As Newt Gingrich wrote, the U.S. economy has been growing and breaking records ever since President Trump first took office and Republicans took control of Congress.
Many in the GOP are hoping this success will help them get re-elected in November. Some consultants I’ve spoken with seem to think it will inoculate Republican candidates against most all Democratic attacks.
They are mostly right, except for one area – health care.
Here I have to modify his thoughts. I think that after this Judge Kavanaugh circus we are, no the Democrats are not finished with the “Me To”/sexual assault and “All Men Are Bad” push. They are going to mobilize the women and some of the crazy men who will listen to their leaders.
But let us continue with the health care issue.
No doubt, Republicans should be proud of the enormous success of the economy. But the economy won’t reach its full potential and the GOP will not win big in the 2018 elections unless Republicans deal with the cost of health care in America.
The reason is simple:
Health care represents nearly one-fifth of our country’s economy and is the largest driver of government spending. It is also such a huge slice of household budgets that many Americans don’t end up feeling the benefits of the 4.1 percent growth in the gross domestic product (GDP). In 2016, individual health care costs amounted to $10,328 per person (in 1960, that figure was $146).
As Dave Winston and Myra Miller at The Winston Group have noted, with nearly half of Americans saying they are living paycheck-to-paycheck (with no reserves for emergencies) it is hard for people to “feel the prosperity” implicit in a remarkably strong macroeconomy. Their individual micro-economies are too deeply impacted by the cost of health care.
Additionally, health care costs are outpacing income growth because businesses have had to eschew raises and promotions to afford more and more health care costs. According to a 2017 report by the Kaiser Family Foundation and the Health Research & Education Trust and federal income data, “premiums for an employer-provided family insurance plan have climbed 19 percent, while worker pay increased 12 percent.” The additional money Americans are receiving in their paycheck from the Tax Cut and Jobs Act helps, but lowering health care costs still needs to be a priority.
A Republican party that hides from the challenge of modernizing the health system is a party, which has conceded a huge part of the political playing field to the left.
Fortunately for Republicans – and for the country – we now have leadership capable of developing a serious strategy for a dramatically improved health care system. Secretary of Health and Human Services Alex Azar has the knowledge and the experience to help shape a new, profoundly better health system for all Americans.
Secretary Azar’s move this week to widen access to less expensive, short-duration health insurance plans was a step in the right direction. These plans will give Americans more options to buy the level of insurance they need for themselves – rather than being forced to buy more expensive coverage they don’t necessarily need.
President Trump’s earlier announced plan for reducing prescription drug prices will also be a huge help for families, and the administration’s support for the expansion of association health plans will provide more options for small businesses and self-employed individuals.
So, while there is still more work to be done, Republicans can point to positive steps that have been taken and progress that has been made — but they can’t shy away from talking about health care.
This reality of half the nation operating on the margin is what drives support for government-run health care, which is now sweeping large parts of the Democratic Party. If Republicans refuse to articulate a better solution, a large portion of the American people will decide that government bureaucracy is better than constant economic anxiety about unknowable, increasing health costs.
As I have written before, if the left wins on health care and puts in place a single-payer system, it would be a disaster.
So, to truly win the economic argument, Republicans must think through and win the health care argument. The dynamics of the fall campaign give them no choice. The Democrats’ government-run health care system will fill the gap left by the absence of a serious Republican alternative.
There is a long tradition of Republicans trying to avoid health issues. Consultants assert “it isn’t our topic.” Incumbents find it hard to communicate a clear policy or plan for improving the health system. “Repeal and Replace” was largely about repeal because Republicans lacked a coherent plan to replace ObamaCare. This is why it failed.
A Republican party that hides from the challenge of modernizing the health system is a party which has conceded a huge part of the political playing field to the left.
Conversely, a Republican party that can explain common sense improvements that will empower Americans to have longer lives, better health, greater convenience, more choices, and lower costs in healthcare is a party that can easily demolish the left’s arguments.
