El-Sayed, the Truth Squad at a Michigan newspaper called her claims “mostly inaccurate” as she tried to equate contributions from private individuals with her corporate contributions.
The task of upsetting the establishment candidate is made more difficult by the presence of faux-progressive Shri Thanedar, who is running as a progressive for strategic reasons, and has put $10 million of his own money into the race. Hopefully the efforts of Bernie Sanders, Alexandria Ocasio-Cortez, and several progressive groups will lead to progressives coming out to vote for the true progressive candidate in the race, Abdul El-Sayed.
There has been a lot of talk lately about an anti-establishment fervor in the Democratic Party, largely fueled by both dissatisfaction with the status quo and the manner in which the DNC rigged the rules to block challengers to Hillary Clinton in 2016. Clinton’s inability to beat a candidate as terrible as Donald Trump cast more doubt on the party establishment’s strategy of promoting moderate candidates. Alexandria Ocasio-Cortez’s victory over party insider Joseph Crowley in New York’s 14th congressional district Democratic primary gave additional hope for progressive and true liberal Democrats hoping to beat the party establishment. In Michigan efforts to beat establishment candidate Gretchen Whitmer (who would still be far preferable to GOP front runner Bill Schuette) for the nomination for Governor might be thwarted by two candidates running as progressives in Michigan who are likely to split the vote. However, only one is a true progressive.
While both Abdul El-Sayed and Shri Thanedar are running as Bernie Sanders style progressives, only El-Sayed looks like the real deal. The Intercept has had multiple articles exposing Thanedar as an opportunist. In a new article today, The Intercept shows how they differ on health care, but first recapped the case against Thanedar:
In Michigan, businessperson Shri Thanedar has spent millions of dollars on television ads casting himself as “the most progressive Democrat running for governor,” and promising that he would bring single-payer health care to Michigan.
“Health care is not a privilege; it is our fundamental right. I will bring single-payer health care to Michigan,” Thanedar says in a TV commercial. “Agree? Vote for Shri.”
But there’s reason to be skeptical.
Over the last year, investigations by The Intercept have revealed many facts which cast doubt on Thanedar’s progressive branding. He donated thousands of dollars to Sen. John McCain’s presidential campaign, he was spotted clapping and nodding approvingly at a Marco Rubio presidential rally, and several Michigan political consultants have claimed that Thanedar once consulted them about possibly running as a Republican.
The Intercept interviewed Thanedar and found that “Thanedar’s much touted single-payer health care ‘plan’ appears to be nonexistent.” In contrast, they found that former Detroit Public Health chief Abdul El-Sayed “has a detailed strategy for how to accomplish it.” However, Thanedar is likely to split the progressive vote due to having spent much more on advertising. The Intercept notes:
Last month, he released a plan to establish “Michicare,” which would levy payroll and business taxes to establish state-funded public coverage for all Michigan residents…
But despite having a more well-developed plan, El-Sayed’s middle-class background means he does not have the same resources to advertise his health care plan as does Thanedar, who, not without controversy, made a fortune in the chemical testing industry.
As a result, there’s a real risk that the public might be misled.
The article also notes how this will impact the race against establishment candidate Gretchen Whitmer:
But by coopting a progressive message and splitting the progressive vote, Thanedar has helped Whitmer, an establishment candidate, take a comfortable lead.
Whitmer is the daughter of former Blue Cross Blue Shield CEO Richard Whitmer. She’s the only Democratic candidate in the race who does not back single-payer, saying that it’s not “realistic” in Michigan at this time. BCBS Michigan lobbyists threw a fundraiser for Whitmer earlier this year. And she’s currently taking heat from an unidentified group who have paid for ads attacking her from accepting “big money” from insurance companies.
El-Sayed has been endorsed by Justice Democrats, Our Revolution, The People for Bernie, Our Revolution, the Progressive Caucus of the Michigan Democratic Party, Democracy for America, and after her victory in New York, by Alexandria Ocasio-Cortez. Whitmer has a long list of establishment endorsements. I am not aware of any significant endorsements for Thanedar but the Grosse Pointe Democratic Club has issued an anti-endorsement for Thanedar warning Democrats NOT to vote for him.
There is wide spread consensus that opiates were overused in the past, and their use has been greatly curtailed in recent years. Many people were placed on high doses for chronic pain when this was considered the standard of care, and the pharmaceutical industry did all it could to promote this practice. The problem is many people who are using high doses safely and responsibly are now being targeted by government efforts to decrease opiate use. While it makes sense to limit new prescriptions, and decrease their use in long-time users when possible, the government has been going overboard in intervening in patient care to decrease their use.
