Haspel Evades Questions On Torture, Cheney Backs It, And Will Democrats Back Down On Resisting Once Again?

The American Civil Liberties Union has outlined how Gina Haspel evaded multiple questions from the Senate Intelligence Committee this week. This included a question from Kamala Harris whether she found torture to be immoral. She evaded questions from Ron Wyden about whether she had wanted the use of torture “to be continued or expanded” between 2005 and 2007. She refused to recuse herself from decisions on declassifying her role in torture, with Haskel making the decisions regarding which documents the CIA will release. She misrepresented the content of torture tapes. She evaded questions on Trump’s views on torture.

While Haspel evaded questions, Dick Cheney had no qualms about presenting his views, which unfortunately consist of strong support for resuming the use of torture. He also said that that he thinks Haspel would “be a great CIA director.”

The vote on Haspel could be very close. So far one Democrat, Joe Manchin, said he would vote for her while John McCain has said he would vote against. Rand Paul previously stated he would oppose the confirmation of both Pompeo and Haspel, but folded on Pompeo.

Stopping her confirmation will depend upon the remaining Democrats sticking together, along with additional Republican defections. Glenn Greenwald questions whether the Democrats will stick together to block her nomination:

It is difficult to be optimistic, to put that mildly. The history of Democrats throughout the war on terror is to ensure that just enough members of their caucus join with the GOP majority to ensure passage of even the most extremist pieces of legislation or nominees justified in the name of terrorism or national security.

The ruse Democrats typically use to accomplish these dirty deeds is quite ingenious: The defectors change so that no one member bears the blame for enabling right-wing measures, while the party itself is able to claim that a majority opposed the extremism. In 2010 — as the Bush-era tactic of Democratic defections to the GOP continued under Barack Obama — I referred to this tactic as “Villain Rotation” and described it this way:

The primary tactic in this game is Villain Rotation.  They always have a handful of Democratic Senators announce that they will be the ones to deviate this time from the ostensible party position and impede success, but the designated Villain constantly shifts, so the Party itself can claim it supports these measures while an always-changing handful of their members invariably prevent it.  One minute, it’s Jay Rockefeller as the Prime Villain leading the way in protecting Bush surveillance programs and demanding telecom immunity; the next minute, it’s Dianne Feinstein and Chuck Schumer joining hands and “breaking with their party” to ensure Michael Mukasey’s confirmation as Attorney General; then it’s Big Bad Joe Lieberman single-handedly blocking Medicare expansion; then it’s Blanche Lincoln and Jim Webb joining with Lindsey Graham to support the de-funding of civilian trials for Terrorists; and now that they can’t blame Lieberman or Ben Nelson any longer on health care (since they don’t need 60 votes), Jay Rockefeller voluntarily returns to the Villain Role, stepping up to put an end to the pretend-movement among Senate Democrats to enact the public option via reconciliation.

We most recently saw the Democrats act more like collaborators than a resistance civil liberties during the votes on FISA renewal with eighteen Democrats siding with the Republicans to prevent consideration of amendments to reform the law. The eighteen Democrats provided exactly the number of votes for cloture to pass.

Bernie Sanders Encourages Progressive Candidates At Training Conference

Bernie Sanders was the keynote speaker last week at a four day conference for the training of progressive candidates. ABC News reported:

Sanders’ legacy political organization, Our Revolution, partnered with the Progressive Change Campaign Committee (PCCC) to host the conference and the organizers were excited by the number of signups. According to event representatives, 70 percent of the conference attendees were actively running in 2018 — 64 percent of them in districts President Donald Trump won in 2016. The group was noticeably diverse too: 55 percent women, 40 percent people of color and 82 percent who have never held political office…

Like Sanders’ team, the PCCC is known in Washington and political circles for talking openly about — and fundraising on — divisions in the Democratic Party between Progressives focused on economic populism and more centrists. Even in the era of Trump, when Democrats have largely unified in their opposition to this White House, a major theme of the conference was that Democratic candidates should not shy away from campaigning hard to the left, even if that means bucking advice from some Democratic Party officials.

“Any old blue just won’t do,” Nina Turner, the president of Sanders’ legacy political organization, Our Revolution, said introducing Sanders. “I am talking about ‘Bernie blue.’”

Several of the attendees lamented that Democratic Party officials had, they thought, handpicked more mainstream candidates around the country or advised folks to temper progressive platforms. At one point, PCCC co-founder Adam Green asked the crowd if any of them had been encouraged to run more to the center and half the hands in the room seemed to go up.

