Democrats’ Unhealthy Debate Over Health Care

Plus, what's next for the budget deal By Yuval Rosenberg and Michael Rainey Democrats’ Unhealthy Debate Over Health Care Over the past two nights, Democratic presidential candidates spent [nearly a quarter]( of their debates arguing over their health care plans. While some useful contrasts came out of that back and forth, much of it was a muddled mess. Yes, health care is complicated. But the discussions thus far, especially Wednesday night’s confrontations, did relatively little to elucidate the candidates’ positions or the differences between Democratic plans — and perhaps even less to emphasize Democrats’ fundamental beliefs on health care and differentiate them from those of President Trump and Republicans. Some of the candidates scored well in that regard, but the health-care debate overall likely failed to help Democrats much — and probably didn’t do much to help voters, either. “The health-care debate on both nights tended to emphasize arcane points of disagreement between the candidates on sweeping proposals,” [writes]( The Washington Post’s Philip Bump. “Those attuned to the debate may have found the discussion informative; those not attuned to it may well have been baffled.” Some of that is the result of the debate format, which plays up head-to-head conflict while providing limited time for candidates to engage in more nuanced discussion. (CNN’s moderators exacerbated that issue by frequently asking candidates to respond to other candidate’s critiques.) Some of that is the result of the simple fact that health care is hard. In that regard, the Medicare for All plans being pitched by Sens. Bernie Sanders and Elizabeth Warren may have an advantage. “Complexity is an enemy in trying to sell a health reform plan to voters,” the Kaiser Family Foundation’s Larry Levitt [tweeted](. “Medicare for all has big political vulnerabilities, but it is a plan that people can understand and fits on a bumper sticker.” Overall, though, Democratic candidates would be well-served to refine their message and rethink their focus at this stage of the primaries. “A nasty case of Plan-it is”: Drew Altman, president and CEO of the Kaiser Family Foundation, says Democrats need to focus more on the big picture. “It’s important that candidates have plans for what to do about health-care costs and coverage,” Altman writes in a [Washington Post op-ed](. “But we’re way too focused on the details of candidates’ policy plans, and it’s not serving the voters’ needs well.” The details of the plans that candidates have been squabbling over would all change anyway before becoming law, he notes. “For now, the most important thing voters need to know is whether a candidate is for a single national health plan such as Medicare-for-all or is instead for building on the Affordable Care Act and setting up a new public plan as an option. That tells voters where candidates stand on the role of government and on spending, as well as where they are on the ideological spectrum relative to other candidates.” The health care debate was also notable for other elements it didn’t focus on: Lowering costs: Voters said leading up to the debates that it was very important that the candidates talked about health care. But in focus groups with likely voters in swing districts, the Kaiser Family Foundation has found that voters aren’t paying much attention to the details of the health-care debate, with many unaware of the term Medicare for All. “You listen to it but it all sounds like the teacher on Snoopy – wah wah wah,” one focus group participant said, according to Altman. The candidates gave those voters plenty more wah wah wah this week, but made little effort to connect their programs — or the systemic savings they insist they would bring about — to the problem Americans most want to hear about: lowering their own rising out-of-pocket costs. Hospitals: “Watching the debates, I got the feeling that there was a swear jar offstage, and candidates would be fined $10,000 if they said the word ‘hospitals’,” [David Dayen writes]( at The American Prospect. “The calculation has been made to choose insurance companies and pharmaceutical manufacturers as the core villains. The candidates have put shackles on themselves, content to debate whether to eliminate private insurance or how much the respective plans will cost. The price of health care, not insurance, was nowhere to be found, even though we pay the highest prices in the world, and concentrated hospital networks, not insurers, are largely to blame.” Protections for patients with pre-existing conditions: As [Bloomberg’s John Tozzi]( points out, the four nights of Democratic presidential debates thus far have hardly touched on one of the Democrats’ winning messages from the 2018 elections. On Wednesday night, former Vice President Joe Biden touted Obamacare’s protections for those patients and Sen. Kirsten Gillibrand of New York charged Republicans with trying to take away health care and make it harder for people with pre-existing conditions to afford. “But that message has been mostly absent from the primary debates, where health-care talk highlights the divisions between the party’s progressive left wing and its more moderate center,” Tozzi says. Or the Trump administration’s attacks on the ACA in general: New Jersey Senator Cory Booker responded to a question about Medicare for All by criticizing the Democrats for their attacks on each other. “The person that's enjoying this