At The Plum Line, Paul Waldfman’s “‘Single payer’ is becoming Democratic Party consensus. Here’s the danger to avoid” identifies some lessons learned about health care politics. “So what lessons can we take from the experience of the ACA that might help Democrats as they move toward another enormous health-care reform?,” asks Waldman. “Here are a few”:

It’s going to take years. There’s a certain amount of wishful thinking in some quarters that goes like this: Medicare-for-all is an idea people find attractive; single-payer systems are simpler than what we have now; so all that’s required to get it done is the proper application of will. But it’s never that easy. It’s going to require lots of detailed policy work and lots of political work to prepare for the moment where Democrats control the presidency and Congress and can make it happen. We all laughed at President Trump when he said “Nobody knew that health care could be so complicated,” so liberals need to keep that in mind.

Disruption is frightening. The fact that people don’t want to lose what they have — and can easily be frightened into thinking they might — is a political reality that will always need to be dealt with. It helped defeat the Clinton plan, it helped undercut the ACA, and it helped defeat the Republican repeal effort. You can’t wish it away. If you’re going to change the insurance millions of people now have, you’d better have a darn good plan to overcome their fears.

We need to think about the transition from where we are now to where we want to go. Other countries with universal systems had an easier time putting them in place than we will, because health care was less complicated decades ago when they did it. We now have an exceedingly complex system in place and transforming it won’t be easy, so the plan we decide on has to be one we can get to from where we are now. The implementation of the ACA was hard enough; implementing a single-payer plan would be even harder. The design of your favored plan should include an understanding of what will happen in the first months and years.

Republican demagoguery is a certainty. Republicans will have legitimate critiques of any universal plan, but they will also tell insane lies about it. Remember “death panels”? Expect that times 10 in the case of single payer.

Beware the interest groups. Some on the left look with scorn on Obama’s decision to co-opt those groups, but if you don’t do that, you’d better be ready for a vicious fight. Insurers, drug companies, medical device makers, hospitals, doctors — they all have a lot of money at stake, and whatever plan you come up with, you’re going to have to deal with them.

There will be winners and losers. Democrats can reasonably claim that many more people will be better off if we move to a universal system, and that everyone has something to gain. But that doesn’t mean that there will be no one who winds up with something worse than they have now, and acknowledging that fact can help you prepare for the backlash.

You have to be able to explain it to people. This was one of the major liabilities of the ACA: It was a complex solution to a complex problem, and few ordinary citizens understood what it did. Single-payer systems start off with an advantage in this area; you can say “Everyone gets Medicaid,” and that’s easy to understand. But if that’s not your preferred plan, you need to find a simple way to describe it.

Waldman argues further that the term “single-payer” may be asking for trouble because it is too narrow. The term “suggests that the only system they’d accept is one in which there is one government insurer and no private insurers. That’s one possibility, but there are many other ways to get to universal, secure coverage that have multiple payers.” Further,

I happen to think the best and most achievable system given where we are is one in which there’s a basic government plan that covers everyone — an expanded Medicaid, perhaps — plus private supplemental insurance on top of it, a hybrid system of the kind that works well in countries such as France and Canada. The point is that it would be much better to speak of “universal coverage,” which allows for a number of different designs as long as they achieve the same goal.

Waldman concludes by repeating his first point, that it’s going to take years. It’s going to require phases, incremental reforms and hybrid public/private policies to move America toward universal coverage. Democrats have to accept that it’s all up to them, since the modern Republican Party is uninterested in building a bipartisan consensus, and seems wholly devoted to obstructing any forward progress on health care. That’s why the 2018 midterm elections are a critical priority for better health care in America.

At a breakfast hosted by the Christian Science Monitor, AFL-CIO President Richard Trumka explained why the labor movement won’t be finding much common ground with the white house anytime soon. As Don Gonyea reports at npr.org:

“You had one faction that actually had some of the policies that we would have supported on trade and infrastructure, but [it] turned out to be racist,” the union leader said….

…Trumka continued, describing the other faction inside the administration, “You had people who weren’t racist, but they were Wall Streeters.” He said that faction was gaining power, and moving the administration away from many of the things that Trump promised during the campaign that union members actually liked…”The Wall Street wing of his administration has won out and they’re doubling down on all the policies that got us here,” he said.