Mark Gruenberg had more on Sanders’s speech for Mint Press News:

Sanders was greeted with a roar, repeated chants of “Bernie! Bernie! Bernie!” and interrupted frequently by applause and cheers—and occasional laughter for his jibes at the GOP, centrist Democrats, and political consultants. He also stated money is useful and needed, but that it’s no substitute for shoe leather.

“Watch out for consultants,” he warned. “There’s a large group of people, particularly here in Washington, who make zillions of dollars and often their advice is conservative, and wrong. Trust your heart.

When I was first elected as mayor of Burlington [Vermont], I defeated a five-term mayor because I literally knocked on thousands and thousands of doors. The most important thing is face-to-face contact,” he said.

“Do not spend your entire lives raising money, as some here would have you do.”

Sanders, even more than the other speakers, pointed out that on issues, the country is increasingly with the progressives, including the issues he raised in his 2016 Democratic presidential primary campaign. Those ideas, such as Medicare for All, $1 trillion in infrastructure spending, free tuition at public colleges and universities, and the wipeout of college debt, were considered radical then.

Many in the Democratic Party, he claimed, waved them aside, or worse. But now, for example, his Medicare for All bill has 16 Senate Democratic co-sponsors and the $15 minimum wage—the Dems at the time were stuck on $10.10—now has 30 U.S. House sponsors. And he said the latest opinion poll shows 59 percent support for Medicare for All.

By contrast, a wide range of attendees reported consultants advising them not to run on progressive planks, not to campaign for the minimum wage increase or Medicare for All or gun control measures and—in some cases—not to even put a (D) on their signs. The attendees rejected that advice.

But it’s not just the GOP standing in the way of the progressives. In some cases, it’s the Democratic establishment. Just as in the close Lipinski-Newman congressional primary on Chicago’s Southwest Side and suburbs, Nevada 4th District hopeful Amy Vilela is taking on the state’s Democratic machine constructed by retired U.S. Senate Majority Leader Harry Reid…

“The establishment wants, #1, to push tax cuts for millionaires and a war agenda. And #2 is to tell you ‘politics are too complicated for you, so don’t get involved.’” And Republicans’ “idea of a good election is nobody votes and big money dominates.”

“But if you look at what my colleagues are doing, you realize anybody can run for anything. Just look at the president of the United States and know that you know more than he does on his best day,” the senator drolly said, to laughter from the crowd.

That prompted him to set a goal for the group: A vast increase in turnout this fall.

“Four years ago,” in the important 2014 off-year election, “we had the lowest turnout since World War II, 37 percent” and the GOP won big, he explained. “If we can go out and increase turnout of young people, people of color, and working people, by giving them hope, and get that up to 50 percent, virtually every single one of you will win your election,” he predicted.

The Drug War Extends To Medicare Patients

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.”

Bernie Sanders’ Response To The State Of The Union Address (Including Full Transcript)

Last night Bernie Sanders was one of five Democratic responses to the State of the Union Address, including Joe Kennedy III’s official response. Sanders criticized Trump for promising to provide “health insurance for everybody,” with “much lower deductibles,” but instead supporting legislation that “would  thrown up to 32 million people off of the health care they had while, at the same time, substantially raising premiums for older Americans.”

Sanders noted that Trump had promised “promised not to cut Social Security, Medicare or Medicaid.” Instead, “he supported a Republican Budget Resolution that proposed slashing Medicaid by $1 trillion and cutting Medicare by $500 billion. Further, President Trump’s own budget called for cutting Social Security Disability Insurance by $64 billion.”

In addition to calling out Trump for breaking his campaign promises, Sanders noted many things which Trump failed to talk about, including climate change and voter suppression.

While overall a good speech, there were things which I wish Sanders had said, and one thing statement which was misleading. As has generally been the case with Democrats, there was nothing said about restrictions of civil liberties–passed with the cooperation of many Democrats. Nor were there protests over the never-ending war which Democrats are now accepting as the status quo. Nothing was said about the drug war, while Joe Kennedy III , among other Democrats, has been on the wrong side of this issue. This is what I want to see from a true resistance.

Sanders also stated that the Russians “interfered in our election in 2016, is interfering in democratic elections all over the world.” While technically true, this plays into the hysteria being spread by Democrats, often based upon misinformation. While true that Russia meddled in our election, this must be kept in context that Russia has meddled in elections for decades–just as the United States has frequently meddled in foreign elections. Russian meddling has also been highly exaggerated. There is also no evidence that Russia had any effect on the election results. The information obtained through the Congressional hearings has shown that claims about Russian tampering with the election have been have been of little consequence. Similarly, multiple media reports of Russian hacking were subsequently retracted as false. I would hope that Sanders would know better to play into the misleading claims of Democrats who are distorting the facts to deny the blame they deserve for losing to Donald Trump due to choosing a candidate as terrible as Hillary Clinton, along with playing into the hands of neocons who are distorting Russian electoral interference as they used false claims of WMD in Iraq to promote their goal of regime change in Russia.

