Biden Sings Same Song, Second Verse
Photo by Pete Souza Public domain
Meanwhile, in non President Trump vs “The Squad” news, current Democratic primary frontrunner Joe Biden was unveiling his healthcare proposal, and the tagline he laid on the folks at an AARP gathering sounds strangely familiar.
Former Vice President Joe Biden on Monday said that under his new health care plan, people who like their insurance coverage won’t be forced to give it up.
Speaking at the AARP presidential forum in Iowa, Biden drew a contrast between his plan, which would give people a Medicare-like public option, and the “Medicare for All” plan championed by more progressive Democratic presidential candidates including Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (Mass.).
“If you like your health care plan, your employer based plan, you can keep it. If in fact you have private insurance, you can keep it,” Biden said.
Biden’s speech echoed the now-infamous “if you like your doctor, you’re going to be able to keep your doctor” catchphrase former President Barack Obama repeatedly said in 2009 and 2010 when he was trying to sell the public on the benefits of the Affordable Care Act.
The GOP seized on those remarks, and spent years throwing them back at Democrats to showcase what they said were ObamaCare’s failures. In 2013, PolitiFact called “if you like your health care plan, you can keep it” the “Lie of the Year.”
But the law has provided 20 million people with health insurance, and it’s now more popular than ever.
Biden is running on protecting ObamaCare. He is banking the law’s popularity will convince voters that his plan of shoring up the law with more subsidies and a public option is a better approach than Medicare for All.
“You get your choice, you get full coverage … I think it’s the quickest, most reasonable rational and best way to get to universal coverage,” he said.
In formally announcing his plan on Monday, Biden equated the push for Medicare for All with the GOP attempts to repeal ObamaCare.“I understand the appeal of Medicare for All, but folks supporting it should be clear that it means getting rid of ObamaCare, and I’m not for that,” Biden said in a video announcing his plan.
It’s pretty ballsy to use that exact line. I’m not sure what Joe’s people are angling for with it. They very obviously chose, purposefully, to use it.
That said, the overarching policy theme seems rock solid to me both politically and policy wise. I hope some of the other centrist candidates copy it.Report
Eh, much lower risk substituting plan for doctor… I can’t really fathom the attachment to plans that are picked by your corporate HR team and given to you with the illusion of choice. But polls tell me they are. Perhaps I’m slightly disabused of the fetish owing to living in a less densely populated area… I may have a Gold-plated Silicon Valley corporate plan, but its only as good as the bronze star practices, doctors and facilities that are local to me.
My second thought for the day is around Joe’s public option. As a caveat, I’m willing to admit I may be wrong prior to seeing the plan details, but the difference between a Public Option with the existing Corporate Infrastructure in place is the difference between offering Medicaid for More vs. Medicare for All. My initial hunch is that this is a political loser on all fronts but the wonk one. But, possibly some of my assumptions about how it will work are wrong.Report
I see your point on substituting plan for doctor. Still too similar for me to think that was accidental (or if it was accidental that is hair raising because I do not want that level of incompetence from the front runners team).
I think the politics of this hinge, not on the details, but the broad brushstrokes. Joe’s saying “You’ll get what you have now plus some more generosity and options.” That’s a big improvement over the leftiers candidates “We’ll take away what you have now and give you something better, trust us.” or the Republican “We’ll take away what you have, piss on you and tell you it’s healing tonic via Fox News.” For wonks like you and I the details will be important but the politics, I suspect, will hinge on the overarching theme.Report
Pretty clear by now that Team Biden is all-in on Obama’s third term… in principle that makes good sense, but in practice it might lead to some odd bits, like as you note, echoing the Obama gaffe, and perhaps more to come. But contra contra, I also think Biden only wins by leaning in to Bidenness… so bring on the gaffes, hug everyone, and signal that all change will be symbolic, but the hope is real.
Regarding the un-proposal itself, “You’ll get what you have now plus some more generosity and options.” Is exactly the sort of symbolic change that could work. [Though seriously, for whom? Who is the audience? The vast, vast majority have employer health insurance… there are no Options for them. Generosity? That’s Medicaid expansion redux… everything else? Tinkering and Marketing.]
I’m just not personally mistaking it for any sort of Healthcare reform. Not yet, anyway.Report
Oh absolutely, Obama is revered by the Democratic Party and he’s viewed very favorably by the electorate at large excluding the rightward cohort who simply were never get-able by anyone with a D next to their name so leaning into Obama’s third term with a Joe flavor is not an irrational play at all.
