Friday, February 12, 2016

Clinton vs. Sanders, a matter of style...

As the Democratic primary race has tightened nationwide, my FaceBook feed has been filled with angry rants from both Clinton and Sanders supporters (I freely admit that some of those rants were my own). As I have thought about the two candidates though my anger has subsided a bit.

This is a very good time to be a Democrat. We have two candidates who are both strong proponents of civil rights and LGBT rights. We have two candidates who both care about health care reform and income inequality (although to different degrees). We have two candidates who care about the environment and women's rights. All of us who are Democrats can rest assured that no matter who gets the nomination they will be vastly better than any of the candidates offered by the Republican party. Of course having two good candidates can cause a problem. How do you decide who to vote for in the primaries? Should we just flip a coin before we flip a lever in the voting booth? Of course we shouldn't, while there are good reasons to vote for either candidate there is one important difference that has helped me to make my decision and might help you with your decision as well. That difference is the opposite political style of each of the candidates.

Style is a word that sounds frivolous in this context but I think it is the word that works best. I'm not talking about hair or clothing, I am talking about the candidates approach to governance and their approaches are considerably different.

Let's look at health care for an example of this difference and why it matters. A few weeks ago Hillary Clinton's daughter Chelsea Clinton was making a speech for her mother's campaign in which she said that Bernie Sanders wants to get rid of the Affordable Care Act. This was a bit disingenuous as it made it sound like Sanders wants to return to the completely broken system that existed before the ACA was passed. In fact he wants to expand health care coverage and lower costs by instituting a single payer system, but the statement said a lot about the political style of the candidates.

Hillary Clinton would claim that Sanders is a radical with his head in the clouds. There is no way he could get a single payer system passed through Congress and she may very well be right about that. However, she says this in a way that implies trying to put a single payer system in effect would destroy the ACA. I believe that it would do just the opposite, even if Sanders failed to implement a single payer system just the effort put into trying would do a considerable amount to protect the ACA. Let me tell you why.

As soon as the ACA became law, Republicans started to attack it. A lot of Democrats seem to take a bit of joy in the fact that the Republicans keep failing to repeal the ACA but we shouldn't get too cocky. The Republicans have already managed to reduce the effectiveness of the ACA with a US Supreme Court case in which a majority of the justices ruled that states could not be required to expand their Medicaid programs. In my home state of Tennessee this has meant many still can't find health care they can afford, which means that they are being fined for not having health care, which also means they still can't afford to go to the doctor or hospital when they need care, which means that hospitals in Tennessee are laying off health care workers or shutting down completely because they aren't receiving an increase in patients to compensate them for the reductions in Medicare payments required by the ACA. So yes, the Republicans have failed to repeal the law but that doesn't mean they haven't done quite a bit of damage to it and limited its effectiveness. We should also remember that recently an attempt to repeal the law didn't just pass in the House, it also passed in the Senate. Luckily it didn't pass with a high enough margin to make it veto proof but it is a sign that the Republicans could be getting closer to their goal. So how will Clinton and Sanders respond to this?

Clinton seems to be interested in taking a defensive position to deal with this issue. She wants to continue to hold off the Republican attacks on the ACA with her veto power and rallying Democrats in Congress to not vote for the Republican bills. This has worked so far for President Obama, but we don't know that it would continue to work for Clinton. Clinton is not well liked by Republicans, in fact they may dislike her even more than President Obama. Putting the word "president" in front of Hillary Clinton's name is only going to enrage them even more. She may face a tougher fight than Obama has to protect the ACA and we have no idea how many Democrats there will be in Congress to help her. We know it would be almost impossible for Democrats to gain a majority in the House because of gerrymandering and regaining a majority in the Senate will not be at all easy, we could even lose seats in both houses. This could mean Clinton would have a massive battle on her hands that we can't be certain she will win.