The video can be seen here and the full text of Sanders’ speech is below:

(more…)

Donald Trump On Women Working For Him, Foreign Policy, and Medicare For All

At the moment we are waiting in limbo for a couple of big stories to break. We don’t know yet if there will be a government shutdown. (If there is a shutdown, will drone attacks and NSA surveillance be halted? Unfortunately no.) One way to avert a government shutdown would be to tell Trump that McDonald’s will shut down if the government does.

The DNC Rules and Bylaws Committee meets tomorrow to vote on the recommendations of the Unity Reform Commission–which are very limited and do not do enough. If the DNC rejects these recommendations the Democratic Party will be demonstrating a contempt for democracy which would make Thomas Jefferson, along with FDR, roll over in their graves. It could also be said that they already demonstrated this in 2016.

While waiting for the answers, I decided to go back and quote interesting passages from Michael Wolff’s recent book, Fire and Fury: Inside the Trump White House. I previously noted some selections from the book here. There were further quotations regarding Wolff’s view that the Russia scandal is about money laundering, and not about collusion to affect the election 2016 election results, here. The question of Trump’s state of mind was reviewed here. Here are some additional items of interest.

It isn’t as crude as grabbing them by the pussy, but this aspect of Trump’s views is  rather demeaning to the women working for him:

While Trump was in most ways a conventional misogynist, in the workplace he was much closer to women than to men. The former he confided in, the latter he held at arm’s length. He liked and needed his office wives, and he trusted them with his most important personal issues. Women, according to Trump, were simply more loyal and trustworthy than men. Men might be more forceful and competent, but they were also more likely to have their own agendas. Women, by their nature, or Trump’s version of their nature, were more likely to focus their purpose on a man. A man like Trump.

Prior to the election I often compared the foreign policy views of Clinton and Trump. I noted that while Trump was not interested in neocon foreign interventionism like Clinton, his views on foreign policy were too incoherent to provide a better alternative. Wolff’s description of Trump’s foreign policy views goes along with my characterization of them as incoherent:

If the Trump White House was as unsettling as any in American history, the president’s views of foreign policy and the world at large were among its most random, uninformed, and seemingly capricious aspects. His advisers didn’t know whether he was an isolationist or a militarist, or whether he could distinguish between the two. He was enamored with generals and determined that people with military command experience take the lead in foreign policy, but he hated to be told what to do. He was against nation building, but he believed there were few situations that he couldn’t personally make better. He had little to no experience in foreign policy, but he had no respect for the experts, either.

While Hillary Clinton campaigned against Bernie Sanders’ Medicare for All proposal, there was a surprising supporter of the plan in Washington–Donald Trump:

All things considered, he probably preferred the notion of more people having health insurance than fewer people having it. He was even, when push came to shove, rather more for Obamacare than for repealing Obamacare. As well, he had made a set of rash Obama-like promises, going so far as to say that under a forthcoming Trumpcare plan (he had to be strongly discouraged from using this kind of rebranding — political wise men told him that this was one instance where he might not want to claim ownership with his name), no one would lose their health insurance, and that preexisting conditions would continue to be covered. In fact, he probably favored government-funded health care more than any other Republican. “Why can’t Medicare simply cover everybody?” he had impatiently wondered aloud during one discussion with aides, all of whom were careful not to react to this heresy.

Of course this has no practical value, with Trump having no understanding of the details of health care legislation and no interest in really doing the work to promote a plan, allowing Congressional Republicans to push their agenda.

Porn Star Running For Democratic Nomination & Other Political Briefs

Are we now Italy? The Hill reports that a porn star has announced her candidacy for the Democratic nomination:

A porn star and a rapper say they have what it takes to win the White House in 2020.

Cherie DeVille, who’s starred in such videos as “Ass Planet” and “Hot Tub Hottie,” says she was inspired to run for office out of her “personal frustration for the current political climate.”

When Donald Trump won the election last year, DeVille — who’s running alongside rapper Coolio — says she sobbed. “I didn’t cry because I hated [Trump] specifically, I cried because of what I felt that meant for the direction our country was going in.”

“We’re voting for people as if we’re on a reality television show, and my concern is if we continue to purely vote for celebrities, or political figures, or the most entertaining, they’re not always going to be quality politicians,” DeVille told ITK on Tuesday.

So the 39-year-old adult film performer decided to toss her hat in the political ring, saying she’s planning on running as a Democrat.