debate most right now is Donald Trump, as we pit Democrats against each other, while he is working right now to take away Americans' healthcare,” he [said](. “There is a court case working through the system that's going to gut the Affordable Care Act and actually gut protections on preexisting conditions.” If the law is ruled unconstitutional, some 20 million people stand to lose their health coverage. Proving Booker right, the Trump campaign issued a [statement]( following the debate, saying, in part: “While Democrats were bickering over big government socialism, President Trump scored another victory for Americans, announcing plans for the importation of cheaper, yet safe prescription drugs, which will save consumers billions of dollars.” Senate Sends $2.7 Trillion Budget Deal to Trump The Senate on Thursday approved the massive two-year budget deal passed by the House last week. President Trump is expected to sign the bill, which was negotiated by House Speaker Nancy Pelosi and Treasury Secretary Steven Mnuchin over the last few weeks. The Senate [vote]( was 67-28, with more Democrats (38) voting for the bill than Republicans (29). Five Democrats voted no, along with 23 Republicans, who nevertheless got a “majority of the majority” to support the package. Senate Majority Leader Mitch McConnell said the deal wasn’t perfect but reflected the comprise required by divided government. “This is the deal the House has passed. This is the deal President Trump is waiting for and eager to sign into law. This is the deal that every member of this body should support,” McConnell said before the vote. What the deal does: The bill sets discretionary spending levels at roughly $1.37 trillion per year in 2020 and 2021 and suspends the debt ceiling through July 2021. The spending levels are about $320 billion higher than those called for by the 2011 Budget Control Act, which expires in 2021 and will therefore no longer play a role in the budgeting process. The agreement will add an estimated $1.7 trillion to the national debt over the next 10 years, according to the Committee for a Responsible Federal Budget. What the deal does not do: The bill doesn’t actually fund the government. Instead, it defines total spending levels that lawmakers will use to write 12 required annual appropriations bills when they return to Washington after Labor Day. The House has already passed 10 of the 12 bills, although they will need to be revised in light of the budget deal. Congress will have just a few weeks to pass all of the appropriations bills before the new fiscal year begins in October. If it fails to do so, lawmakers will need to pass stopgap spending measures until any disagreements that crop up can be resolved. Funding for Homeland Security, which involves the border wall with Mexico, is one area that could potentially cause problems in September. The tea party’s last gasp? Conservative lawmakers and advocacy groups criticized the deal due to its effects on the debt and deficit. Sen. Rand Paul of Kentucky, one of the Republicans who voted against the bill, said Wednesday that the agreement “marks the death of the tea party” and fiscal responsibility. “Can you hear it? Can you hear the somber notes, the feet shuffling, the solemn tones ... It’s a dirge, a funeral march; it’s the death of a movement,” Paul said on the Senate floor. “A once-proud movement with hundreds of thousands of people gathered on the National Mall, it’s the death, it’s the last gasp of a movement in America that was concerned with our national debt,” Paul added. What comes next: Although there may be disputes about spending levels for specific programs such as border security, overall spending levels for the next two years are pretty well set — along with big jumps in deficit spending and increases in the national debt. Trump has hinted that he will cut spending if he wins reelection, but for now the president and the majority of lawmakers on Capitol Hill seem happy to avoid further fiscal fights. “Budget Deal is phenomenal for our Great Military, our Vets, and Jobs, Jobs, Jobs!” Trump [tweeted]( Thursday. “Two year deal gets us past the Election. Go for it Republicans, there is always plenty of time to CUT!” Number of the Day: 90% President Trump won more than 2,600 of the nation’s 3,000-plus counties in the 2016 election, and residents in nearly 90% of those counties — or more than 2,300 — have received some level of aid from the administration’s Market Facilitation Program, a $16 billion effort that compensates farmers for losses incurred as a result of Trump’s trade war with China. Drawing on a new report from the Environmental Working Group, The Washington Post’s Philip Bump [says]( the data “show the extent to which [the farm] subsidies overlap with Trump’s base of political support.” To be fair, about 80% of the counties Hillary Clinton won also received some degree of aid, Bump says, but there are many fewer of them, given the concentration of her supporters in urban areas. Overall, residents in more than 2,600 counties in the U.S. have received payments from the farm aid program, with the heaviest concentration in the Midwest. We can all use some [baby pandas]( today, right? Send your tips and feedback to yrosenberg@thefiscaltimes.com. Or connect with us on Twitter: [@yuvalrosenberg]( [@mdrainey]( and [@TheFiscalTimes](. And please ell your friends they can [sign up here]( to get their own copy of this newsletter. 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