Healthcare Is The No. 1 Issue For Voters; A New Poll Reveals Which Healthcare Issue Matters Most
And as Robert Pearl, M.D. stated, depending on which news outlet, politician or pundit you ask, American voters will soon participate in the most important midterm election “in many years,” “in our lifetime” or even “in our country’s history.”The stakes of the November 2018 elections are high for many reasons, but no issue is more important to voters than health care. In fact, NBC News and The Wall Street Journal found that healthcare was the No. 1 issue in a poll of potential voters.
What’s curious about that survey, however, is that the pollsters didn’t ask the next, most-logical question.
What Healthcare Issue, Specifically, Matters Most To Voters? To answer this question, I surveyed readers of my monthly newsletter. Will the opioid crisis sway voters at the polls? What about abortion rights? The price of drugs? The cost of insurance?
See for yourself:
To understand the significance of these results, look closely at the top four:
- Prescription drug pricing (58%)
- Universal/single-payer coverage (57%)
- Medicare funding (50%)
- Medicaid funding (40%)
Notice a pattern here? All of these healthcare issues come down to one thing: money.
Healthcare Affordability: The New American Anxiety Because the majority of my newsletter readers operate in the field of healthcare, they’re well informed about the industry’s macroeconomics. They understand healthcare consumes 18% of the gross domestic product (GDP) and that national health care spending now exceeds $3.4 trillion annually. The readers also know that Americans aren’t getting what they pay for. The United States has the lowest life expectancy and highest childhood mortality rate among the 11 wealthiest nations, according to the Commonwealth Fund Report. But these macroeconomic issues and global metrics are not what keeps healthcare professionals or their patients up at night. Eight in 10 Americans live paycheck to paycheck. Most don’t have the savings to cover out-of-pocket expenses should they experience a serious or prolonged illness. In fact, half of U.S. adults say that one large medical bill would force them to borrow money. The reality is that a cancer diagnosis or an expensive, lifelong prescription could spell financial disaster for the majority of Americans. Today, 62% of bankruptcy filings are due to medical bills.
To understand how we’ve arrived at this healthcare affordability crisis, we need to examine the evolution of health care financing and accountability over the past decade.
The Recent History Of Healthcare’s Money Problems
Until the 21st century, the only Americans who worried about whether they could afford medical care were classified as poor or uninsured. Today, the middle class and insured are worried, too. How we got here is a story of evolving policies, poor financial planning and, ultimately, buck-passing.
A big part of the problem was the rate of health care cost inflation, which has averaged nearly twice the annual rate of GDP growth. But there are other contributing factors, as well.
Take the evolution of Medicare, for example, the federal insurance program for seniors. For most of the program’s history, the government reimbursed doctors and hospitals at (approximately) the same rate as commercial insurers. That started to change after a series of federal budget cuts and sequestration reduced provider payments. Today, Medicare reimburses only 90% of the costs its enrollees incur and commercial insurers are forced to make up the difference. As a result, businesses see their premiums rise each year, not only to offset the growth in their employee’s medical expenses but also to compensate hospitals and physicians for the unreimbursed portion of the cost of caring for Medicare patients.
Combine two high-cost factors: general health care inflation and price constraints imposed by Medicare and what you get are insurance premiums rising much faster than business revenues.
To compensate, companies are shifting much of the added expense to their employees. The most effective way to do so: Raise deductibles. By increasing the maximum deductible annually, the company reduces the magnitude of its expenses the following year, at least until that limit is reached. A decade ago, only 5% of workers were enrolled in a high-deductible health plan. That number soared to 39.4% by 2016 and jumped again to 43.2% the following year.
High-deductible coverage holds individual patients and their families responsible for a major portion of annual healthcare costs, anywhere from $1,350 to $6,650 per person or $2,700 to $13,3000 per family. This exceeds what the average available savings for most American families and helps to explain the growing financial angst in this country.
And it’s not just employees under the age of 65 who are anxious. Medicare enrollees also fear that the cost of care will drain their savings. As drug prices continue to soar, Medicare enrollees are hitting what has been labeled “the donut hole,” which means that once the cost of their “Part D” prescriptions reaches a certain threshold, patients are on the hook for a significant part of the cost. Now, more and more seniors find themselves having to pay thousands of dollars a year for essential medications.