“If our criteria now for becoming a political official is minor celebrity, I have that,” says DeVille, who boasts 190,000 Twitter followers. “I feel like I can be potentially what I’m feeling the American people — for better or for worse — want, which is interesting news, scandalous news, you know, not ‘boring’ political news.”

“But at the same time [I can] do what the American people really need,” she continues, which is “having a person with integrity, and having someone listen to the people, and actually care about America in public office.”

A former physical therapist, DeVille — whose campaign slogan is “Make America F—— Awesome Again” — says a lot of people “giggle” when they learn that “Gangsta’s Paradise” rapper Coolio is running as her VP.

The Guardian has a story under the headline Christopher Steele believes his dossier on Trump-Russia is 70-90% accurate. So, in other words, he admits that his dossier, which fueled much of the Russia-gate hysteria (and which Clinton and the DNC hid the fact that they paid for) could be 30% false.

Portions of the left and libertarian right do often share some views in common. For example, CounterPunch today has a post on The Logic of Drug Legalization:

The Drug Lords of today exist because of the extraordinary profits resulting from criminalization. Estimates run in the half a trillion range globally per year. By way of comparison there are only twenty or so countries with a national economy of that size. The situation is exactly analogous to the prohibition era. When gunfights, beatings, murders and firebombs were the business strategy of choice for the pushers of alcohol. Once booze was legalized the bootleggers were immediately driven out of business. Alcohol is heavily taxed today there are however no Bootlegging Lords on the playground pushing cheaper booze on our children.

Nor would such pushers exist for any other drug that we might choose to legalize. Sure the criminals could evade the cost of taxes on their product but there are enormous costs incurred by criminal enterprises that don’t apply to legal ones. This is why marijuana today is sold for hundreds of times what it costs to grow. Our legal producers will not be faced with those costs and so can sell to us below current prices on the street. With profit margins cut to the bone the ‘dread lords and masters’ that control the illegal drug market today will simply melt away like the last snow before the advancing spring…

Matthew Yglesias writes at Vox, Bill Clinton should have resigned: What he did to Monica Lewinsky was wrong, and he should have paid the price. What is amazing about this is that it comes from a usually very pro-Democratic Party source. Now that they aren’t concerned about white washing the past for Hillary, some Democrats might be able to face the truth about at least some aspects of their party.

Also at Vox, yet another reason to oppose the Republican tax bill: Republicans’ tax bill could trigger a $25 billion cut to Medicare.

Periodically I see articles from people who have good intentions but don’t understand how health care really works argue that we should end private practice and have all doctors become employees to save costs. The reality is that this trend has increased costs rather than save money, as discussed in this article at Modern Healthcare entitled Hospital-employed physicians drain Medicare:

“When hospitals grow their physician network, with a subsidy of $150,000 to $200,000 per physician, they have to cover those costs by driving ancillary services and (getting more people) in hospital beds,” said Dr. Jeffrey LeBenger, CEO of Summit Health Management, an integrated, physician-led independent physician group that includes some 800 doctors. One of the main drivers of physician acquisitions is to increase referral networks, he said.

Bernie Sanders Brings Us One Step Closer To A Single-Payer Health Plan

Bernie Sanders has introduced legislation to establish a single-payer health care plan, as he promised during his run for the Democratic nomination. In an op-ed in The New York Times he wrote Why We Need Medicare for All beginning with describing the problem we face:

This is a pivotal moment in American history. Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right? Or do we maintain a system that is enormously expensive, wasteful and bureaucratic, and is designed to maximize profits for big insurance companies, the pharmaceutical industry, Wall Street and medical equipment suppliers?

We remain the only major country on earth that allows chief executives and stockholders in the health care industry to get incredibly rich, while tens of millions of people suffer because they can’t get the health care they need. This is not what the United States should be about.

All over this country, I have heard from Americans who have shared heartbreaking stories about our dysfunctional system. Doctors have told me about patients who died because they put off their medical visits until it was too late. These were people who had no insurance or could not afford out-of-pocket costs imposed by their insurance plans.

I have heard from older people who have been forced to split their pills in half because they couldn’t pay the outrageously high price of prescription drugs. Oncologists have told me about cancer patients who have been unable to acquire lifesaving treatments because they could not afford them. This should not be happening in the world’s wealthiest country…

This has divided the Democratic Party. Hillary Clinton ran a dishonest campaign against Medicare for All during the primaries, and remains opposed. Much of the Democratic leadership, which badly needs to be replaced, is also opposed. Several of those being mentioned as candidates in 2020 are supporting the plan, showing that they realize this is where a leader of the party must be.