…As for Charlottesville and the president’s combative approach, Trumka described it as “a spirited defense of white nationalists, neo-Nazis and other groups of that sort, and we were not going to be associated with that.”

Ultimately, he says all of this left the AFL-CIO with no acceptable partner to try to work within the White House.

Jessica Corbett of commondreams.org quotes Trumka on the effects of Trump’s economic inaction:

“There’s no question that the optimism of a lot of people―our members, of all the sectors, not just the building trades, a lot of the optimism is fading,” Trumka said. “I think a significant amount of the optimism has faded away, because we haven’t seen an infrastructure bill, we haven’t seen the renewal of manufacturing, we haven’t seen the things that we were hopeful about that we could work with him on.”

Gonyea notes that “Labor endorsed Democrat Hillary Clinton. According to exit polls, she carried union households, but by just 9 percentage points. Compare that with President Barack Obama’s 18-point margin among labor voters four years earlier. The shift certainly helped Donald Trump secure victory in closely contested battleground states like Michigan, Wisconsin and Pennsylvania.”

As for how organized labor is preparing for the 2018 midterm elections, Monitor staff writer Francine Keifer reports,

“For a long time, our program stopped focusing on our members and giving them the facts they needed,” Trumka explained, when asked about what’s new in their approach to the coming election. “Now we’re going back and doing it every day.” As workers hear “the simple facts” about Trump’s actions, as he put it, people are beginning to “come back across the bridge.”

Polling indicates that’s starting to happen. A plurality of non-college educated white voters in the Rust Belt battlegrounds of Wisconsin and Michigan disapprove of how the president is doing his job, according to new NBC/Marist polls. In those states plus Pennsylvania, a large plurality of voters say he has not kept his campaign promise to bring back manufacturing jobs, and they want to see Democrats take back Congress in 2018.

He said his organization would focus on the “blue wall” in 2018 – traditionally Democratic states such as Wisconsin and Michigan that went narrowly for Trump – and that it would, in a sense, come home to its members.

It sounds like some of Trump’s white working-class supporters are beginning to bail, and there is no reason to think they will support Republican midterm candidates, who clearly support Wall St. more than workers. But many may stay at home on election day, unless otherwise inspired. The challenge for Democratic candidates in 2018 is to make it clear to disillusioned Trump voters that they will fight for fair trade, a major infrastructure investment and other programs that benefit working families..

At The Daily Beast Michael Tomasky has some choice words for Republican hypocrisy on federal spending. “You could say calling Texas politicians hypocrites because they voted against Hurricane Sandy aid but presumably want every federal dollar they can get their hands on now is shooting fish in a barrel,” Tomasky writes. “That, of course, doesn’t mean we shouldn’t do it. Some fish end up in barrels for a reason.”

However, Tomasky adds, “The flood victims are people and they’re Americans, and we should support them getting the federal aid they need, because we believe in the government doing this kind of thing irrespective of who the people are.” Helping Texas get through this disaster is part of our patriotic obligation and also a matter of simple human decency. But that doesn’t mean ted Cruz and other Republican politicians get a free ride on their double standard when it comes to helping people of other states when they experienced natural disaster, nor their monumental hypocrisy about government spending in general, as Tomasky points out:

We should have a discussion about hypocrisy on this question that’s a lot broader than disaster relief. How much federal money do those government-haters down in Texas get, anyway? How many federal dollars go to its many excellent research hospitals? How many federal highway dollars? How much federal money sustains Texas agriculture and livestock? How many senior centers and convention centers and community centers were built with federal money? It’s an awfully big state!

It can be hard to find answers to these questions because no single clearinghouse exists to provide, which is something I’ve long argued some rich liberal ought to fund (read this piece I wrote on the topic in the journal I edit). But I did find this on scientific research funding at higher-education institutions in Texas. The total amount was $4.52 billion in 2014, 45 percent of which came from the feds (20 percent private, 19 percent state, 16 percent from the institutions themselves). Here, if you’re interested, is a documentprepared by some outfit in Texas called the Legislative Budget Board that summarizes the federal money Texas receives in every area from human services to homeland security and everything else. Even if you do no more than browse through the table of contents, you’ll see the staggering extent to which the state, like any state, simply could not function without the federal dollars it gets. Federal funds across the board pay for one-third of everything the state of Texas does.

