Health Care

Today, US News published Simon's latest column, “Make ACA Sign-Ups an Annual Civic Ritual.”  An excerpt –

.....Somewhere around 1 in 12 Americans of any age – about 25 million people – get their health insurance and health care through provisions of the Affordable Care Act. The annual period to sign up for insurance starts on Nov. 1, and it is critical that responsible members of both political parties – but particularly Democrats – commit time and resources to help people sign up this year.

Why is this so important? Because, remarkably, President Donald Trump's administration has taken a series of dramatic steps to make it harder for his fellow citizens to sign up under the health care law this year. It has cut the enrollment window to sign up from 12 to just six weeks, and is spending far less money marketing the enrollment period to the public (TV ad spending is dropping from $100 million to $10 million). Regional directors in the Department of Health and Human Services were told not to participate in outreach events and administrators will take down healthcare.gov on most Sunday mornings during the already shortened enrollment period. It is likely that without a significant push by office holders, community leaders, health care providers and regular citizens, millions of Americans could miss the deadline this year and end up without insurance. It is hard to believe that our government is taking such aggressive steps to make it harder for American citizens to get affordable care – but it is so. And those of us who believe in the ACA, as the law is known for short, should do something about it.

To continue reading, please refer to the US News link. You can Simon's previous US News columns here.

Looking out onto the smoky, endless skyline of Seoul, Korea, I think about our two nations’ similar economic paths, from abject underdevelopment to world-class modernization and wealth. In the 19th century, there was one place in the world that managed to move all the way up from low-income to high-income, and that was the United States. From 1870 to 1970, another society, Japan, managed the same achievement. Now, one other society will make the same great leap from 1960 to 2030 or so, and it will be Korea. If you doubt it, consider that since 1960, the real per capita income of Koreans has grown 37-fold, and the country’s real GDP has expanded up 50-times. They’ve managed it in much the same way we did – making huge, sustained investments in education and infrastructure; sustaining a voracious work ethic animated by meaningful jobs open to anyone able to perform them; adopting astute policies that support native businesses but also expose them to foreign competition from more advanced rivals; and setting global ambitions for the nation’s economy. 

Yet, even these achievements by Korea in this period and by ourselves a while ago don’t guarantee future success. Korean policymakers, businesses and workers certainly all face difficult challenges. But our interest here lies in our own, future path. President Obama and Congress, beset by a series of crises, have found themselves playing the role of a fire brigade. To his genuine credit, the President reached past the fires around him to drive basic health care reforms, a remarkable exercise of presidential will even if we’re unsure of their real costs and benefits. Alas, the achievement represents only a modest piece of a larger economic strategy still waiting to be articulated and carried out, if we are to hope for a better economic future than the one being deeded to most Americans by the mistakes and dismal neglect of the preceding administration.

This is the first of three essays in which we will lay out a new economic strategy for the next decade. The last time such large ambitions were seriously attempted, they it came from conservatives led by Ronald Reagan, who also tried to surmount the emergencies of his time with broader reforms. Perhaps less than half of that attempt proved to be sound, and more than half clearly was not; but they all left long legacies. The big task for Mr. Obama and progressives today is to think and act as big as Reagan, and get at least three-quarters of it right this time.

Today, we will lay out the three basic parts of that task and begin to think through the first of them. These three economic challenges that demand basic reform are: 1) Restore real prospects for economic progress for average working Americans; 2) reclaim real, structural soundness for the government’s finances in the face of the serious social challenges we will face over the next decade; and 3) secure America’s leading role in the global economy.

The first part of this task is the most urgent politically, although not more so economically than the others. In fact, if we do not successfully address the second and third parts, the progress we make with the first will not be sustained. The essence of the first challenge is to ensure that average Americans can lead lives of economic progress and dignity. That aspiration, in turn, rests most fundamentally on restoring strong and dynamic job creation, so that everyone who wants to can not only find work, but also move up periodically to more demanding, better-paid jobs. A labor market that works this way – the kind we had in the 1950s, 1960s, and in the 1990s for a brief while – can deliver the basic elements of the American dream  through meaningful work that provides real opportunities for rising incomes and upward mobility.

Every piece of this goal is in peril today. For a decade, job creation has slowed sharply, income gains for most people have stalled, and upward mobility has become the privilege limited to the top 20 percent of Americans. We all can see the growing gap that has opened up between the skills of most Americans and the demands of most new, well-paying jobs with futures. In one way or another, those jobs all now involve advanced technologies, which themselves also displace other jobs for millions of people. Finally, we can feel the pressures that squeeze so many jobs and wages, as businesses dealing with the intense competition created by globalization also face fast-rising costs, especially for health care, energy, and pensions. 