Al Franken has blown apart Hillary Clinton’s arguments against Sanders, showing that supporting Medicare for All is not an attack on Obamacare or Medicare as Clinton falsely claimed. Politico reported:

Sen. Al Franken (D-Minn.), who has been mentioned as a possible 2020 candidate, also expects to sign on to the single-payer bill, a spokesman said Tuesday. Franken noted that his cosponsorship reflects the bill’s status as a long-term goal while the party continues short-term work on Obamacare.

“This bill is aspirational, and I’m hopeful that it can serve as a starting point for where we need to go as a country,” Franken said in a statement. “In the short term, however, I strongly believe we must pursue bipartisan policies that improve our current health care system for all Americans — and that’s exactly what we’re doing right now in the Senate Health Committee, on which both Senator Sanders and I sit.”

Yes, we can defend Obamacare and support improvements, including a Medicare buy-in and a robust public option if that is something more quickly obtainable, while also understanding that a single-payer plan must be the ultimate goal.

Many centrists, both within and outside of the Democratic Party, remain opposed. Jonathan Chait misses the point when he argues that Bernie Sanders’s Bill Gets America Zero Percent Closer to Single Payer. This is not the first time Sanders has introduced legislation to promote a single-payer plan. This is also not the bill which will ultimately establish it. What Sanders has done has made single-payer the goal of the left and many on the center-left. This is analogous to making support for same-sex marriage the expected position of a Democratic leader to the degree that even Hillary Clinton had to alter her position prior to running in 2016, no matter how much this conflicted with her socially conservative beliefs.

The Affordable Care Act was a tremendous improvement over the system we had before, for the first time providing access to coverage which could not be taken away based upon one’s medical condition. However it did very little to change the reality that coverage on the individual market is expensive. Ironically, Republicans are pushing the inevitability of a single-payer plan without realizing it. This includes Republicans in state governments who have denied access to the expanded Medicaid plan to those in several states, and Donald Trump who is trying to destabilize the marketplace plans.

With the limitations of Obamacare, a single-payer plan is the only idea which makes long term economic sense. A majority of doctors have come around to realizing this. Bernie Sanders is now making the Democratic Party acknowledge this. When Obamacare was first being considered, discussion of single-payer plans was blocked. Bernie Sanders has made single-payer part of any discussion of further health care policy.

Vox, A Voice Of The Democratic Establishment, Now Realizes That Bernie Sanders Is The Democrats’ Real 2020 Frontrunner

During the 2016 campaign, Matthew Yglesias and Vox were often seen as a voice for Hillary Clinton and “Neoliberal Corporatism.” It is with this background that I find it significant that Yglesias now proclaims that Bernie Sanders is the Democrats’ real 2020 frontrunner. While many establishment Democrats continue to resist Sanders and his supporters to various degrees, there are signs such as this that others are acknowledging this reality.

The post by Yglesias makes some points which I have made in the past, leaves out some things of significance, and does have some interesting material which Sanders supporters might not be aware of.

Yglesias does repeat a point I have made previously, both in the context of one reason why Sanders lost, along with an explanation for why Sanders went on to back Clinton and try to work with the establishment. It is important to understand how things looked before Sanders entered the race. Clinton’s nomination appeared inevitable and nobody (including Sanders) thought he had a chance. Sanders two main goals were to force Democrats to consider his economic views, and to strengthen his position in the party in order to push his priorities in the future. As Vox put it:

By the time it was clear the Sanders 2016 campaign had legs, it was already fatally hobbled. Almost no one believed in the summer and fall of 2015 that he stood any chance of beating Hillary Clinton — and that included Sanders himself. As Patrick Healy and Yamiche Alcindor reported last April, he “was originally skeptical that he could beat Mrs. Clinton, and his mission in 2015 was to spread his political message about a rigged America rather than do whatever it took to win the nomination” and only began to really focus on trying to win when his poll numbers unexpectedly soared in early 2016.

Consequently, labor leaders who sympathized with Sanders’s critique of Clinton didn’t give any serious thought to actually endorsing him. Instead, they used his presence in the race as leverage to extract concessions on issues like the Trans-Pacific Partnership and the Cadillac tax on high-value health insurance plans from Clinton.

And since Sanders was running to raise the profile of his issues rather than to win, he didn’t bother to develop much in the way of answers to foreign policy questions, even though Clinton’s record of support for the 2003 invasion of Iraq and her hawkish instincts were some of her biggest vulnerabilities with the Democratic Party base.

Elected officials were almost uniformly afraid to endorse him, even if their policy views were closer to his than to Clinton’s, and left-of-center think tanks — including ones that are deliberately positioned to the left of mainstream Democrats ideologically — shied away from working with Sanders on policy development, for fear that Clinton’s wrath would destroy them if they did.

