Democrats are Running Out of Time

The political window of opportunity for Joe Biden and Democrats to deliver on their promises to the American people and pass the legislation the country needs, could close at any time. 

We must understand how rare it is that the Senate and the House and the presidency are all under the control of the Democratic Party.

That’s happened in only 4 of the past 28 years

The Democrats’ current Senate majority would end with the shift of a single seat from Democrats to the Republicans. That could happen even during this session of Congress. In 27 of the 38 Congresses since World War II, the party in control of the Senate has changed during the session.

Not to be morbid, but we also need to consider that this Senate has six Democratic senators, over the age of 70, who are from states where a Republican governor would be free to replace them with a Republican should a vacancy occur.

Five other Democratic senators are from states in which a Democratic vacancy would go unfilled for months until a special election was held to fill the seat — which itself would hand the G.O.P. control of the Senate at least until that special election.

It would be foolish to count on the Democrats increasing their numbers in the Senate or the House in the midterm elections of 2022. The president’s party rarely, if ever, picks up more seats during midterm elections. The last time a Democratic president has not lost Democratic seats in Congress in his first midterm election was 1934.

Meanwhile, state Republicans — who, not incidentally, control a majority of state governments — are proposing an avalanche of bills to make it harder for likely Democratic constituencies to vote, including people of color, young people, and low-income people. Some states, like Georgia, have already put these voter suppression measures into place.

And with these state Republicans in control of the upcoming once-in-a-decade redistricting process, we could see even more gerrymandering in these states — meaning an even greater likelihood that Republicans gain ground in the House.

If Joe Biden and the Democrats are going to accomplish what a majority of Americans want them to — such as raising the minimum wage, expanding health care, strengthening unions, raising taxes on big corporations and the wealthy, providing free public higher education, and strengthening voting rights with the For the People Act — they’ve got to get it done, now. 

That means Democrats have to get rid of the Senate filibuster and stop worrying about bipartisanship. 

The window of opportunity is already tiny. And it’s closing fast.

Employer outlays for workers’ health insurance slowed from a 9 percent jump last year to less than half that – 4 percent – this year, according to a new survey from the Kaiser Foundation. Good news?

Our political class believes it is. The Obama administration attributes the drop to the new Affordable Care Act, which, among other things, gives states funding to review insurance rate increases.

Republicans agree it’s good news but blame Obamacare for the fact that employer health-care costs continue to rise faster than inflation. “The new mandates contained in the health care law are significantly increasing the cost of insurance” says Wyoming senator Mike Enzi, top Republican on the Senate health committee.

But both sides ignore one big reason for the drop: Employers are shifting healthcare costs to their workers. (The survey shows workers contributing an average of $4,316 toward the cost of family health plans this year, up from $4,129 last year. Many are receiving little or no employer-provided coverage at all.)

Score another win for American corporations – whose profits continue to be robust despite the anemic recovery – and another loss for American workers.

Those profits aren’t due to a surge in sales. Exports are down (Europeans, Japanese, and Chinese are all pulling in their belts) and American consumers don’t have the dough to buy more.

The profits are largely due to lower corporate costs, especially when it comes to their payrolls. Employer-provided health and pension contributions are shrinking, and the real median wage continues to drop.

High unemployment has given companies more bargaining leverage over their workers, who have to accept lower real pay and benefits or risk losing their jobs.

When it comes to health insurance, employees increasingly have to choose between health-insurance policies with sky-high premiums or with sky-high co-payments and deductibles. And since they can’t afford the former they’re opting for the big co-payments and deductibles – or no insurance at all.

The result is fewer visits to the doctor and less use of other medical services.

This is a new trend, and it comes despite the Affordable Care Act (which hasn’t been fully phased in). And it wouldn’t be worrisome if we were seeing too much of doctors before, and using up medical resources we didn’t need.

But it’s worrisome if it means less preventive care, or health problems going untreated until they become chronic illnesses or crises.

Healthcare costs do have to be better controlled. They now claim 18 percent of our entire economy. But the best way to control them isn’t by cutting back care. It’s by wringing inefficiencies out of the system.

Our healthcare system wastes 30 cents of every dollar spent on health care, according to new calculations by the well-respected Institute of Medicine. Much of it is wasted on repeated tests, and a huge portion wasted on paperwork – between doctors and hospitals and specialists and insurers, to justify expenditures by one group to be paid by another.

A single-payer system would be far more efficient. 

So back to my original question. Is the dramatic slowdown in employer health-care costs good news? It all depends. If we and our families are in good health, or we’re high earners who can afford good health coverage without big co-payments and deductibles, or if we own lots of shares in companies showing higher profits because they’re trimming pay and benefits – or we’re in all three categories – it’s probably good.

But if we’re none of these, it might not be good news – especially if it means we’re getting less care than would otherwise keep ourselves and our families healthy. 

At the least, if we’re concerned about the health and well-being of all Americans, we need to find out much more before we celebrate.

The Administration’s decision to pull the plug on long-term health insurance in the new healthcare law (so-called Community Living Assistance Services and Support or, as it was known by healthcare insiders, CLASS) offers an important lesson. 

As written, the law had three incompatible parts. 

First, it required beneficiaries to receive at least $50 a day if they had a long-term illness or disability (to pay a caregiver or provide other forms of maintenance). That $50 was an absolute minimum. No flexibility on the downside. 

