Category Archives: OpEd

Medicare-for-all: A New Vote

Senator Bernie Sanders (I-VT) speaks during an event to introduce the “Medicare for All Act of 2017” on Capitol Hill in Washington, U.S., September 13, 2017. REUTERS/Yuri Gripas

On September 13th, Bernie Sanders and 16 Democratic co-sponsors introduced the “Medicare for All Act of 2017” to establish a national health insurance program. Responses to the legislation, and its supporters, have ranged from praise to worry to scorn. Nobody expects the bill to pass. So should Democrats support this bill?

Supporters of the bill see the legislation as a way to focus the health care debate around universal coverage, rather than fixing Obamacare or “repeal-and-replace.” Pragmatic liberals, who may support universal health insurance, are worried there is not enough detail in Sanders’s legislation to demonstrate the feasibility of his plan. But Sanders has admitted his plan is meant to be a very rough draft – an opening bid.

Opponents are using the estimated cost of universal insurance coverage ($1.4 trillion per year) as another reason not to support the bill. Even Democratic legislators have expressed concern about the cost of universal coverage. Sen. Diane Feinstein recently told Politico she won’t support Medicare-for-all because “the cost is enormous.” Critics of the bill, however, are peddling an inconsistent argument. Some legislators who oppose the bill because of a lack of detail previously supported, and voted for, legislation introducing a high-cost program without specific details.

In 2002, 29 Democratic senators voted to send the United States to war in Iraq, despite the absence of a detailed plan. Depending on the source, the wars in Iraq and Afghanistan have cost between $1 trillion and $6 trillion dollars, which would have been enough to fund Sanders’s plan for approximately one to four years. Five Democratic senators, including Feinstein, who are currently not supporting the “Medicare-for-all” bill voted to approve the Authorization for Use of Military Force (AUMF), sending our country to war.

Our legislative history repeatedly shows that politicians ignore cost when they deem issues important. Another relevant example is the 2008 Troubled Assets Relief Program (TARP), which 39 Democratic senators voted to pass. Despite the high price tag, politicians considered the bill vital in the wake of the economic collapse of 2008, giving the Treasury Secretary broad leeway “to purchase troubled assets from any financial institution.”

Democrats need to put their reservations aside, as they have in the past, and support “Medicare-for-all.” If Democrats want to make national health insurance coverage mainstream, they need to visibly and repeatedly express support for the bill. Fox News and the Tea Party have succeeded in making more radical ideas mainstream by using discourse that consistently supports and familiarizes these ideas. Democrats should use this same tactic to build support for universal insurance coverage.

By making a significant, coordinated push to familiarize the public with universal health care coverage, Democrats can make a radical policy more socially acceptable in the future.

First-year Blake Rosser is a Master of Public Policy candidate interested in campaign finance reform and social justice.

Opinion: The Trump Presidency as a Catalyst for Millennial Activism

The views and opinions expressed in this article are those of the author and do not necessarily reflect the policy or position of the Sanford Journal of Public Policy.

Source: National Gallery of Australia

No election in modern history has so publicly exposed the political divide between the young and the old as the 2016 election of Donald Trump. Millennials voted overwhelmingly for Hillary Clinton, who garnered 55% of the 18-29 vote, while Donald Trump only picked up 37%. On the flip side, 53% of those aged 65+ voted for Trump and 45% voted for Clinton. This glaring divide in American politics between the young (18-29) and the old (65+) has widened dramatically since George W. Bush’s first election when there was only a two percentage point difference between the young and the old that voted Democrat. The historic Millennial unfavorability for Trump, his cabinet, and his policies may well serve as a catalyst that spurs an increasingly generation-divided electorate to activism.

Clinton’s electoral defeat came as a complete surprise to the majority of the country, especially Millennials. The loss was particularly surprising because Clinton’s odds of winning had been projected at 95% by Reuters/Ipsos three weeks before the election and 71.4% by Millennial statistical soothsayer Nate Silver, up until the day of the election itself.

The fact that Clinton won the popular vote by nearly 2.9 million votes, mostly from the Democratic and economic stronghold state of California, but lost the Electoral College is one manifestation of the specific characteristics that set Millennials apart from older generations. At 28.7%, Millennials make up the largest share of the US population, and are notorious for their lack of political participation.