These forces gripping American jobs and wages are all very complex, and there’s no single magic bullet to vanquish them. So, we have to take them on piece by piece. For example, most new jobs come from relatively young businesses that are expanding quickly. We can ease some of the costs of creating those jobs by reducing the employer’s payroll taxes on net, new employees and by assuming part of their health-care costs – approaches actually in place already in limited forms, in the new health care reforms and the latest jobs bill. Now, for some real innovation, let’s also require that in exchange, these businesses become staging grounds for enhancing the skills of the new workers they hire. Half of what they save on payroll taxes and health care would go for onsite training or vouchers for ongoing outside instruction, especially in the information technologies that pervade most workplaces. For everybody else, new grants to community colleges could cover the cost of keeping their computer labs open and staffed on evenings and weekends, for anyone to come by and receive free training in those technologies.

These reforms, however, won’t ease the cost pressures squeezing jobs and wages in most companies. So this plan also needs additional steps to reduce the fast-rising cost burdens on business from health care, energy and pensions. One sensible step that may seem radical by today’s cramped standards would be to lighten those pension and health care burdens by (the radical part) expanding Social Security and Medicare. Start by raising the benefits of those who continue to work beyond ages 62, 65 and 70, which will directly reduce their employers’ pension liabilities. Follow it up by the government assuming the obligations of many large companies for part of their retirees’ health care. It might amount to federally-financed “medigap,” a social provision which eventually progressives should want to extend to everyone.   

It shouldn’t surprise anyone that addressing the profound problems most Americans now face with jobs and wages won’t be cheap. Next week, we will lay out the second part of our progressive economic strategy, on how best to restore sound financing for the national government. Progressives did that in the 1990s, with some help from conservatives, and they can do it again. This time, however, we also have to tackle the looming costs of two structural challenges to our future fiscal state, namely, health care for the retiring boomers and climate change. Then, in part three, we will turn to America’s ongoing leadership in the global economy, especially with regard to our strength as the source of innovation worldwide and our central place in the global financial system.

I was on Neil Cavuto's show on Fox News today talking health care and the new political reality in DC.  When I said that in a recent poll I saw only 45 percent of the country was against the President's health care proposal, about the same number who voted against Barack Obama in 2008, Neil jumped on me saying all the polls he has seen showed overwhelming majority support against. 

This is important.  For it you listen to the Republican opposition to the plan these days, the argument goes - it is unconstitutional, the Dems rammed an unpopular bill down the throats of the public, it is a big government take over, it is going to blow a hole in the deficiit.   The argument about it being unpopular - thus showing the tryannical nature of the Dems, which will cost them dearly in November - seems to be the most common.

The problem is that it is not true.  Take a look at a new Gallup poll today.  It shows 49% of the country believes that passing the health care bill was a "good thing," and only 40 percent say it was a "bad thing,"  Whevever the public was on the bill a few months ago, it is now pretty happy it has passed. 

And Neil, I did get my figures wrong.  I said the country was split on the bill, with about 45% being for, and equal number against - or about the same number as voted for John McCain in 2008.  But the most current poll has different numbers, and they are actually better than the ones I had.  So no these numbers did not come from Pravda, as you suggested, but Gallup, a polling outfit that has not always been so friendly to the Dems.

As Congress returns from its holiday vacation, it and President Barack Obama need to address a number of challenges facing the country from health care reform to jobs and what strategy to pursue in Afghanistan.  How the Democratic leadership deals with these issues may well determine the future loyalty of an entire generation of new voters, and with it the future of the Democratic Party.

A recent study by two economists, Paola Giuliano and Antonio Spilembergo, entitled "Growing Up in a Recession," suggests that experiencing an economic recession during the impressionable ages of 18-25 can have lifelong effects on a person's attitude toward government and its role in the economy. The Democratic Party's most enthusiastic and loyal new constituency, Millennials (born 1982- 2003), have had their young lives thoroughly disrupted by the current economic downturn. With their level of unemployment exceeding 25%, what is for other generations a Great Recession is for Millennials their very own Great Depression.  Such an experience is likely, according to the new study, to increase Millennial support for policies that favor government redistribution of income and other liberal economic ideas.

