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.
TDS Strategy Memos
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By Ed Kilgore
May 26: DeSantis Stumbles Out of the Gate
Like everyone else, I listened to DeSantis’s botched Twitter Spaces launch, but then reached some conclusions about the trajectory of his campaign at New York:
Before long, the laughter over the technical glitches that marred Ron DeSantis’s official presidential campaign launch with Elon Musk on Twitter Spaces will fade. We’ll all probably look back and place this moment in better perspective. Political-media folk (not to mention DeSantis’s Republican rivals and Democratic enemies) tend to overreact to “game changing” moments in campaigns when fundamentals and long-term trends matter infinitely more. Relatively few actual voters were tuned in to Twitter to watch the botched launch, and even fewer will think less of DeSantis as a potential president because of this incident.
It mattered in one respect, however: The screwed-up launch stepped all over a DeSantis campaign reset designed to depict the Florida governor as a political Death Star with unlimited funds and an unbeatable strategy for winning the GOP nomination. The reset was important to rebut the prevailing story line that DeSantis had lost an extraordinary amount of ground since the salad days following his landslide reelection last year, when he briefly looked to be consolidating partywide support as a more electable and less erratic replacement for Donald Trump. For reasons both within and beyond his control, he missed two critical strategic objectives going into the 2024 race: keeping the presidential field small enough to give him a one-on-one shot at Trump and keeping Trump from reestablishing himself as the front-runner with an air of inevitability about a third straight nomination.
To dissipate growing concerns about the DeSantis candidacy, the top chieftains of his Never Back Down super-PAC let it be known earlier this week that they had a plan that would shock and awe the political world, based on their extraordinary financial resources (fed by an $80 million surplus DeSantis transferred from his Florida reelection campaign account). The New York Times wrote up the scheme without questioning its connection to reality:
“A key political group supporting Ron DeSantis’s presidential run is preparing a $100 million voter-outreach push so big it plans to knock on the door of every possible DeSantis voter at least four times in New Hampshire, Nevada and South Carolina — and five times in the kickoff Iowa caucuses.
“The effort is part of an on-the-ground organizing operation that intends to hire more than 2,600 field organizers by Labor Day, an extraordinary number of people for even the best-funded campaigns….
“The group said it expected to have an overall budget of at least $200 million.”
In case the numbers didn’t properly document the audacity of this plan, Team DeSantis made it explicit. The Times report continues:
“‘No one has ever contemplated the scale of this organization or operation, let alone done it,’ said Chris Jankowski, the group’s chief executive. ‘This has just never even been dreamed up.’” …
At the helm of the DeSantis super PAC is Jeff Roe, a veteran Republican strategist who was Mr. [Ted] Cruz’s campaign manager in 2016. In an interview, Mr. Roe described an ambitious political apparatus whose 2,600 field organizers by the fall would be roughly double the peak of Senator Bernie Sanders’s entire 2020 primary campaign staff.
Clearly opening up the thesaurus to find metaphors for the extraordinary power and glory of their plans, one DeSantis operative told the Dispatch they were “light speed and light years ahead of any campaign out there, including Trump’s.”
Now more than ever, DeSantis’s campaign will have to prove its grand plans aren’t just fantasies. Those doors in Iowa really will have to be knocked. Thanks to Trump’s current lead, DeSantis will absolutely have to beat expectations there and do just as well in New Hampshire and South Carolina before facing an existential challenge in his and Trump’s home state of Florida. And while DeSantis had a good weekend in Iowa recently, picking up a lot of state legislative endorsements even as Trump canceled a rally due to bad weather that never arrived, he’s got a ways to go. A new Emerson poll of the first-in-the-nation-caucuses state shows Trump leading by an astonishing margin of 62 percent to 20 percent. And obviously enough, Iowa is where DeSantis will likely face the largest number of rivals aside from Trump; he’s a sudden surge from Tim Scott or Mike Pence or Nikki Haley or even Vivek Ramaswamy away from a real Iowa crisis.
Door knocking aside, a focus on Iowa, with its base-dominated caucus system and its large and powerful conservative Evangelical population, will likely force DeSantis to run to Trump’s right even more than he already has. The newly official candidate did not mention abortion policy during his launch event on Twitter; that will have to change, since he has a crucial opportunity to tell Iowa Evangelicals about the six-week ban he recently signed (similar, in fact, to the law Iowa governor Kim Reynolds enacted), in contrast to Trump’s scolding of the anti-abortion movement for extremism. DeSantis also failed once again to talk about his own religious faith, whatever it is; that will probably have to change in Iowa too. He did, however, talk a lot during the launch about his battle against the COVID-19 restrictions the federal government sought to impose on Florida even during the Trump administration. That will very likely continue.
The glitchy launch basically cost DeSantis whatever room for maneuvering he might have enjoyed as the 2024 competition begins to get very real — less than eight months before Iowa Republicans caucus (the exact date remains TBD). He’d better get used to spending a lot of time in Iowa’s churches and Pizza Ranches, and he also needs to begin winning more of the exchanges of potshots with Trump, which will only accelerate from here on out. All the money he has and all the hype and spin his campaign puts out won’t win the nomination now that Trump is fully engaged, and it sure doesn’t look like the 45th president’s legal problems will represent anything other than rocket fuel for his jaunt through the primaries. So for DeSantis, it’s time to put up or shut up.