I would also add that the view that he could not win also affected Sanders’ early strategy. He continued to work in the Senate and initially only campaigned part time. If he realized how close the campaign would be he might have campaigned more in 2015, including going to the Super Tuesday states and work earlier to increase minority support. He might also have protested more about the lack of early debates, and made an issue out of Clinton’s scandals.

The lack of early debates also brings up another point which Yglesias ignored–the degree to which the nomination was rigged for Clinton from the start. There was undoubtedly pressure to clear the field for her, and Wikileaks made it clear that the DNC was not following their own rules about neutrality. This has further been confirmed in the class action lawsuit against the DNC.

Rules since McGovern, including Super Delegates and front loading the process with southern states, were specifically written to get a more conservative nominee. The irony is that they failed to change with the times, and these rules gave the Democrats a nominee who could not even beat Donald Trump, while harming a strong general election candidate such as Sanders when he did arise.

Rather than reverse the outdated rules, the Democrats instead altered the rules even further in 2016 to help Clinton. This included limiting debates, changing fund raising rules, and refraining from announcing the popular vote in Iowa, which Sanders probably won, as was done in 2008. Harry Reid’s actions in Nevada, at a time when he claimed to be neutral, also helped tilt the race towards Clinton. Despite the primary process, Hillary Clinton was chosen in back rooms by the Democratic establishment in 2016 in a manner which was little different than how parties picked their nominees in the proverbial smoke filled rooms in the past, ultimately costing the Democrats the election.

Things will be different in 2020. Yglesias also points to how Sanders is building a team to expand upon the issues he raised in 2008. As I noted again yesterday, among the major reasons I supported Sanders were his opposition to the Iraq war and the Patriot Act, as opposed to the major issues he campaigned on. A future campaign will hopefully include these issues. Yglesias wrote:

Earlier this year, Sanders — who doesn’t sit on the Foreign Relations, Armed Services, or Intelligence Committees — quietly added to his team Matt Duss, a veteran Middle East analyst known for looking askance at America’s tendency toward uncritical alliance with Saudi Arabia and Israel. It’s a clear sign that Sanders, who had a keen interest in left-wing foreign policy as mayor of Burlington but hasn’t had much of a profile on the issue in Congress, is serious about being able to play competently on the full spectrum of issues.

Sanders also picked up Ari Rabin-Havt, best known in recent years for his Sirius XM radio show but previously an adviser for Harry Reid in his early years as Democrats’ Senate leader.

While Sanders is deepening his team in Washington, his national political organization Our Revolution is diligently working to get Sanders supporters elected to state and local offices. Critically, the list of Our Revolution winners — a group that includes House members, state legislators, state party chairs, and even city council members — is quite ethnically diverse. His camp is aware that 2016’s African-American outreach strategy was flawed in both concept and execution, and he’s setting himself up to be able to count on black and Latino elected officials from all regions of the country as surrogates while also courting national leaders like the NAACP’s William Barber.

Yglesias also says that Sanders is moderating his views, but if true he does remain well to the left of Hillary Clinton. While Clinton campaigned against single payer health care, Sanders continues to push for Medicare-for-all. I cannot disagree with Yglesias when he points out that Sanders’ age could be a problem in 2020. We will have to wait and see if he is still up to running. The post did look at other possible candidates should Sanders not run, concluding by saying that “Among the Bernie faithful the most frequently named fallback candidate isn’t the well-known Warren or labor-liberal warhorse Sherrod Brown. It’s Nina Turner…”

Yglesias ended with a strong argument that “It’s time to take Bernie Sanders seriously”

The Democratic Party establishment is, in many respects, in worse shape than it realizes.

Sanders’s insurgent campaign revealed a Democratic Party electorate that is fairly eager to embrace an ideological champion as a progressive counterpoint to the decidedly conservative GOP. The notion of pragmatism continues to carry weight, but having lost control of all three branches of the federal government and blundered to a point where Democrats don’t control the state Senate in New York or the governor’s mansion in Illinois, party leaders’ credentials as strategic masterminds are in question.

Last but by no means least, relying on African-American voters as a bulwark against left-wingery, as Clinton did, is tenuous as black views on economic policy are generally quite left-wing. Democrats now rely heavily for votes on the large — and very Democratic-leaning — millennial generation that lacks clear political memories of the Cold War or the booming neoliberal economy of the 1990s, so “socialism” isn’t a scare word for them, even as it remains unpopular nationally.