Second, insurance premiums had to fully cover these costs. In budget-speak, the program was to be self-financing. Given the minimum benefit, that meant fairly hefty premiums. 

Third, unlike the rest of the healthcare law, enrollment was to be voluntary. But given the fairly hefty premiums, the only people likely to sign up would know they’d need the benefit because they had or were prone to certain long-term illnesses or disabilities. Healthier people probably wouldn’t enroll. 

Yet if the healthier didn’t enroll, the program would have to be financed entirely by the relatively unhealthy – which meant premiums would have to be even higher. So high, in fact, that even the relatively unhealthy wouldn’t be able to afford it. 

End of story. End of program. 

The lesson: If a public insurance system has minimum benefits and must pay for itself, it can’t be voluntary. Everyone has to sign up.

Or something else has to give – benefits have to be more flexible, or the program can’t be expected to pay for itself. 

For example, Medicare and Social Security are mandatory. Everyone effectively signs up through their payrolls. Even so, questions arise about how flexible their benefits have to be if the programs must be self-financing. 

So what does this mean for the remainder of the new healthcare law? Its fate hinges on the so-called individual mandate – the requirement that everyone, including younger and healthier people, participate (or pay a fine if they don’t).

Today’s decision to jettison long-term care offers clear evidence why that individual mandate is so necessary. 

Unfortunately, the mandate isn’t popular – because it wasn’t modeled on Social Security or Medicare but based instead on private insurers who’ll want to maximize revenues. It’s also vulnerable to constitutional challenge, largely for the same reason. The Supreme Court will likely decide its fate this term. 

Why, oh why, didn’t the Obama administration make life easy for itself and for Americans by choosing the simplest and most efficient system for both primary and long-term health insurance  – Medicare for all? 

It didn’t because it wanted to get Republican votes. It got almost none. And now the Republicans are enjoying the prospect of the law being dismembered piece by piece, starting today.  

Two appellate judges in Atlanta – one appointed by President Bill Clinton and one by George H.W. Bush – have just decided the Constitution doesn’t allow the federal government to require individuals to buy health insurance.

The decision is a major defeat for the White House. The so-called “individual mandate” is a cornerstone of the Affordable Care Act, President Obama’s 2010 health care reform law, scheduled to go into effect in 2014.

The whole idea of the law is to pool heath risks. Only if everyone buys insurance can insurers afford to cover people with preexisting conditions, or pay the costs of catastrophic diseases.

The issue is now headed for the Supreme Court (another appellate court has upheld the law’s constitutionality) where the prognosis isn’t good. The Court’s Republican-appointed majority has not exactly distinguished itself by its progressive views.  

Chalk up another one for the GOP, outwitting and outflanking the President and the Democrats.

Remember the health-care debate? Congressional Republicans refused to consider a single-payer system that would automatically pool risks. They wouldn’t even consider giving people the option of buying into it.

The President and the Democrats caved, as they have on almost everything. They came up with a compromise that kept health care in the hands of private insurance companies.

The only way to spread the risk in such a system is to require everyone buy insurance.

Which is exactly what the two appellate judges in Atlanta object to. The Constitution, in their view, doesn’t allow the federal government to compel citizens to buy something. “Congress may regulate commercial actors,” they write. “But what Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die.”

Most Americans seem to agree. According to polls, 60 percent of the public opposes the individual mandate. Many on the right believe it a threat to individual liberty. Many on the left object to being required to buy something from a private company.

Had the President and the Democrats stuck to their guns during the health-care debate and insisted on Medicare for all, or at least a public option, they wouldn’t now be facing the possible unraveling of the new health care law.

After all, Social Security and Medicare – the nation’s two most popular safety nets – require every working American to “buy” them. The purchase happens automatically in the form of a deduction from everyone’s paychecks. 

But because Social Security and Medicare are government programs they don’t feel like mandatory purchases. They’re more like tax payments, which is what they are – payroll taxes.

There’s no question payroll taxes are constitutional, because there’s no doubt that the federal government can tax people in order to finance particular public benefits.

Americans don’t mind mandates in the form of payroll taxes for Social Security or Medicare. In fact, both programs are so popular even conservative Republicans were heard to shout “don’t take away my Medicare!” at rallies opposed to the new health care law.

Requiring citizens to buy something from a private company is entirely different. If Congress can require citizens to buy health insurance from the private sector, reasoned the two appellate judges in Atlanta, what’s to stop it from requiring citizens to buy anything else? If the law were to stand, “a future Congress similarly would be able to articulate a unique problem … compelling Americans to purchase a certain product from a private company.”

Other federal judges in district courts – one in Virginia and another in Florida – have struck down the law on similar grounds. They said the federal government has no more constitutional authority requiring citizens to buy insurance than requiring them to buy broccoli or asparagus. (The Florida judge referred to broccoli; the Virginia judge to asparagus.)

Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.

The Republican strategy should now be clear: Privatize anything that might otherwise be a public program financed by tax dollars. Then argue in the courts that any mandatory purchase of it is unconstitutional because it exceeds the government’s authority. And rally the public against the requirement. 

Remember this next time you hear Republican candidates touting Paul Ryan’s plan for turning Medicare into vouchers for seniors to buy private health insurance.

So what do Obama and the Democrats do if the individual mandate in the new health care law gets struck down by the Supreme Court?

Immediately propose what they should have proposed right from the start — universal health care based on Medicare for all, financed by payroll taxes. The public will be behind them, as will the courts.