When it comes to paying for health care, the United States is an anxious nation in search of relief. The fear of not being able to afford out-of-pocket requirements is the reason so many voters have made health care their No. 1 priority as they head to the polls this November. And it’s why both parties are scrambling to deliver the right campaign message.
On Healthcare, Each Party Is A House Divided
In the last presidential election, the Democratic Party chose a traditional candidate, Hilary Clinton, whose views on healthcare were closer to the center than her leading challenger, Bernie Sanders. Two years later, the party is divided by those who believe that (a) the only way to regain control of Congress is by fronting centrist candidates who support and want to strengthen the Affordable Care Act as the best way to attract undecided and independent voters, and (b) those who will accept nothing less than a government-run single payer system: Medicare for all. The primary election of New York congressional candidate Alexandria Ocasio-Cortez, a Sanders supporter, over long-time incumbent Joseph Crowley, represents this growing rift within the party.
The Republicans also face two competing ideologies on healthcare. Since his election in 2016, President Donald Trump has sought to dismantle the ACA. In addition, he and his political allies want to shift control of Medicaid (the insurance program for low-income Americans) from the federal government to the states—a move that would lower health care spending while eroding coverage protection. There are others in the Republican Party who worry that shrinking Medicaid or undermining the health exchanges will come back to bite them. Most of them live and campaign in states where voters support the ACA.
Do The Parties Agree On Anything?
Regardless of party, everyone, from the president to the most fervent single-payer advocate, understands that voters are angry about the cost of their medications and the associated out-of-pocket expenses. And, not surprisingly, each party blames the other for our current situation. Last week, the president gave the Medicare program greater ability to reign in costs for medications administered in a physician’s office. In addition, Trump has promised a major announcement this week to achieve other reductions in drug costs. Of course, generous campaign contributions may dim the enthusiasm either party has for change once the voting is over.
Playing “What If” With Healthcare’s Future
If both chambers remain Republican controlled, we can expect further erosion of the ACA with more exceptions to coverage mandates and progressively less enforcement of its provisions. For Republicans, a loss of either the Senate (a long-shot) or the House (more likely), would slow this process.
But regardless of what happens in the midterms, no one should expect Congress to solve healthcare’s cost challenge soon. Instead, patient anxiety will continue to escalate for three reasons.
First, none of the espoused legislative options will do much to address the inefficiencies in the current delivery system. Therefore, prices will continue to rise and businesses will have little choice but to shift more of the cost on to their workers. Second, the Fed will persist in limiting Medicare reimbursement to doctors and hospitals, further aggravating the economic problems of American businesses. whose premium rates will rise faster than overall health care inflation. Finally, compromise will prove even more elusive since so many leading candidates represent the extremes of the political spectrum.
Politics, the economy, and health care will all be deeply entangled this November and for years to come. I believe the safest path, relative to improving the nation’s health, is toward the center. Amending the more problematic parts of the ACA is better than either of the two extreme positions. If our nation progressively undermines the current coverage provisions, millions of Americans will see their access to care erode. And on the other end, a Medicare-for-all health care system will produce large increases in utilization and cost.
It’s anyone’s guess what will happen in three months. But, whatever the outcome, I can guarantee that two years from now healthcare will remain top-of-mind for voters.
The Memo: GOP to win Kavanaugh fight but Dems vow midterm revenge
Niall Stanage noted that Brett Kavanaugh is set to be confirmed to the Supreme Court on Saturday, notching a big victory for President Trump and the Republican Party — but one that carries sizable complications.
Democrats believe their voters are now more fired up than ever to deliver a rebuke to the GOP in the November midterm elections.
They vow that women’s anger at the judge’s near-certain confirmation, despite allegations of sexual assault and misconduct against him, will be a potent electoral force.
“What I have seen is anger and outrage from women in a way that I’ve never seen before,” said Karine Jean-Pierre, senior adviser and national spokeswoman for MoveOn, a progressive group. “I don’t think Republicans realize what they have unleashed.”