Sanders became their champion over the course of 2016 and continues to hold that status now. But while in 2016 he faced a unified — and intimidating — opponent and launched with a ramshackle campaign, today he has a strong national political organization, a proven fundraising track record, and is moving decisively to address his weak points on international affairs, policy development, and minority outreach. Everyone agrees that in a perfect world he’d also wave a magic wand and scrape 10 or 15 years off his age, but that’s not possible. The movement he’s created lacks an obviously more compelling successor, and he continues to be broadly popular with the public.

Predicting the future is a mug’s game. But if Bernie Sanders runs again, he’ll be hard to beat. And as far as one can tell, he’s doing everything you would do to set yourself up to run again.

While I often disagreed with Yglesias during the 2016 campaign, this is a far more realistic viewpoint than he expressed previously, and far more realistic than the delusional account of the race which Peter Daou posted on Facebook today.

Republicans Willing To See Over 200,000 Die In Order To Give Tax Cut To The Wealthy

The Republican efforts to repeal and replace Obamacare have been stalled due to the devastating report from the Congressional Budget Office showing that 22 million people would lose health care coverage. Only 12 percent of Americans back the plan according to a USA TODAY/Suffolk University Poll. They did find considerable consensus that any health care plan include the following:

  • Pre-existing conditions: More than three-fourths, 77%, say it is “very important” that the health care system permit people with pre-existing medical conditions to buy health insurance at the same price as others. Just 6% say that protection isn’t important to them. The Senate bill requires insurers to accept those with pre-existing conditions, but it allows states to seek permission to reduce required benefits. Some patients could face dramatically higher costs or lifetime limits for treatments no longer defined as essential.
  • Medicaid expansion: Nearly two-thirds, 63%, say it is “very important” that lower-income people who became eligible for Medicaid through the Affordable Care Act continued to be covered by Medicaid. Just 10% say that isn’t important to them. The nonpartisan Congressional Budget Office estimates that the Senate plan, which would cut Medicaid spending by $772 billion over the next 10 years, would result in 15 million fewer people being covered.
  • Lower premiums: Close to six in 10, 57%, say it is “very important” that insurance premiums go down in price; 17% say that’s not important. The CBO predicts that premiums would rise for a few years under the Senate plan, then fall by about 30%. But overall health care costs would go up for most people because deductibles would be higher and some states wouldn’t require insurers to provide some benefits that are now mandated.

A growing number of Republican Senators are also opposing the plan, necessitating major changes if there is any chance for passage.

While Republicans claim that repeal of Obamacare is necessary because the program is collapsing, the CBO report on the Republican plan reaffirms statements in previous reports that these Republican claims are false. The current Congressional Budget Office report states:

Although premiums have been rising under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference between that percentage and the premiums for a reference plan.

It also needs to be kept in mind that premiums for plans on the individual market typically had double digit increases annually prior to the passage of the Affordable Care Act, and that this is not a new problem created by Obamacare. Unlike insurance plans sold before Obamacare became law, current plans have limits on out of pocket expenses, no lifetime maximums, and cannot be cancelled by insurance companies when people became ill. Of course there also were no subsidies to assist with paying for the plans. It was also commonplace to have limited options and to see insurance companies leave markets prior to Obamacare.

The actual problem with Obamacare is that it did not go far enough. A public option  or Medicare buy-in was necessary to provide more affordable care for those who do not obtain coverage through an employer or government plan. Expansion of Medicare to all would also have provided a more cost effective solution.

Vox looked at the likely effects on mortality should the Senate Republican plan pass, estimating that there will be 208,500 additional deaths over the next decade:

Drawing on that work, we estimate that if the Senate bill becomes law, 22,900 excess deaths will occur in 2020 — and the figure will grow over time. 26,500 extra deaths will take place in 2026. Over the next decade, we estimate that a total of 208,500 unnecessary deaths will occur if the law is passed (see Table 1).

We also calculate anticipated additional deaths, state by state, using state-level coverage losses for the year 2026 (see Table 2). The predicted excess deaths by state range from 30 in North Dakota to 2,992 in California in 2026 alone.

Some commentators have argued that it’s inappropriate — beyond the pale — to suggest that people will die as a result of this legislation. To the contrary, we contend that no debate over a health care policy can ignore evidence that it could have negative effects on health and mortality.

In making these calculations, we draw on the scientific literature demonstrating that expanding health insurance reduces deaths. We specifically apply the results of a particularly robust study of the effects of health care reform in Massachusetts on mortality. Massachusetts’ health care reform — which expanded Medicaid, offered subsidized private insurance, and included an individual mandate — famously served as a model for the ACA. The Massachusetts study looked at county-level mortality data in 2001 to 2005 (pre-reform) and 2007 to 2010 (post-reform), and compared the changes to carefully selected control groups in other states that had not enacted health reform.

