Election 2020 #1

Here we are in another Presidential election cycle. It seems like only a bit more than 3 years since we elected our last President. During the 2015-2016 Presidential election cycle, I had a different title for every article. This time, I’m not going to be as creative (or confusing, depending upon your point of view). Each new post will simply be the next in this series.

The Democrats …

On October 15, 2019, the night of the fourth Democratic National Debate, there were 19 major [1]  candidates in the race to be the 2020 Democratic Presidential Nominee. Since that debate six candidates have dropped out … Tim Ryan on October 24th, Beto O’Rourke on November 1st, Wayne Messam on November 20th, Steve Bullock and Joe Sestak on December 2nd, and Kamala Harris on December 3rd.

On November 7th, Michael Bloomberg filed for the Alabama democratic presidential primary in order to meet that state’s deadline. On November 12th, he filed in Arkansas presumably for the same reason. He officially declared his candidacy on November 24th. Deval Patrick formally entered the race on November 14, 2019 … bringing the count to 15.

15 Candidates as of 3-Dec-2019

Twelve candidates qualified for the October 15th debate … Joe Biden, Cory Booker, Pete Buttigieg, Julian Castro, Tulsi Gabbard, Kamala Harris, Amy Klobuchar, Beto O’Rourke, Bernie Sanders, Tom Steyer, Elizabeth Warren, and Andrew Yang.

Only 10 qualified for the debate on November 20th … Joe Biden, Cory Booker. Pete Buttigieg, Tulsi Gabbard, Kamala Harris, Amy Klobuchar, Bernie Sanders, Tom Steyer, Elizabeth Warren, and Andrew Yang. (Julian Castro did not qualify and, of course, Beto O’Rourke had dropped out of the race).

10 Debaters on 20-Nov-2019

The next debate will be held on Thursday, December 19, 2019 (tomorrow night) on CNN and other sources. Only 7 candidates will be participating in the debate. The qualified participants are former Vice President Joe Biden; Mayor Pete Buttigieg of South Bend, Indiana; Minnesota Senator Amy Klobuchar; Vermont Senator Bernie Sanders; billionaire activist Tom Steyer of California; Massachusetts Senator Elizabeth Warren; and entrepreneur Andrew Yang of New York.

07 Debaters on 19-Dec-2019 855W

Kamala Harris also qualified but, of course, will not be participating because campaign funding shortfalls have forced her to leave the race.

 

In this first installment of the series (and some later ones), I shall not focus on all of the positions of all of the Democratic candidates. Instead, I want to discuss a prominent concern, healthcare coverage and costs. I shall refer to individual candidates only when a particular plan is connected to one or two candidates.

Healthcare

Coverage

While there are minor differences and nuances among the candidates proposing each, there seem to be two major ideas about how to assure universal healthcare in the United States:

  1. Medicare for All
    To many of us who are already signed up for Medicare, the term “Medicare for All” doesn’t do justice to S.1129 — 116th Congress (2019-2020), the bill introduced by Senator Bernie Sanders. [2]  When we hear the term “Medicare”, most of us think of Medicare A and B. Until we apply for Medicare (or listen to the onslaught of Medicare commercials on TV at this time of year), most of us don’t know that:
     
        a. Medicare A and B cover only about 80% of costs.
     
        b. Medicare B isn’t free. One must pay for part of Medicare B.
            Most of us have the cost deducted from our Social Security
            checks.
     
        c. Medicare A and B do not cover vision, dental care, or drugs.
            Medicare Advantage (or Medicare C) plans usually cover
            vision and drugs at an additional cost. Medicare D also covers
            drugs. Dental coverage usually requires a private plan.
     
        d. Medicare Advantage plans often require copays.
     
    S.1129 covers everything covered by Medicare A and B plus vision, dental care,  drugs, etc. with almost no copays. [3]  One way or another, “Medicare for All” will require a substantial tax increase. Proponents claim that the savings on medical expenses and insurance will be more than the increase in taxes … yielding an overall increase in real income for most of us.
     
    The major concern expressed by opponents of “Medicare for All” is cost. “How do you plan to pay for this?”, they disdainfully ask supporters. Bernie Sanders, who wrote S.1129, says very simply, “Taxes will go up” and “The cost of healthcare will go down”. Other candidates question the overall balance of the tax increase versus cost savings.
     