However, Giuliano and Spilembergo also demonstrate that this same experience often makes young people less trusting of government institutions. Conservative columnist Ross Douthat suggested recently that the difference between the Democratic New Deal loyalties of the GI Generation that came of age during the Great Depression and the greater Republican orientation of Generation X that experienced Jimmy Carter's stagflation economy in the 1970s is the degree to which government dealt effectively with the economic crisis of their youth. "When liberal interventions seem to be effective, a downturn can help midwife an enduring Democratic majority. But if they don't seem to be working - or worse, if they seem to be working for insiders and favored constituencies, rather than for the common man - then suspicion of state power can trump disillusionment with free markets."

This raises the stakes for what Congress does in the next six months to new heights. Millennials, more than one-third of whom lack health insurance, will be watching closely to see if their needs are addressed in the final version of health care reform, something Millennials support to a far greater extent than any other generation. Of course, failure to pass meaningful reform may well sound a death knell for the emerging Democratic majority that the Obama campaign created last year. 

But Millennials care even more about jobs and the health of the economy.  With record unemployment among members of this generation, any jobs package Congress puts forward must specifically meet the concerns and needs of Millennials. In particular, Congress must deal with the high cost of education (something Millennials still see as the ticket to future economic success), the lack of job opportunities even at the intern level for those just entering the work force, and the lack of access to fundamental job skills training that community colleges can provide to those ready to go to work soon.

While the Democratic leadership often believes that today's youth thinks about issues of war and peace in the same reflexive way that young Baby Boomers did four decades ago, Millennials are more likely to want to understand the mission and strategy for success in Afghanistan before making up their mind on whether or not to support a deepening American involvement in that conflict. With Millennials providing the overwhelming majority of front line troops, however Congress chooses to pay for that campaign, it must ensure that those who do go to fight are better equipped than the military force George W. Bush initially sent to Iraq.

The effectiveness of any legislation Congress adopts over the next six months will not be known for years, but the way Congressional Democrats approach their policy decisions will be clear enough to Millennials.  The stakes are large and will have long-reaching impact. If the decisions are made by cutting deals with special interest groups, none of which represent this generation and its financial concerns, or by compromising Millennial principles of equity and social justice, members of the generation are likely to sit out the 2010 midterm elections and wait for their favorite messenger, Barack Obama, to return to the ballot in 2012 before making their future preferences known. If that happens, the results in the gubernatorial elections in Virginia and New Jersey last month will only be a prelude for a much bigger Democratic disaster next November.  If, instead, Democratic leaders take off their generational blinders and recognize that the base of their party is now made up of an overlapping core of Millennials, minorities, and women and respond accordingly, they will help to solidify the Democratic loyalties of America's largest generation for decades to come. 

For more on this subject, see Winograd & Hais' previous essay, For Millennials, It's The Economy, Stupid.

The Washington Post has a very good piece this morning by David Montgomery for anyone wanting to learn more about the debate over covering immigrants in the various health care bills.

After enduring the rancorous dog days of August, last week was a good one for President Obama. It began with his talk to America's young people. Faced with charges from paranoid conservatives and Republicans that he was attempting to indoctrinate school children with a radical and foreign message, the president simply asked kids to study hard, stay in school, get good grades, and be unwilling to accept failure. His words likely inspired many of the students to whom they were addressed while at the same time making his opponents appear silly, if not downright bizarre.

But the capstone of the president's week was his address to a joint session of Congress in which he detailed his plan to reform America's health care system. In his speech, President Obama described his plan's benefits, addressed the legitimate concerns of Americans about the major changes the plan would bring, rebutted the distorted charges of his opponents, and inspired his allies with an emotional appeal to enact the plan as a posthumous memorial to Senator Ted Kennedy.

The end result was a rise in Obama's poll numbers. The first to report were CNN and the Democracy Corps, both of which questioned voters before the president's congressional address and then again immediately afterward. Because, not surprisingly, Democrats were more likely to watch Obama's speech than Republicans, the CNN survey somewhat oversampled Democratic identifiers. Even so, considering that Obama's approval ratings had declined seriously among Democrats over the summer, the results were encouraging for the president. CNN found that three-quarters (77%) of those who watched the speech had a positive reaction to it overall, with 56% being very positive.  Nearly as many (72%) believed that Obama clearly stated the goals for his health care plan in his speech. As a result, the president's numbers improved significantly on a number of key items. After the address, 70% believed that Barack Obama's policies would move the country in the right direction as compared with 60% who felt that way before. Most important, the number favoring the president's health care reform plan rose sharply to 67% from 53%.

The Democracy Corps used electronic dials to gauge the perceptions of 50 "independent and weak partisan" voters in Denver before, during, and immediately after President Obama's speech. Those who participated in the Democracy Corps research were about evenly divided among those who initially supported and opposed the president's health care reform plan and McCain and Obama voters. Among these swing voters, support for Obama's plan rose 20 points (from 46% before the address to 66% after). Moreover, attitudes toward specific aspects of the plan improved sharply following the address.