Over 200,000 deaths is a high price to pay in order to provide tax cuts for the ultra-wealthy, which appears to be the major goal of the Republican plan.

Republicans Vote To Deny Health Care Coverage To Millions But It Is Far From Certain That Democrats Can Take Advantage Of This

The lie of the week is that the Republican-controlled Congress voted to repeal and replace Obamacare. Repeal yes, but the law they passed is too worthless to seriously be called a replacement. Republicans voted to deny health care coverage to millions, and to open the door for insurance companies to deny coverage for preexisting conditions. Doctors, insurance companies, hospitals, AARP, and many consumers groups are unified in opposing this legislation. Fortunately even some Senate Republicans realize that this is a terrible plan and want to start from scratch.

To summarize the effects of the House plan:

  • Tax cuts for the wealthy–always a Republican priority
  • Defunds Planned Parenthood for one year
  • Allows older Americans to be charged more
  • Cuts benefits to Medicaid recipients
  • Cuts school services for disabled children
  • Could weaken employer sponsored health care along with plans sold on the exchanges, including removing coverage for the essential health benefits now in Obamacare, and removing prohibition on annual limits of coverage

The House plan could return us to the days when insurance companies made their profits by taking in premiums but finding ways to avoid paying out money on claims. Only selling insurance to the healthy very well could result in lower premiums, but this defeats the purpose of having health insurance. Republicans claim to be funding high risk pools to care for those with preexisting conditions, but they are only providing funding to cover five percent of those with preexisting conditions.

Of course, this will depend upon what happens in the states, and how many red states actually do opt out of the current requirements. Scott Walker has already stated he might apply for a waiver for coverage of preexisting conditions in Wisconsin.

Democrats are excited that this will help them politically, with some saying that the GOP just doomed itself. Even those who support many of the GOP goals see this plan as being politically damaging for Republicans.

Health care should dominate politics in upcoming cycles, but Democrats cannot count on this by itself being the key to retaking control of the House. Democrats need to keep up the pressure and do a far better job of making their arguments than they did when the Affordable Care Act was initially passed. It is questionable if anything resembling the House plan will ever pass the Senate and become law. (Presumably Donald Trump will sign whatever the Republicans pass, regardless of how much it violates his campaign promises).

Democrats could have the same problem in capitalizing on this as they did in promoting Obamacare. While some might lose insurance coverage immediately, many others might feel safe, not realizing that developing a medical problem could put them at risk of losing coverage in the future. Some will even be happy as young, healthy people very likely could wind up paying less–as long as they remain young and healthy. The adverse effects of this law won’t be fully apparent in 2018.

The Democrats could also lose due to their political cowardice. During the 2016 presidential campaign, Hillary Clinton opposed Bernie Sanders’ proposal for Medicare for All. Truthout debunked Clinton’s arguments. Now Nancy Pelosi and the Democratic establishment are refusing to take this opportunity to push for a single payer plan. The Observer’s view of Pelosi and mainstream Democrats is quite close to that expressed previously by Truthout:

Their failure to support a proposal that the majority of their base wants illuminates the growing disconnect between elected officials and their constituents and the massive influence of the health insurance and pharmaceutical industries. Americans want single payer health care, and the obstacles blocking them from the system they want are special interests, which are bought and paid for Democrats in office who avoid taking principled stances on issues. Democrats like Pelosi don’t stand for anything because fighting for something like single payer health care would upset the party’s wealthy donors.

Pelosi’s and other Democrats’ arguments excuse themselves from supporting progressive policies and reaffirm the Democratic Party as a corrupt entity tied to the wealthiest 1 percent of Americans. On May 1, the Washington Post reported a poll conducted in January among Trump voters who had previously voted for Obama. When those polled were asked what the Democratic Party stands for they gave responses like, “The 1 percent,” “The status quo” and “They’re for the party. Themselves and the party.” One woman, asked whether the Democratic Party is for people like her, flatly declared, “Nope.”

As Donald Trump has learned, health care is complicated. You cannot reduce costs without reducing coverage, unless you make fundamental changes in the system. The most obvious way would be a single payer plan which both removes the huge profits of the insurance industry and places everyone in the same risk pool. In hiding from this reality, Democrats show why they tend to lose and Republicans have been winning. Republicans did not care that their ideas have been far out of the mainstream. They pushed their ideas until they won over enough people to win, even if it has been on fallacious arguments. The party which stands for something, regardless of what it stands for, has an advantage over a party which stands for nothing. Thus we have seen the Democratic losses in 2010, 2014, and now 2016.