Sanders, on the other hand, wants to introduce legislation to set up a single payer system. If he succeeds, we will have a new health care system that will provide universal coverage, lower costs, and might even find support in the business sector as it would prevent them from having to provide health insurance to their employees and create considerable savings for them. Of course it will face a very negative response from Republicans and no one could say with a straight face that it would be an easy piece of legislation to pass. Of course just focusing on if it could pass or not doesn't tell the entire story.

Under a Clinton presidency Republicans would be free to put considerable time and effort into repealing or weakening the ACA, and they might wind up being successful. Under a Sanders presidency the Republicans wouldn't be able to focus on repealing or weakening the ACA because they would be forced to fight against Sanders' single payer plan. If Sanders' plan didn't pass, well guess what, we would still have the ACA in effect. We might also, as the fight against the single payer plan unfolded, manage to get the Republicans to agree to some measures strengthening the ACA in order to prevent a single payer plan from taking effect. In other words the Republicans would have to stop fighting to move us backwards on health care and instead would have to fight against moving forward on health care. I like our odds in that fight a whole lot more and I believe if nothing else Sanders' single payer plan would effectively safeguard the ACA from future attacks, at least for a while.

Of course Sanders' style of playing offense has advantages across the board. We have to try for more to even know what we can get. If we keep the Republicans in a defensive stance, if we make them fight against progress and fight against making people's lives better, their popularity will suffer. If we, with Clinton take a primarily defensive position it puts the programs we support in peril. We give the Republicans a strong advantage. You can only score when you have the ball. We have let the Republicans hold on to the ball for far too long.

The governing styles of Clinton and Sanders look like they would be very different even if they share a lot in common on the issues. Democrats have taken the position as fighters for a long time, it is time we have a leader instead of a fighter. Political style makes a tremendous difference and I believe that Bernie Sanders has the exact style that we need right now.

2 comments:

  1. With regard to the single payer health plan: Sanders seems to be saying that the USA will immediately enter into a situation like Canada where the doctors work for the government and draw a paycheck; and the patients come get treatment with no cost to them. If I'm misunderstanding this, please say. I don't see how we are going to get these overpaid fat cats in the medical world to go along here. There are some doctors who won't even take Medicare and lots who won't take Medicaid. And those programs just discount what they are willing to pay the doctors. Of course, the doctors and hospitals have simply increased their billed amounts, etc... and we all know where this trickle down or pass up the line or whatever it is will go. Just wondering how to implement the de-privatization of the medical professionals.

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  2. Actually no. Single payer systems come in a few different forms. In the UK the government owns the hospitals and all of the doctors and nurses are government employees. This is a very efficient way of doing things because the government controls pretty much all aspects of health care and so a system like this will produce the lowest health care costs. Canada, on the other hand, does not control all aspects of health care. There are private hospitals and most doctors and nurses don't work for the government (a few do, but some do in the US as well, think of VA hospitals). In Canada the government just acts as the health insurance company, it does not control all of the other aspects. This type of system may not lower health care costs as much as the UK system but it can still keep them under control fairly effectively because every person in Canada belongs to the same health insurance plan which gives that plan tremendous negotiating power when they are deciding pricing with the hospitals, health care workers, and drug companies. While all Canadians belong to the government plan they can also opt to get secondary private insurance which can get them nicer accommodations in hospitals, cover elective procedures, and offer other benefits not available through the government plan.
    What Bernie is proposing is Medicare for all. This would build on our already existing Medicare program and extend it to every American. The doctors, hospitals, and so on would be, as they are now, working independently and would not be government employees. They would just not have to deal with a multitude of health insurance companies any longer, they would only deal with Medicare (although I would guess that secondary private insurance would also be available if a person chose to get it, but the vast majority of payments to the hospitals and doctors would come from Medicare). This would mean that the hospitals and doctors would see a huge reduction in their administrative costs as they would know in advance what they would be paid for a procedure and they wouldn't need an army of employees to just file billing paperwork and to try to keep up with all of the different insurance company policies. This would be a much simpler, more cost effective, and effective way of doing business for everyone and their would be no de-privatization of health care workers.

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