Both in January 2016 and January 2017 I encountered cases where Medicare drug plans abruptly reduced the doses of pain medications they would approve, and Medicare is now considering far more draconian cuts as of January 2018. This is largely based upon distorting recommendations from the Centers for Disease Control, with even writers of those guidelines protesting actions by the Medicare plans. Some patients have tried to get around this by paying for part of their prescriptions, but I have recently been informed by local pharmacists that they are now under pressure to stop filling prescriptions for amounts beyond what is approved. This is driving some to the use of cheaper street drugs such as heroin, increasing the risk of overdoses, contrary to the stated goals of regulations to reduce opiate use.
The New York Times has an excellent article on the situation. I have some excerpts below, but recommend reading the full article.
Medicare officials thought they had finally figured out how to do their part to fix the troubling problem of opioids being overprescribed to the old and disabled: In 2016, a staggering one in three of 43.6 million beneficiaries of the federal health insurance program had been prescribed the painkillers.
Medicare, they decided, would now refuse to pay for long-term, high-dose prescriptions; a rule to that effect is expected to be approved on April 2. Some medical experts have praised the regulation as a check on addiction.
But the proposal has also drawn a broad and clamorous blowback from many people who would be directly affected by it, including patients with chronic pain, primary care doctors and experts in pain management and addiction medicine.
Critics say the rule would inject the government into the doctor-patient relationship and could throw patients who lost access to the drugs into withdrawal or even provoke them to buy dangerous street drugs. Although the number of opioid prescriptions has been declining since 2011, they noted, the rate of overdoses attributed to the painkillers and, increasingly, illegal fentanyl and heroin, has escalated.
“The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient,” said Dr. Joanna L. Starrels, an opioid researcher and associate professor at Albert Einstein College of Medicine. “That takes a lot of clinical judgment. It’s individualized and nuanced. We can’t codify it with an arbitrary threshold.”
…Dr. Stefan G. Kertesz, who teaches addiction medicine at the University of Alabama at Birmingham, submitted a letter in opposition, signed by 220 professors in academic medicine, experts in addiction treatment and pain management, and patient advocacy groups.
His patients include formerly homeless veterans, many of whom have a constellation of physical and mental health challenges, and struggle with opioid dependence. For them, he said, tapering opioids does not equate with health improvement; on the contrary, he said, some patients contemplate suicide at the prospect of suddenly being plunged into withdrawal.
“A lot of the opioid dose escalation between 2006 and 2011 was terribly ill advised,” Dr. Kertesz said. “But every week I’m trying to mitigate the trauma that results when patients are taken off opioids by clinicians who feel scared. There are superb doctors who taper as part of a consensual process that involves setting up a true care plan. But this isn’t it.”
Some two dozen states and a host of private insurers have already put limits on opioids, and Medicare has been under pressure to do something, too. Last July, a report by the inspector general at the Department of Health and Human Services raised concerns about “extreme use and questionable prescribing” of opioids to Medicare recipients. In November, a report from the Government Accountability Office took Medicare to task, urging greater oversight of opioid prescriptions…
Opponents of the new limit say that doctors are already overwhelmed with time-consuming paperwork and that many will simply throw up their hands and stop prescribing the drugs altogether.
A delay or denial would put chronic pain patients — or those with inflammatory joint diseases, complex shrapnel injuries or sickle cell disease — at risk of precipitous withdrawal and resurgence of pain, doctors said.
The Medicare proposal relies on guidelines from the Centers for Disease Control and Prevention that say doctors should not increase an opioid to a dose that is the equivalent of 90 milligrams of morphine.
But experts say that Medicare misread the recommendations — that the C.D.C.’s 90-milligram red flag is for patients in acute pain who are just starting opioid therapy, not patients with chronic pain who have been taking opioids long-term. The acute pain patient, the guidelines say, should first be offered treatments like acetaminophen or ibuprofen. A short course of a low-dose opioid should be a last resort.
“We didn’t take a specific position on people who were already on high doses,” said Dr. Lewis S. Nelson, the chairman of emergency medicine at Rutgers New Jersey Medical School and University Hospital, who worked on the guidelines.