Democrats and liberals need to do a much better job of getting in the faces of Texas Republicans, and the ones from all the other deep-red states, and calling them on this. Suppose the next time a gun nut shoots up a movie theater in a red state, Democrats muse about withholding federal crime victim assistance money to that state? They shouldn’t do it, of course. But they should make citizens aware of the contradiction that the government-haters live every day of their lives.

Further, notes Tomasky:

Let’s get out of the false narrative that there’s either rugged self-reliance (laudable, American!) or government dependence (weak, foreign!) and nothing in between. In real life, virtually everything is in between. Everybody—yes, everybody—needs the federal government. Even the richest Texas oilman, needs police protection, a fire department, good roads to drive on, clean water to drink and air to breathe, someone to clear take-off and landing for their private planes, and 50 other services that only government can provide and only tax dollars can pay for. I’d happily acknowledge that yes, sometimes government does get in the way, provided they’d acknowledge this obvious truth.

As Tomasky concludes, “So let’s save Houston. But while we do it, let’s remind Texas what it owes Washington.” And let’s do a better job of reminding voters that the same Republicans who trash federal government spending can often be found feeding on it in their home states.

The following article by Democratic strategist Mike Lux, author of The Progressive Revolution: How the Best in America Came to Be, is cross-posted from HuffPo:

The following article by William A. Galston, Ezra K. Zilkha Chair and Senior Fellow – Governance Studies at Brookings and author of  Public Matters: Politics, Policy, and Religion in the 21st Century, is cross-posted from Brookings:

An NPR/PBS News Hour/Marist poll released on August 16contained bad news for President Trump. Only 31 percent of registered voters believe that his response to the events in Charlottesville, Virginia, was strong enough, compared to 51 percent who think that it was not.

A CBS News poll released the next day continued the drumbeat, with a new twist: the more the president reacts, the deeper the hole he is digging for himself. Among respondents surveyed before Mr. Trump’s impromptu news conference on Tuesday, 35 percent approved of his response and 52 percent disapproved, a negative margin of 17 points. Among those surveyed after the news conference, approval fell slightly, disapproval rose sharply, and his negative margin widened to 25 points.

In both surveys, reaction to the president divided along partisan lines, with a majority of Republicans supporting the president and majorities of Democrats and Independents opposed. But there was a surprise that should give the rally-the-base strategists in the White House pause: although 59 percent of Republican respondents in the NPR/PBS/Marist poll felt that that Mr. Trump’s Charlottesville response was strong enough, just 32 percent of white working-class voters—the linchpin of Mr. Trump’s upset victory last November—agreed.

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Regarding the impact of Obama-Trump voters in 2016, Nate Cohn writes at The Upshot:

The story of the 2016 presidential election is simple. Donald J. Trump made huge gains among white voters without a college degree. His gains were large enough to cancel out considerable losses among well-educated white voters and a decade of demographic shifts.

There are questions and details still up for debate: whether Democrats can win back these voters, and how to think about and frame the decline in black turnout. But postelection surveys, pre-election surveys, voter file data and the actual results all support the main story: The voters who switched from President Obama to Mr. Trump were decisive.

Cohn cites a study which “found that 9.2 percent of Obama voters flipped to support Mr. Trump — a hair lower than the estimates from other surveys.” But Cohn emphasizes that the Obama-Trump voters were critically-important in key states, noting that Clinton “lost primarily because of the narrow but deep swing among white working-class voters who were overrepresented in decisive battleground states.” Further, “Just 74 percent of white Obama voters with a high school diploma or less backed Mrs. Clinton,” according to the Democracy Fund Voter Study Group. “Similarly,” notes Cohn, “the Cooperative Congressional Election Study found that Mrs. Clinton won just 78 percent of white Obama voters without a bachelor’s degree. The figure was even lower in the key Rust Belt battlegrounds.”

Cohn adds that “Strong evidence suggests a lot of these voters will lean Republican for the foreseeable future, and certainly will lean toward Mr. Trump. But Democrats can still win a meaningful and potentially decisive share of these voters, many of whom probably voted Democratic down-ballot in 2016.”

