As you probably know if you’ve been following the presidential campaign news, Barack Obama released his long-awaited health care reform proposal earlier this week, and it’s getting decidedly mixed reviews from the chattering classes. Two progressive blogger/journalists with pretty good street cred on health care issues, Ezra Klein and Jon Cohn, have published quite similar takes, praising many of the details of the plan but decrying its timidity in challenging the health care status quo–most particularly its failure to provide universal coverage (other than for children). On the positive side, it does indeed seem that Obama’s plan represents sort of a greatest hits collection of incremental health care reform ideas. It picks up John Kerry’s underappreciated 2004 proposal for federal reinsurance of catastrophic health costs, which could have a big impact on rising insurance premiums. It adopts the federal employee health plan model for a national insurance purchasing pool, which makes abundant good sense substantively and politically. It calls for a federally-driven shift towards prevention and chronic disease management, along with IT investments to help control costs and improve quality, which ought to be a point of agreement among those who may disagree on financing mechanisms and/or the role of public and private sectors. It includes a direct assault on health care industry abuses through federal regulation, instead of treating such abuses as an unavoidable byproduct of for-profit involvement in health care. It does cover all kids, which makes sense if you aren’t going to cover everybody. And it provides very robust subsidies to make voluntary health insurance affordable to as broad a segment of the uninsured as possible, along with an employer mandate to avoid erosion of existing coverage. Those are a heap o’ positives, but the negatives, most especially the plan’s failure to include a universal individual mandate for health insurance, and its complexity, are likely to get more attention, on both substantive and political grounds. Substantively, the plan obviously fails to fundamentally overhaul the current system, with its patchwork of public and private programs, its heavy reliance on economically damaging and arguably regressive employer-based coverage, and its failure to cover everyone. And politically, the plan will reinforce claims that Obama isn’t quite the transformative, great-leap-forward progressive so many have seen in him. One particular problem for Obama is that his plan superficially resembles the Massachusetts initiative signed by Republican presidential candidate Mitt Romney, with the crucial exception that Massachusetts did include a universal individual mandate for coverage (underfunded, to be sure, but still in place). Another is that Obama’s plan achieves less than universal coverage at a pretty steep price tag, given its lavish subsidies to tempt rather than force individuals into obtaining insurance. Beyond the initial reactions, perceptions of Obama’s plan will be crucially influenced by his rivals for the Democratic presidential nomination. John Edwards is already in a position to exploit Obama’s incrementalism on health care, given his own comprehensive universal plan, which not only embraces an individual mandate for coverage but also provides a stronger Medicare-style public option attractive to Democrats who favor a single-payer system. Given Edwards’ competition with Obama for the support of left-leaning Democrats, this could become an important point of distinction between the two candidates, at least among activists. But the other shoe that will soon drop is Hillary Clinton’s; she’s slowly rolling out a very thorough and comprehensive health care reform proposal, building on her unquestioned expertise in this field. Still under wraps is what she would do to achieve expanded coverage. If she goes for a universal plan (which is quite likely), then Obama will begin to look like an incrementalist outlier among those who care about policy details.
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Editor’s Corner
By Ed Kilgore
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July 17: Looking at Newsom’s Complicated Plan of Retaliation for Trump’s Texas Power Grab
Democrats desperately want their politicians to fight back against Trump’s outrages, and California Governor Gavin Newsom has a plan for one kind of retaliation. I discuss the pros and cons at New York.
Just as nature abhors a vacuum, a national political opportunity is rarely passed up by California governor Gavin Newsom, a likely 2028 presidential candidate whose heavily Democratic state is both a target for and a major point of resistance against Donald Trump’s regime. So when Texas Republicans bent to Trump’s demand for a mid-decade re-redistricting of the state’s congressional map in order to gin up a few extra U.S. House seats for the GOP prior to the 2026 midterms, Newsom was predictably quick to respond, as Politico reports:Gavin Newsom suddenly can’t stop talking about Texas gerrymandering — and a provocative idea to counter it in California.
“On podcasts and social media, the California governor has threatened that if Texas follows President Donald Trump’s advice and redraws its congressional districts to shore up the GOP’s slender House majority, California should throw out its own maps to boost Democrats, circumventing or overhauling the state’s voter-approved redistricting commission.
“It’s a proposal capturing the imagination of a Democratic Party spoiling for another fight with Republicans and desperate to regain a foothold in Washington. This week, House Minority Leader Hakeem Jeffries privately huddled with members of the California delegation to discuss redistricting at the bloc’s weekly lunch. And in California, text threads are ablaze with discussions of what a redraw would look like, who would benefit, and how it would affect active efforts to recruit candidates and raise money.”
The idea of matching Texas in partisan audacity is catnip to Newsom, who has long engaged in long-distance rhetorical battles with the GOP leaders of the red megastates of Texas and Florida. But there’s a bit of a problem with a tit-for-tat response to the Lone Star State. In Texas, the legislature fully controls redistricting; it can do whatever it wants short of violating the increasingly toothless federal Voting Rights Act or “one person, one vote” considerations. California, by contrast, conducts redistricting via an elaborate citizens-commission process approved by voters in two constitutional-amendment ballot initiatives passed in 2008 and 2010.
Efforts to emulate the Great Texas Power Grab in California will require some risky legal and political work-arounds that will offend not just the opposition party but some actual voters. Newsom has obviously thought about that but seems willing to take the plunge via one of two strategies, as Punchbowl News reports:
“Newsom can call a special session. The legislature would put a proposition on the ballot that would “pause” the commission or rescind its redistricting power. California voters would have to approve this in a special election. They might not …“[A second] path is less likely because it is more complicated and legally murky. The California legislature would embark on redrawing districts under the theory that it is permitted because the state’s constitution is silent on mid-decade redistricting. And if the California constitution doesn’t address that scenario, then Democrats could do the mid-decade redraw without the commission.
“This strategy would depend on surviving a legal challenge. Newsom called it ‘a novel legal question.’ It’s a risky tactic, but could be done more expediently than a ballot initiative.”
It appears that California’s Democratic U.S. House members are onboard with the scheme, at least publicly, even though it might make some of their own districts marginally more competitive. It’s unclear, even if everything works out, that California could completely offset the Texas action: Punchbowl News estimates that a two-to-four-seat Democratic gain is possible in a legislative redistricting that ignores all the competition-enhancing principles of the current system; Trump has asked Texas Republicans for five more seats. And while there’s some talk of Texas backing down in the face of California’s threat, I wouldn’t count on that at all — this is Donald Trump demanding an egregious gerrymander, and it’s always possible the California gambit could backfire in the courts or at the ballot box.
California is significantly more Democratic in its voting preferences than it was when the citizens commission was adopted in order to take partisan politics out of the redistricting process. And without any question, highly partisan Democrats in and beyond California will love the idea of competing with the very worst Republican practices in imposing one-party rule in Washington and in the states. But some progressives and probably many independents will still be offended, and a few are making their voices heard already, Politico notes:
“‘Trying to save democracy by destroying democracy is dangerous and foolish,’ said Assemblymember Alex Lee, the head of the state Legislature’s Progressive Caucus. ‘By legitimizing the race to the bottom of gerrymandering, Democrats will ultimately lose.’
“Or as one Democratic political consultant granted anonymity to speak freely put it, ‘The idea of taking away the power from the citizens and giving it back to the politicians — the optics of that is horrendous and indefensible.’
“The consultant said, ‘That’s insane. That’s a crazy hill to die on.'”
There’s also some grumbling that this is a self-serving Newsom gambit, but asking California Democrats to subordinate their good-government instincts to the mission to match Republican partisanship will be a tempting proposition for most.