Despite this, Millennials are ripe for activism not only because of Trump, but more broadly because of their youth, diversity, education, and discontent with their social and economic situation. Even though Millennials are the most well-educated generation, they are also underemployed and earn 20% less than their parents did at the same stage of life. Among Millennials themselves, there is a growing income gap between those with college degrees and those without, fueling a cultural gap as many college graduates head to liberal and economically powerful states on the coasts or to larger cities with relatively more job opportunities than the more rural or blue-collar communities from which they migrated out. For these non-urbanite Millennials, many of whom supported Trump, a common hope was that he would change the way Washington politics were “stacked against them.” However, by May of this year, only 40% of people said Trump had made such progress in changing the way Washington worked, while a majority 54% said he hadn’t. No wonder trust in the President to do the right thing has reached a nadir of just 24% among Millennials.

Only 32% of Millennials approve of Trump’s performance thus far, according to a poll released by the Harvard Kennedy School’s Institute of Politics. A new Pew study has identified a massive 23% shift of young Republicans (under 30) to the Democratic Party since December 2015, further emphasizing the fact that Millennials are dropping the GOP like hotcakes.

Here’s where my opinion comes in. In my view, my generation is one that is increasingly feeling isolated from society, disaffiliating from organized religion, and suffering from mental illness, bleak economic prospects, and manufactured crises, such as the opioid epidemic. Despite the unprecedented challenges we face from global warming and other man-made disasters, older generations have dismantled the very social institutions, specifically education and housing, that made them the most prosperous group of people in American history, to the detriment of my own. They brought about the election of Donald Trump who many Millennials believe won the election illegitimately. In fact, a majority of Millennials oppose a great many of Trump’s policies, including climate change, tax reform, legalized marijuana, the Muslim ban, and healthcare.

The latest decision of Trump to back out of the Paris Agreement is indicative of the entire presidency not only in its short-sightedness, but also in terms of its backlash. Every generation that faces immense global challenges, such as the Greatest Generation, must have a catalyst that spurs them to action, a crucible that forges their will and inspires them to organize. The Millennial backlash can be seen in the Women’s March in DC, which shattered the previous US record for largest one-day protest, and in the insurgent grassroots rise of special election Democrats, such as the razor thin losses in Georgia and South Carolina.

Despite the worrying trajectory that Trump’s presidency has taken thus far, perhaps the silver lining is that this presidency has and will continue to galvanize this country’s young into political participation and give them the tools to face the immense challenges of the next half century head on.

Phil Hah is a 2017 Master of Public Policy graduate interested in politics, renewable energy, innovation ecosystems, and international affairs.

Opinion: We’ve Got a ‘Oui’ Problem

The views and opinions expressed in this article are those of the author and do not necessarily reflect the policy or position of the Sanford Journal of Public Policy.

The decision to withdraw from the Paris Climate Agreement befuddled many experts, precisely because we know the factors that did not inspire the decision. Trump did not pledge to leave the deal because Trump-voting states no longer want to participate. The majority of residents in every state support the Paris deal. Some of Trump’s high-profile advisors and cabinet members came out against the decision, including Gary D. Cohn, Director of the National Economic Council, and Rex Tillerson, Secretary of State. Even Trump’s daughter, Ivanka Trump, opposed the decision to withdraw.

Despite pulling the country out of the Paris Agreement, Trump does not believe America is better off without a seat at “la table” (the French word for table). Trump made it clear he intends to negotiate a new climate agreement that allows America to get more and pay less: The Art of the Deal before our very eyes. Trump has made his (unsubstantiated) billions using this methodology. Buy low, sell high; buy one, get one free. Trump is always looking for a bigger, “better” deal.

Source: Peace Palace Library (2016)

Here’s how Trump’s deal making works: Let’s say I was a billionaire business tycoon (an unrealistic fantasy) with untamed hair (my daily reality). I have something you want, and you have something I want. But you need me more than I need you, so I feign disinterest until finally, in desperation, you come to me with a better offer. Transactional relationships are quite frequently fueled by an uneven power dynamic, and often result in the dominant player coming out ahead. Shoot, I hope I didn’t spoil the ending of Marx’s Capital for you.