    Estimates of the 10-year cost of “Medicare for All” range from $13.8 trillion to $38.9 trillion. [4]  There is no question that the individual cost of healthcare would go down. It would go from the current average of $10,345 per person per year to essentially $0.00 per person per year. Over 10 years, given the present population of the U.S., that’s a savings of $34.1 trillion … about $27,207 per average household.
     
  2. Restore, improve, and expand the Patient Protection and Affordable Care Act. Most people call this legislation Obamacare, the Affordable Care Act, or simply the ACA. They tend to downplay or ignore the “Patient Protection” part of the act. One reason that the statement, “If you like your health care plan, you can keep it,” caused so much trouble for the Obama Administration was that some existing plans did not meet the standards of the “Patient Protection” parts of the act.
     
    When it became clear that a Republican-dominated Congress could not “repeal and replace Obamacare”, the Trump Administration began a series of tactics aimed at crippling the implementation of the law. Among other things, they removed links and information from websites run by the Department of Health and Human Services, weakened the protection for those who have pre-existing conditions, cut funding from supporting programs, cut the enrollment period in half, and reduced the hours of availability of Healthcare.gov.
    Several of the Democratic Presidential candidates have proposed undoing this damage, amending the original law to correct some now obvious weaknesses, and adding a “public option” to the list of available plans. If the public option became significantly more popular than the plans provided by private insurers, it might evolve into “Medicare for All” over time.

If it could meet the goal of individual healthcare savings exceeding individual tax increases, “Medicare for All” would seem to be the better approach except for one thing. In the light of public opinion, it is probably too much change too fast. From Social Security through Medicare and Medicaid and on to the Affordable Care Act, federally mandated social welfare programs have met an enormous amount of political and public resistance initially. All required a Democratic majority in the House and Senate for passage and a Democratic President to sign them into law. [5]  Although many Republicans call these programs “entitlements”, all have become increasingly popular with the passage of time. [6] 

If the 2020 election can provide a Democratic President and strong and progressive Democratic majorities in the House and Senate, S.1129 could become law. It is likely that it would generate a lot of whining and screaming from a public perennially nervous about sudden change. Adding a 100% coverage of all health needs (taken directly from S.1129) as a “public option” for the Patient Protection and Affordable Care Act might be the way to go. Those choosing might pay the premium as part of their Federal Income Tax as it would be if “Medicare for All” were the national healthcare approach. [7]  During the first year, only the “early adopters” would choose this “public option”. In 4 (or, maybe, 8 years) enough of the public would be comfortable with and taking advantage of the “public option” for the shift to the ideals of S.1129 to seem perfectly natural.

Healthcare and Prescription Drug Costs

For a number of reasons, the United States has the highest Healthcare costs in the world:

  • Decentralized billing and collecting increases administrative costs.
  • The costs associated with Healthcare vary widely from region to region.
  • The U.S. spends more than other countries for the same things. Drugs, doctors, hospitals, and medical equipment all cost more in the U.S.
  • Prices are less transparent and, in many cases, totally opaque.
  • The U.S. government intervenes less actively to force down prices than other countries’ governments do.
  • The Federal Drug Administration (FDA) has a backlog of generic drugs waiting for review.

Both “Medicare All” and “The Patient Protection and Affordable Care Act” attempt to deal with some or all of these problems.

 

The Republicans …

Not surprisingly, there are not as many candidates for the Republican Presidential nomination. Some state Republican Parties have decided to eliminate their primaries or caucuses. One can guess who the delegates of those states will back at next year’s Republican National Convention.

4 Candidates as of 8-Oct-2019 600W

I believe that I’ve made my opinion of the President abundantly clear in my 2018 article “Donald Trump” and my 2019 article “This is Your President!” I have nothing more to add. Doing so would be bad for my blood pressure. About the only things I know about South Carolina Governor Mark Sanford and Representative Joe Walsh from Illinois is:

  • They are both more conservative than the President. [8]
  • Neither of them seems to be actively campaigning nationally.
     

I am a bit more informed about former Massachusetts Governor Bill Weld. He was Governor of my state for over 6 years and he has been campaigning nationally insofar as being a guest on a number of cable news and network talk shows. He describes his political philosophy as fiscally conservative and socially liberal. That’s a difficult balancing act, but Bill managed it when he was governor. He worked well with Massachusetts’ perennially Democratically-dominated legislature.