One national women’s group, UltraViolet Action, issued a stark two-sentence statement Friday from co-founder Shaunna Thomas.
“This doesn’t end tomorrow. It ends in November,” Thomas said.
Sen. Kamala Harris(D-Calif.), widely predicted to become a 2020 presidential candidate, made a broader argument that the GOP had disrespected women by backing Kavanaugh.
“To all survivors of sexual assault: We hear you. We see you. We will give you dignity. Don’t let this process bully you into silence,” Harris tweeted as the Kavanaugh drama neared its peak on Friday afternoon in the Senate.
Some Republicans had expressed concern earlier this week when Trump mocked Kavanaugh’s most prominent accuser, Christine Blasey Ford, during a rally in Mississippi. They worried that the president’s rhetoric seemed likely to cause deeper erosion of support for the GOP among suburban women in particular — a demographic that is already skeptical of the president.
An NPR/PBS/Marist poll conducted in late September showed Trump’s job approval rating to be very negative among college-educated white women. Fifty-seven percent within that group disapproved of Trump’s job performance, whereas only 38 percent approved.
At that time, GOP strategist Liz Mair told The Hill: “The party is already in trouble with suburban women. I just have a sneaking suspicion that the Republicans will find a way to mess this up. We are already in trouble with a group of voters we need to not totally hate us.”
But by Friday such concerns seemed to have been supplanted by satisfaction about getting Kavanaugh to the finish line.
Republicans believe they will be rewarded by conservative voters who might not have gone to the polls had GOP senators proved unable to confirm Kavanaugh, who’s spent the past 12 years as a judge on the U.S. Court of Appeals for the District of Columbia Circuit. Many social conservatives voted for Trump with a degree of ambivalence in 2016, given his colorful personal life, but did so in the hope that he would tilt the Supreme Court in their favor.
Kavanaugh’s confirmation would give the nine-member high court a solid 5-4 conservative majority.
“At the moment it appears that Republican voters, Trump voters, have re-engaged and are heading to the polls,” said GOP pollster John McLaughlin on Friday.
Had Kavanaugh plunged to defeat, McLaughlin asserted, “you would have a lot of angry Trump voters who would blame the Republicans and not show up” for the Nov. 6 midterms.
The Kavanaugh drama came to a head on Friday afternoon when Sen. Susan Collins(R-Maine), who had not previously declared her position, announced she would support him.
Moments after her announcement, Sen. Joe Manchin (D-W.Va.) became the only Democrat to cross party lines to back the judge. Manchin is seeking re-election this year in a state that Trump carried by 42 points in 2016 over Hillary Clinton.
The liberal dismay about those decisions was immediately evident on social media and elsewhere.
Susan Rice, who served as U.S. ambassador to the United Nations during former President Obama’s administration, suggested she would be willing to challenge Collins when she comes up for reelection in 2020. It was not clear if Rice was being serious.
Democracy for America, a progressive group, announced that it would work with “anyone we can to finish the job” of defeating Collins.
In a parallel development, former Alaska Gov. Sarah Palin (R) suggested she would consider challenging Sen. Lisa Murkowski(R-Alaska), who voted against Kavanaugh in a procedural vote Friday morning.
“Hey, @LisaMurkowski – I can see 2022 from my house…” Palin tweeted, referring to the year when Murkowski is up for reelection.
Beyond that, the sheer bitterness of the battle over Kavanaugh is striking to all sides.
“The starting gun for the 2020 election was fired with this confirmation fight,” said Ron Bonjean, a Republican who served as a communications strategist in the battle to confirm Trump’s first Supreme Court nominee, Neil Gorsuch, in 2017.
“This rollercoaster nomination has bonded both parties together in a way,” Bonjean added, “because of the intensity of it, how close this vote was and the unfair tactics both sides claimed the other party utilized.”
The president seemed to begin a victory lap on Friday. “Very proud of the U.S. Senate for voting ‘YES’ to advance the nomination of Judge Brett Kavanaugh!” he tweeted.
Democrats are hoping that air of celebration will be short-lived.
Who is correct? We will soon see!