But a globalized economic system is a lot more complicated than a two-person transaction. Trump’s constituents are already undermining his refusal to participate in the Paris deal. Individuals, corporations, and municipal and state leaders, including North Carolina’s Governor, Roy Cooper, are pledging their commitment to the Paris Accord. Michael Bloomberg pledged $15 million to the UN’s fight against climate change. $15 million barely scratches the surface of America’s commitment to the Paris Agreement, but indicates, in Bloomberg’s words, that Americans are “forging ahead.”Consumers want to buy green, and companies and governments are responding. Companies are more profitable if they promote and engage in sustainable initiatives. The public has spoken! They want those silly little light bulbs with the curly glass tubes.

Trump’s decision was nothing more than political stubbornness. I have faith in corporate America’s pursuit of profit (is anything more reliable?), and I believe economic incentives will continue to inspire a shift toward renewable energy and sustainability. But if exiting the Paris Agreement leads to a decline in cooperation between America and the rest of the world, then Trump’s “American Exceptionalism” will become “American Isolationism.” If relations with other countries sour, as nearly happened with Mexico, American consumers, particularly low-income Americans, will feel the burden of this artless negotiation.

Annie Krabbenschmidt is a second-year Master of Public Policy candidate interested in social psychology and organizational behavior.

Denial of a Safe Haven: Domestic Violence as a Means of Denying Healthcare

By Jason Richie‡

Although the intense debate surrounding health care reform has drawn attention to a variety of important issues, there has been little discussion regarding the denial of coverage to victims of domestic violence. Eight states—including North Carolina, Idaho, Mississippi, Oklahoma, North Dakota, Wyoming, South Carolina, and South Dakota—and the District of Columbia still allow insurers to deny health care coverage to victims of domestic abuse – a practice known as “pinklining.”

Although insurers do not ask applicants directly if they have been victims of domestic violence, they often review emergency room visits, doctors’ records, and even court-issued protection orders for grounds to deny care. The very agencies victims of domestic violence turn to for help, support, and guidance are in many cases being used against them, often with tragic consequences.

Georgia is one of eleven states that has modified its state laws on this issue since 2000, but it took the Georgia General Assembly nearly three years to makes these modifications. The bill passed unanimously 169-0, a feat that, according to Law Professor Rebecca Brannan, was in large part due to publicity surrounding the denial of coverage to a staff member at a Georgia domestic violence shelter after she was shot multiple times by her abuser.

More recently, Kaiser Health News, a subset of the Henry J. Kaiser Family Foundation, profiled the 2006 experience of an Albuquerque, New Mexico, attorney, Jody Neal-Post. Ms. Neal-Post, who herself advised victims of domestic violence, was rejected by her insurer after the insurer learned of counseling she had received following her own domestic abuse experience with her ex-husband. New Mexico’s Public Regulation Commission intervened, forcing the insurer to reverse its decision as required by New Mexico’s Domestic Abuse Protection Act.

Insurers use risk as a shield to deny care. Reasons for denial range from interpretations of domestic abuse as a pre-existing condition to the view that the abused person is somehow participating in a dangerous or alternative lifestyle. Fern Shen of The Washington Post quoted one insurance executive, saying, “Whether it’s battering or breast cancer or HIV or a sky diver or a person recovering from breast cancer, if we fail to take these things into account, it could lead us into bankruptcy.” An insurer can tailor its risk. A sky diver can choose his or her own risk. However, a victim of domestic violence or a patient suffering from breast cancer cannot choose her risk, despite the best intentions and the most stable circumstances.

Within North Carolina, county agencies and programs receiving funding from the North Carolina Council for Women/Domestic Violence Commission handled 101,076 crisis calls in 2007-2008, which are the most recent years that these numbers are available. While there are no figures as to how many of these callers were denied care, North Carolina’s history of pinklining puts these callers at further risk. Not only does the denial of health care coverage harm those trying to escape violent family members, but it also jeopardizes the lives of the millions of children who accompany their parents into newly formed family units. This denial further intensifies the victimization of those who have fought courageously in these often private struggles.

The North Carolina State Legislature enacted a statute banning the treatment of domestic violence as a pre-existing condition in 1997. However, the same statute also attempts to prevent a denial based on disability, medical condition, or past medical care – a measure that has proved largely ineffective. In an attempt to fill the void, North Carolina’s Insurance Commissioner, Wayne Goodwin, recently filed for a new addition to the North Carolina Administrative code that would explicitly prohibit the classification of domestic violence as a pre-existing condition.