 

… And 35 Senators

Voters will be deciding on 35 Senate seats in 2020. Currently, Republicans hold 23 of those seats and Democrats hold 12. Three Republicans … Johnny Isakson of Georgia, Pat Roberts of Kansas, Lamar Alexander of Tennessee … and one Democrat … Tom Udall of New Mexico … are not seeking re-election.

35 by Party 3 x 11

There are 23 Republicans and 12 Democrats in this group. The Senate of the 116th Congress is composed of 53 Republicans, 45 Democrats, and 2 Independents. The 2 Independents, Angus King of Maine and Bernie Sanders of Vermont, caucus with the Democrats. If all of the Democrats retain their seats (and a Democrat replaces the retiring Tom Udall), replacing 4 Republicans with Democrats (or Independent allies) [9]  would flip the Senate to Democratic Party control (51%). I especially encourage the voters of Kentucky and South Carolina respectively to put Mitch McConnell and Lindsey Graham out of our collective national misery.

In the less likely event that Democrats could replace 20 Republican Senators and win an additional 58 seats in the House of Representatives, they would have veto-proof control of the 117th Congress.

 
 [ Election 2020 #2 ]
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End Notes
  1. As of October 21, 2019, there were 904 candidates who claimed to be running for President, including:
     
            *  286 Democratic candidates
            *  133 Republican candidates
            *    41 Libertarian candidates
            *    18 Green candidates 
     
    Return to Point of Reference


  2. The bill is co-sponsored by Senators Tammy Baldwin, Richard Blumenthal, Cory Booker, Kirsten Gillibrand, Kamala Harris, Patrick Leahy, Ed Markey, Jeff Merkley, Brian Schatz, Tom Udall, Elizabeth Warren, Sheldon Whitehouse, Mazie Hirono, and Martin Heinrich.
     
    Return to Point of Reference


  3. In its present form, S.1129 allows for up to $200 per year  (adjusted for inflation annually) copays on drugs. Those who have an annual income at or below two times the poverty line will have no copays.
     
    Return to Point of Reference


  4. It’s not clear to me why presidential candidates tend to provide 10-year monetary projections. At best, they can be President (and, therefore, have direct influence) for 8 years. Then, some Bozo can be elected and wipe out as much of your work as possible (just ask Barack Obama). Maybe they or their number crunchers can multiply and divide only by powers of 10.
     
    In any case, Bernie Sanders (and Elizabeth Warren) estimate that “Medicare for All” will cost $34 trillion over a period of 10 years.
     
    Return to Point of Reference


  5. Social Security was passed by the 74th Congress and signed into law by President Franklin D. Roosevelt. Medicare and Medicaid were passed by the 89th Congress and signed into law by president Lyndon B. Johnson. The Patient Protection and Affordable Care Act was passed by the 111th Congress and signed into law by President Barack Obama.
     
    Return to Point of Reference


  6. The Republican Party wants the public to believe that the word “entitlements” refers to some sort of handout. You’re damned right that I’m entitled to my Social Security checks and Medicare health coverage! I paid the tax for them defined by the Federal Insurance Contributions Act (FICA) for my whole working life. (The Millennials may have passed the Baby Boomers as the largest generational demographic, but there are still a lot of us. Just try to eliminate our “entitlements” and see what happens.)
     
    As for the Patient Protection and Affordable Care Act … in a poll taken in 2017, when Congress and the President were trying to repeal and replace Obamacare, 17% of those who took the poll believed the ACA and Obamacare were different, while another 18 percent said that they didn’t know. That’s 35% folks.
     
    Return to Point of Reference


  7. I’ll leave it to Congress to figure outDumb as a Trump 125 how to roll an insurance premium into the Federal Income Tax of those who choose the public option. I believe they are reasonably intelligent people and that the “Dumb as a Trump” behavior being exhibited by many of them now is an anomaly.
     
    Return to Point of Reference


  8. It’s not surprising that these Mark Sanford and Joe Walsh are more conservative than Donald Trump. They are both at least nominally Republicans. The President is a Republican-In-Name-Only (RINO). Even if they have fallen victim to the Trumpist Party’s siren call, Mark and Joe have enough of the values of real Republicans to run against the usurper in the White House.
     
    Return to Point of Reference


  9. Of course, if Cory Booker, Amy Klobuchar, Bernie Sanders, or Elizabeth Warren is the Democratic Party’s Presidential Candidate, 5 Republican seats will have to be overturned.
     
    Return to Point of Reference
 
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