So far the afterglow from President Obama's speech has had legs. On the Gallup daily tracking of his job performance, the president's approval versus disapproval margin has gone up from nine percentage points to thirteen since his address. In the public survey with the most consistently Republican tilt, the Rasmussen Reports, the number who strongly approve of Obama's performance is up five points since the speech while those who strongly disapprove is down four. Overall, after spending nearly all of August on the downside, a slight majority is now positive about the job President Obama is doing (52% vs. 48%). These are the president's highest marks in the Rasmussen surveys since mid-July.

A CNN-Opinion Research survey conducted with a representative national sample over the weekend after Obama's address provides even greater detail-and more good news. That survey indicates that the president's approval score rose five points since late August (to 58% from 53%). During the same period, Obama's approval rating is up solidly for his handling of specific policy areas: the federal budget deficit (+10 points); taxes (+7); health care policy (+7); the economy (+5); and, foreign affairs (+4). Finally, undoubtedly as a direct result of his address to congress, a majority now favors rather than opposes Obama's plan to reform health care (51% vs. 46%). Most important, strong opposition to the president's plan declined by nine percentage points since CNN last polled on the matter.

But the biggest jump in Barack Obama's poll ratings came in the Daily Kos weekly tracking survey. In just one week, the president's overall favorable to unfavorable margin improved by eight percentage points (favorable up 4 points and unfavorable down 4). Obama's favorable marks week-to-week improved in virtually very demographic and political group except among Republicans. However, the biggest gains came within Democratic core groups including Millennials (young people born 1982-2003), Latinos, residents of the Northeast, and Democratic identifiers. This suggests that, after a period of drift during the summer, what President Obama said last week, especially in his health care reform address, reinforced his base. There is little doubt that Democrats are simply glad that the president is sounding like the man they put in the White House last November.

Unfortunately, President Obama's Democratic colleagues in Congress did not share in the week's polling upswing. The Daily Kos survey indicates that the favorable ratings of Nancy Pelosi, Harry Reid, and congressional Democrats overall were essentially unchanged during a week in which the president registered significant gains. Perhaps it is for this reason that GOP consultants are telling Republican candidates to attack congressional Democrats, rather than President Obama, in the 2010-midterm elections. (http://politics.theatlantic.com/2009/09/gop_in_2010_focus_on_dems_in_congress_not_on_obama.php)

 It seems clear that the public, even the Democratic base, is taking a wait and see attitude about inside-the-Beltway Democrats other than President Obama. The coming months will determine whether or not the Democratic majority in Congress is prepared to do the job that it was sent to Washington to do and, among other things, at long last enact meaningful health care reform. This week's polling numbers suggest that would not only be good for America, but also for congressional Democrats. Let's hope they're paying attention.

Michael D. Hais is an NDN Fellow and co-author, with Morley Winograd, of Millennial Makeover: MySpace, You Tube, and the Future of American Politics, named one of the ten favorite books of 2008 by the New York Times.

Last week I wrote about how Immigration Reform is NOT Health Care Reform.  Yesterday, NDN fellow Dr. Rob Shapiro was on CNBC discussing undocumented immigrants and health care reform, and set Mark Krikorian from CIS straight:

A recent Pew Research Center survey suggests that generational conflict in the U.S. has significantly declined in the 40 years since Woodstock, NY symbolized the sharp differences between the Baby Boom Generation (born 1946-1964) and its elders. A plurality (38%) believes that strife between the generations has diminished since the late 1960's and early 1970s. Boomers are especially likely to believe that inter-generational strife is less severe than it was four decades ago: 43% of them believe it has declined. Now only a quarter (26%) of Americans perceive that there are very strong or strong conflicts between young people and older people, far less than those detecting significant discord between immigrants and people born in the United States (55%), rich and poor people (47%) and blacks and whites (39%).

But, as generational theorists, William Strauss and Neil Howe indicate, generational conflict, like the poor, is always with us. A deeper analysis of the Pew data suggests that what has changed is not so much the fact of generational conflict, but its tone. Young people and their elders may not shout at one another across the generation gap as they did four decades ago, but they still appear to differ in many ways.

The American public is right in perceiving a continuing generational conflict, at least with regard to politics. Today's young people, the Millennial Generation (born 1982-2003) are sharply distinctive from older generations in their political attitudes, identifications, and behavior. These differences will strongly benefit the Democrats and the progressive movement, but only both of those forces have the foresight and courage to take advantage of the opportunity that the emerging Millennial Generation offers. The Democratic Party and Barack Obama clearly benefitted from it in 2006 and 2008 winning first a large, presumably unassailable, majority in both houses of Congress and later the White House. Since then, however, the Democrats seem intent on frittering away the sizeable gift that the electorate, led by the Millennials, has given them.