Although Mr. Goodwin’s efforts are a step in the right direction, we need to guarantee that insurers do not continue to use domestic violence to deny health care coverage, a practice which routinely occurs with other items mentioned in the statute, including disability and medical history. North Carolina can use the health care reform movement as an opportunity to ensure that no adult or child is denied health care coverage for seeking help and a safe haven.

Jason Richie is a law student at the University of North Carolina School of Law.

The History of Health Care Reform: Where We’ve Come From and Why It Matters

By Sarah Cassanego‡

Today’s debate over comprehensive health care reform in the United States suffers from a lack of historical perspective. Many in the public seem to think that the crisis in our health care system recently appeared on the political scene. But in fact, the first calls for universal coverage came not under President Clinton in the 1990’s, or even President Johnson in the 1960’s, but during the Progressive Era – almost a century ago. In 1912, Teddy Roosevelt ran for president as the Progressive Party candidate on a platform that included national health insurance. Irving Fisher, a prominent Yale economist and reform leader, argued in 1917 that health insurance must be universal and obligatory – something he also thought was right around the corner.

Support for universal coverage ramped up during the years of the Great Depression and continued through World War II and the post-war years. Although health care costs are higher today than ever, concerns over rising costs also fueled mid-twentieth century calls for reform. In 1932, the Committee on the Costs of Medical Care released a report stating that millions of families who were not considered poor by conventional measures still faced financial ruin when family members got sick or hurt. But ironically, President Roosevelt, father of the New Deal and Social Security, never publicly advocated for universal coverage. Even President Truman, who delivered a number of special messages to Congress on the subject and is seen by some proponents of reform as the first great champion of universal coverage, did not aggressively take his cause to the American people.

Reform efforts achieved major success with the passage of Medicare in 1965. While President Johnson’s political skill played a key role in this achievement, so too did a unique political climate. In the wake of JFK’s assassination, Johnson received 61 percent of the popular vote and a two-thirds majority in Congress in the 1964 election, providing him a unique opportunity to pursue his legislative agenda. Momentum for reform built again with the election of President Clinton, but Clinton was never able to garner the level of support Johnson had.  Ultimately, the public came to fear the Clinton plan’s complexity more than the status quo.

Organized opposition to reform has had a similarly long history. Jill Lepore of the New Yorker describes how insurance companies warned in the late 1910’s that providing universal health care in California would “spell social ruin to the United States.” By the 1960’s, the threat of “socialized medicine” was in full force. The New York Times reported in June 1965 that the American Medical Association (AMA) had placed ads in 100 newspapers calling Medicare “the beginning of socialism.” Ironically, the AMA is now an entrenched defender of Medicare, denouncing proposed cuts to Medicare payment rates and advocating for changes that will “ensure seniors can count on Medicare now and for years to come.”

The key historical difference is that health care reform today faces a significantly more complex lawmaking landscape than in the past. In 1975, congressional rules changed so that a single piece of legislation could be referred to multiple committees. In the 1960’s, Johnson could concentrate his efforts on one committee chairman (whose opposition or support was paramount, but ultimately obtainable). Today, a president supporting health reform might have to work with five or six committee chairs, all with differing agendas and priorities.

Political parties are also more divided than ever. Medicare passed with the support of 83 moderate Republicans; this level of bipartisan support would be truly extraordinary in Congress today. According to the Congressional Quarterly, 2009 was the most partisan year since they started measuring in 1953. Over 50 percent of votes in the House and 70 percent of votes in the Senate were partisan (majorities in both parties voted against each other).

Finally, trust in government matters, and it is currently at an all-time low. In a 1958 American National Election Study, 73 percent of respondents said they trusted the federal government “just about always” or “most of the time.” A New York Times/CBS News poll from 2008 showed that number to be just 17 percent. While past and current polls have shown that Americans by and large support some kind of health care reform, distrust in government has increasingly overwhelmed major reform efforts.

In light of the long history of reform efforts and today’s legislative complexities, the recent passage of a health care reform bill under President Obama represents a significant accomplishment. But the debate over universal coverage will not end here, and understanding the history of reform efforts will remain vital as the debate continues. The history of health care reform is long, and the reasons for success and failure are complex. Each decade of debate has been both a repeat of the past and a unique moment in time. Unless we fully understand this dynamic history, today’s debate can only be based on semi-truths at best. And surely an issue as important as this one deserves better.

Sarah Cassanego is an alumna of the Sanford School of Public Policy at Duke University (Master of Public Policy program).