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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May 3: Democrats Should Call Out Trump’s Big Lies on Abortion
Everyone knows that Donald Trump can’t be trusted on abortion policy (or many other things). But his particular lies on abortion are worth noting, as I explained at New York.
There is no exercise more exhausting and probably futile than examining a Donald Trump speech or social-media post for lies, half-truths, and incoherent self-contradictions. But it’s important on occasion to highlight some very big whoppers he tells that are central to his political strategy. It’s well known that Trump’s own position on abortion policy has wandered all over the map, and it’s plausible to suggest his approach is entirely transactional. Now that he’s staked out a “states’ rights” position on abortion that is designed to take a losing issue off the table in the 2024 presidential election, he’s telling two very specific lies to justify his latest flip-flop.
The first is his now-routine claim that “both sides” and even “legal scholars on both sides” of the abortion debate “agreed” that Roe v. Wade needed to be reversed, leaving abortion policy up to the states:
This claim was the centerpiece of Trump’s April 9 statement setting out his position on abortion for the 2024 general election, as CNN noted:
“In a video statement on abortion policy he posted on social media Monday, Trump said: ‘I was proudly the person responsible for the ending of something that all legal scholars, both sides, wanted and, in fact, demanded be ended: Roe v. Wade. They wanted it ended.’ Later in his statement, Trump said that since ‘we have abortion where everybody wanted it from a legal standpoint,’ states are free to determine their own abortion laws.”
This is clearly and demonstrably false. The three “legal experts” on the Supreme Court who passionately dissented from the decision to reverse Roe are just the tip of the iceberg of anguish over the defiance of precedent and ideological reasoning underlying Justice Samuel Alito in the majority opinion in Dobbs v. Jackson Women’s Health Organization. The Society of American Law Teachers immediately and definitively issued a “condemnation” of the Dobbs decision. When the case was being argued before the Supreme Court, the American Bar Association filed an amicus brief arguing the constitutional doctrine of stare decisis required that Roe be left in place. None of these views were novel. Back in 1989 when an earlier threat to abortion rights had emerged, 885 law professors signed onto a brief defending Roe.
Sure, there was a tiny minority of “pro-choice, anti-Roe” liberals over the years who claimed resentment of the power of the unelected judges who decided Roe would eventually threaten abortion rights (not as much, it turns out, as the unelected judges that decided Dobbs). And yes, there have always been progressive critics (notably Justice Ruth Bader Ginsburg) of the particular reasoning in the original Roe decision, but by no means have any of them (particularly Ginsburg) favored abandoning the federal constitutional right to abortion even if they supported a different constitutional basis for that right. So Trump’s claim is grossly nonfactual and is indeed not one that any self-respecting conservative fan of Dobbs would ever make.
The second big lie that Trump has formulated to defend his latest states’-rights position is that he’s just supporting the age-old Republican stance on the subject, as he has just asserted at Truth Social:
“Sending this Issue back to the States was the Policy of the Republican Party and Conservatives for over 50 years, due to States’ Rights and 10th Amendment, and only happened because of the Justices I proudly Nominated and got Confirmed.”
Yes, of course a growing majority of Republicans have favored reversal of Roe as a way station to a nationwide ban on abortion, but not as an end in itself. The GOP first came out for a federal constitutional amendment to ban abortion from sea to shining sea in its 1980 party platform, and every single Republican presidential nominee since then has backed the idea. There have been disagreements as to whether such a constitutional amendment should include exceptions for pregnancies caused by rape or incest. But the last GOP presidential nominee to share Trump’s position that the states should be the final arbiter of abortion policy was Gerald R. Ford in 1976, as the New York Times reported at the time:
“[Ford] said that as President he must enforce the 1973 Supreme Court ruling that forbids states to ban abortions. But he has come out in favor of a constitutional amendment that would overturn that ruling and return to the states the option of drawing up their own abortion laws.”
Ronald Reagan, who challenged Ford’s nomination in 1976 and was already a proponent of a “pro-life” constitutional amendment, and the GOP formally adopted that position in 1980; four years later, it adopted its long-standing proposal that by constitutional amendment or by a judicial ruling the protection of fetal life under the 14th Amendment should be recognized and imposed on the country regardless of what states wanted. Anti-abortion leader Marjorie Dannenfelser noted this well-known history in a not-so-subtle rebuke to Trump’s revisionist history, as NBC News reported:
“’Since 1984, the GOP platform has affirmed that 14th Amendment protections apply to unborn babies and endorsed congressional action to clarify this fact through legislation,’ Marjorie Dannenfelser, the president of Susan B. Anthony Pro-Life America, said in a statement to NBC News. ‘Republicans led the charge to outlaw barbaric partial-birth abortions federally, and both chambers have voted multiple times to limit painful late-term abortion. The Senate voted on this most recently in 2020. In January 2023, House Republicans also voted to protect infants born alive during an abortion.’”
It’s pretty clear that anti-abortion activists know Trump is lying about both Roe v. Wade and the GOP tradition and will support him anyway. But the rest of us should take due notice that the once and perhaps future president’s word on this subject, including his current pledge to leave abortion policy to the states, cannot be trusted for even a moment. Absent the abolition of the Senate filibuster (which, lest we forget, Trump backed as president out of impatience with the Senate’s refusal to bend the knee to his every demand), there isn’t going to be a complete federal ban on abortion in the foreseeable future. But Trump can be counted on to use the powers of the presidency to make life miserable for women needing abortion services, among the many “enemies of the people” he wants to punish.