The stakes in firmly capturing the loyalties of the Millennial Generation couldn't be higher. At 95 million, Millennials are the largest generation in American history. There are now 17 million more Millennials than there are surviving Baby Boomers and 27 million more of them than there are members of Generation X (born 1965-1981), the relatively small generation between Boomers and Millennials. In 2008, when only 40% of Millennials were eligible to vote, they accounted for about 17% of the electorate. In 2012, when Barack Obama runs for reelection, about 60% of Millennials will be old enough to vote and they will comprise nearly a quarter of the electorate. By 2020, when virtually all members of the generation will be at least 18 years old, more than one in three voters will be a Millennial. This will put Millennials in position to dominate American politics, as has no other generation before them.

So far, by any measure, the Millennial Generation has been solidly liberal and Democratic. In 2008 Millennials voted for Barack Obama over John McCain 66% to 32%, accounting for about 80% of the president's popular vote majority and converting what would have been a narrow win into a solid one. Millennials also gave Democratic congressional candidates almost the same level of support that they gave Obama (66% vs. 34%). And, as indicated in a June 2009 Pew survey, Millennials identify or lean to the Democrats over the Republicans by nearly 2:1.

Finally, Millennials are the first generation in at least four to contain a greater number of self-perceived liberals than conservatives.

In their attitudes, Millennials are "liberal interventionists" in the economy, "tolerant non-meddlers" on social issues, and "activist multilateralists" in international affairs.

Decades of political research indicates that, for most people, once attitudes, identifications, and behaviors like these are formed during youth they tend to remain in force for the rest of their lives. Coupled with the sheer size of the Millennial Generation, this gives the Democratic Party an opportunity to dominate American politics for at least the next four decades.

Are Barack Obama and the Democratic Party taking advantage of this opportunity and maintaining the loyalty of the Millennial Generation, especially during the past several months as the president's approval rating has declined? The picture is mixed. On the one hand, as Daily Kos tracking surveys data indicate, Obama and his party have lost ground, albeit much less sharply, among Millennials just as they have among the electorate as a whole. Since January, favorable opinions of the president have fallen by 17-percentage points among all voters, but only by five points among Millennials. Similarly, positive attitudes toward the Democratic Party have declined by 12 points within the entire electorate, but by just two among Millennials. At the same time, Millennials remain significantly more positive toward Barack Obama and the Democratic Party than older generations.

Moreover, Democratic losses among Millennials (indeed among all voters) have not been matched by Republican gains. In fact, the GOP has lost more ground since the first days of the Obama administration than either the president or the Democratic Party. Since January positive impressions of the GOP have been cut in half among all voters and, among Millennials, have dwindled to nearly the vanishing point (only 4%).

All of this raises the question of why the administration and congressional Democrats have persisted in their well-intentioned, but now clearly ill-advised and so-far never ending effort to enlist significant Republican support on virtually all important parts of President Obama's legislative program.

The directive delivered to Democrats by voters last November couldn't have been clearer. A post-election CNN survey indicated that 59% of the electorate favored the idea of the Democrats controlling both elective branches of the federal government. Only 38% said that one-party rule was a bad idea. A Wall Street Journal poll completed at the same time confirmed those results and presented the rationale for them: when the same party controls both Congress and the presidency, "it will end gridlock in Washington and things will get done."

In spite of this, Democrats in Washington have continued to pursue the chimera of bipartisanship. The response from across the aisle was a political version of Mohammed Ali's "rope-a-dope" strategy: induce the opponent to expend major energy, accomplish nothing, and exhaust himself in the process. This recently reached the ultimate absurdity when the GOP's most visible health insurance reform negotiator in the Senate, Iowa's Chuck Grassley, said that he wouldn't vote for a bill that he himself had negotiated except in the very unlikely event that large numbers of his fellow Republicans would join him. That is why rumors that the administration and congressional Democrats may now finally be willing to go it alone in passing health care insurance are encouraging. It's been a hard lesson to learn, but better late than never.

However, to avoid missteps in the future, the Bible (and election and poll results) offers a plan: "a child shall lead them" and "out of the mouths of babes comes wisdom." The answer is with the emerging liberal and Democratic Millennial Generation on the youthful side of today's version of the generation gap. If Democrats and progressives go there, they will prosper now and in the future.