“We did say that established, high-dose patients might consider dosage reduction to be anxiety-provoking, but that these patients should be offered counseling to re-evaluate,” he added. “There is a difference between a C.D.C. guideline for doctors and a C.M.S. hard stop for insurers and pharmacists.”
Dr. Erin E. Krebs recently released a comprehensive study showing that patients with severe knee pain and back pain who took opioid alternatives did just as well, if not better than, those who took opioids. Nonetheless, she and seven others who worked on the C.D.C. guidelines signed the letter opposing the Medicare rule.
“My concern is that our results could be used to justify aggressive tapering or immediate discontinuation in patients, and that could harm people — even if opioids have no benefit for their pain,” said Dr. Krebs, an associate professor of medicine at the University of Minnesota.
“Even if we walk away from using opioids for back and knee pain, we can’t walk away from patients who have been treated with opioids for years or even decades now,” she added. “We have created a double tragedy for these people.”
Democrats suffered serious losses in Congressional and state races in 2010 and 2014 after running as a Republican-lite party. Despite trying to shift the blame to Russia and others, Democrats lost the 2016 election to a candidate as terrible as Donald Trump by nominating a corrupt conservative warmonger who has spent her career undermining liberal values. Finally we are seeing people question the conventional wisdom that nominating more conservative candidates will increase the chances for Democrats to win. I looked at this issue yesterday, and found that Bud Budowsky, a Democratic columnist at The Hill, has written a column on the same topic.
Budowsky wrote that A Sanders-Warren ticket could win big in 2020. Besides this ticket, Budowsky discussed two other hypothetical Democratic tickets, Joe Biden-Amy Klobuchar and Joe Kennedy III with either California Attorney General Xavier Becerra or Senator Kamala Harris. He wrote the following in favor of a more progressive ticket:
Behind the scenes of the national Democratic Party, it is commonly accepted wisdom, though not proven by facts, that the most progressive candidates are not the most electable candidates. In some states and districts this might be true.
But, in terms of winning the national popular vote and an electoral vote majority, there is a credible case that the most clearly progressive and politically aggressive Democrats can indeed win, and potentially win big.
The most important and powerfully persuasive data in modern American politics is that virtually every poll in 2016 showed Sanders defeating Donald Trump by 10 percent or more. In the Real Clear Politics summary of 2016 polling, Sanders ran ahead of Trump by an average margin of more than 10 percent and often by much larger margins.
Whether one supports Sanders or any other potential candidate in 2020, the case is clear that a strong progressive program and message would give Democrats a decided advantage in any campaign against the scandal-ridden and crony-capitalist-dominated presidency of Trump and his GOP allies in Congress…
While I could support Sanders, Warren or any of the progressive Democratic change candidates who could run on the ticket in 2020, it is important to disabuse the false notion, which is contrary to the facts demonstrated by national polling throughout 2016 and beyond, that progressive candidates are less electable.
Americans want a clear message of progressive change and would enthusiastically support a Sanders-Warren ticket, or any other ticket running on a similar program in 2020.
I agree with nominating candidates who have a clear message and stand for change. My one nitpick is that I would not limit this to progressive economic ideas. While Bernie Sanders did concentrate on this message in 2016, there were other factors which led many to support him over Hillary Clinton. It was partially over character, but there were other issues too. One study argues that Clinton lost because of being a warmonger. While I question if this was the main factor, foreign policy is important. Democrats attracted new voters when they opposed neoconservatives while George Bush was in office. They lost votes when they nominated a neocon interventionist such as Hillary Clinton, whose policies have caused considerable death and suffering around the world.
Sanders’ views on social and cultural issues were also far more attractive to voters than than Clinton’s socially conservative views. Many voters, especially young voters, are more socially libertarian. Democrats might be preferable to Republicans on reproductive rights, but fail to consistently support policies to reduce the role of government in the private lives of individuals. In addition to Clinton’s support for military interventionism, and the toleration of this by establishment Democrats, there is their support for the drug war. Clinton did not change her views on same-sex marriage until it became politically inexpedient to continue to oppose it. While it is still a government program, support for single payer healthcare, which Clinton campaigned against and the DCCC continues to oppose, is far more acceptable than government mandates pushed by Clinton to purchase private insurance plans with outrageous deductibles.
It is a good sign that more Democrats are paying attention to Bernie Sanders’ criticism of corporate Democrats, along with his support for Medicare-for-All. If Democrats are to rebuild a winning majority, they should more consistently challenge establishment views in other areas too.