Cohn concludes that “it does seem likely that at least a portion of the Obama-Trump vote can be lured back to the Democrats — especially against traditional Republican candidates who emphasize small government, free markets and social conservatism…Whether that means it should be the crux of the Democrats’ path to power is another question. But it will most likely be a part of it, and will probably need to be for Democrats to secure parts of the Rust Belt that continue to play an outsize role in American elections.”

And what keeps getting overlooked in many media discusssions of Democratic prospects for winning back white working-class voters is that it doesn’t have to be a majority, or even a plurality of this large constituency — just a bigger share in key states.

Read more…

The following article by Ruy Teixeira, author of The Optimistic Leftist: Why the 21st Century Will Be Better Than You Think and other works, is cross-posted from his blog, “The Optimistic Leftist”:

Some have argued that the emotional bond between Trump and his supporters is so strong that it’s nearly impossible to break.

I don’t believe this is true for a couple of reasons. First, Trump is attached to the GOP and the GOP is remarkably out of touch with the voters who supported Trump. This is a non-trivial problem, as Ron Brownstein explains in The Atlantic.

The Senate Republican health-care bill has been repeatedly crushed in a slow-motion collision between the party’s historic ideology and the interests of its modern electoral coalition. Yet congressional Republicans appear determined to plow right through the wreckage.

Even as the Senate’s latest effort to repeal the Affordable Care Act collapsed on Tuesday, the House Republican leadership released a 10-year federal-budget blueprint that points them toward a similar confrontation, between their dominant small-government dogma and the economic needs of their increasingly blue-collar and older white base.

The Urban Institute found that 80 percent of those who would lose coverage under the Senate repeal-and-replace bill were non-college educated, 70 percent worked full-time and 60 percent were white. Rural areas would be particularly hard hit by the Medicaid cuts and so on. Candidate Trump of course said he would do none of this stuff but that went out the window once he started dealing with Congressional Republicans and their libertarian proclivities.

This matters. Brownstein notes that Trump’s approval ratings among white noncollege women is now 19 points lower than his vote support among this group back in November. Will all of these voters abandon him? No, but if a serious chunk does it will hurt both him and the GOP.

But isn’t it true that Trump’s overall support has been rock-steady? On net, aren’t his voters sticking with him? This is a myth. It is certainly true that he retains most of this support. But that’s different from all. Brendan Nyhan points out in a New York Times Upshot column that the seeming stability in Trump’s approval rating among GOP partisans may be an illusion. This is because Republican identifiers who disapprove of Trump may cease identifying as Republicans, thereby propping up his numbers among that group. But he’s still losing support.

A new Ipsos poll finds that one in eight Trump supporters from last November now say they aren’t sure they’d do it again after the last six months. We don’t know of course whether these voters would actually follow through on their sentiments. But it is not a good sign, either for Trump or the GOP.

People are reluctant, understandably so, to believe in Trump’s vulnerability. People will not soon forget the night of November 8, 2016 when nothing turned out like it was supposed to. But if his supporters have a fear of falling downward economically, what happens if they conclude he can’t stop the fall, much less lift them up? He will be punished like all politicians. It is just a matter of when and how much.

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The following interview of Ruy Teixeira by John Judis, co-authors of The Emerging Democratic Majority and other books, is cross-posted from Talking Points Memo:

Ruy Teixeira (pronounced Tush-aira) and I have been friends since the early 1970s when we were members of a socialist group, the New American Movement, that was supposed to perpetuate the saner parts of the new left. (It merged later with the Democratic Socialist Organizing Committee to form the Democratic Socialists of America.) I didn’t see him for 15 years or so until we both turned up in Washington, D.C. In 2001, we co-authored “The Emerging Democratic Majority.”  Radio and television producers would sometimes call me to do interviews because, one TV person explained, they wanted someone who could speak English clearly. In fact, Ruy, the son of a Portuguese diplomat, was born and raised in Silver Spring. Ruy has worked with various think tanks in Washington and most recently has been a fellow at the Center for American Progress. His new book is titled “The Optimistic Leftist: Why the 21st Century will be Better Than You Think.” It’s a potentially tough subject, but Ruy writes clearly and persuasively, and it’s surprisingly easy to read. As readers will note from this interview, I don’t quite share Ruy’s optimism, but I certainly hope that he is right.

Judis:  In your book, you explain at several points that you are no longer a socialist and instead support a reformed capitalism. When we met many years ago, we were in a socialist organization. When did this transformation occur?