The audience is mostly the lower middle and middle income peeps who’re hating their healthcare options the most. Higher income peeps on employer plans will hear that their plans will be left alone and will mostly stop caring and be fine with it. Lower income peeps who are getting medicaid will hear that they’ll still get it and mostly be on board. It’s the people who fall in that window between the medicaid cutoffs and the subsidy taper offs who could use more generosity and might be get-able with this kind of talk. So if it doesn’t hurt or outrage the vast majority and appeals to a significant constituency that makes it potentially good politics and, importantly, makes it hard to attack unlike medicaide for all.
But I’d also agree with you that depending on the details it may not qualify as capital H Healthcare Reform on the merits.Report
It seems to me that people want one of two things:
1) What they have now, only cheaper
2) Something better, only without paying more (or appreciably more)
On top of that, the definition of “Good Health Care” is a moving target. There is Health Care that would have been considered “Good Health Care” in 1999 would be considered malpractice today. There is Health Care available today that was not available in 1999 and withholding it is considered to be denial of Good Health Care.
And when you marry all of these things to the Iron Triangle…
Well, you’re boned.
Best to lie about it.Report
You mean, people want one of three things:
1) What they have now, only cheaper
2) Something better, only without paying more (or appreciably more)
3) SOMETHING, because pre-ACA they had nothing at all.
You analysis, like most, is written with the assumption that everybody just everybody, has health insurance of some sort and the only possible issue to talk about is to make it cheaper or better.Report
I think its interesting that #3 is making a re-appearance.
One of the things that confused me with ACA #1 was that it had a complicated mixed message. A (The?) fundamental selling point was that there were 34M uninsured Americans and we needed the ACA to fix that. Second, the ACA was going to Reform Health Care, Provide Options, and Bend the Cost Curve… and other such sundries.
Let’s say for the record, that all of those goals are fine and dandy by my calculations. One of the things I think Team Blue didn’t appreciate was that marginal decreases in Uninsured rates (primarily via Medicaid Expansion) did not off-set the general disappointment that the ACA didn’t deliver any meaningful Health Care reform.
I know, I know the Republicans said xyz… I’m not making a Partisan Republican argument… I’m saying the ACA was fundamentally a disappointment because it covers 5% of the insurance market and didn’t do bupkiss for the other 95%.
I get the emotional appeal of, “hey there are people without insurance out there” but politically if Bidencare is a marginal reduction in uninsured primarily via Medicaid expansion. There are going to be a lot of people scratching their heads in 2022 wondering how they made the same mistake twice.
If there’s a functioning alternate party, it will be ouchy indeed.Report
Who all is saying it was a disappointment?Report
Gotcha… symbolic change 2.0. Godspeed.Report
The way you phrased it, was like there is this universal consensus and I’m just not aware of that.Report
Not really, my point is the overlooked aspect of the 6-year disapproval of ACA was partly due to the over-promise/under-deliver factor.
Medicaid expansion is Medicaid expansion… good, bad or ugly. Health Care reform disguised as Medicaid expansion is an underappreciated factor (or so say I)…
Now, returning to uninsureds as *the* reason to do health care reform and then delivering more Medicaid expansion is bad politics. Even if you think there should be Medicaid expansion.
Plus, if you are running *against* M4A then disguising Medicaid expansion as an alternative to M4A – it will prove not only foolish, but disastrous on both sides of the divide.Report
I don’t think there’s very much explanatory power in the first section of your analysis here considering that the ACA’s favorable ratings with the public inverted from mildly to strongly disapproving into mildly to strongly approving the exact minute it looked like the ACA was in danger of being repealed even though the uninsured number gradually rose as the Republicans chipped away around the margins at it.
But this all assumes his “public option” will simply be a medicaid expansion. Who the hell knows if it will be at all.Report
Another way to look at it is:
ACA was fundamentally a [success] because it covers 5% of the insurance market and didn’t do [any harm] for the other 95%.
We were able to curb the worst problems of the pre-ACA period, without any significant pain to the rest.
I mean, has anyone here suffered any measurable harm? Would your life be better if the ACA disappeared?Report
I googled “Obamacare is a disappointment” and found this.
Don’t feel like you have to read it.
I didn’t.Report
Obamacare always suffered from being attacked by the edges of both parties.
Liberals wanted more, conservatives wanted less, and both showed up in surveys as being “opposed” to Obamacare.
But now I wonder, if offered the choice to eliminate the ACA entirely, how many people would prefer that?
In other words, is the Republican offer of “Nothing” really some barn burner of a political strategy?Report
Hey. You asked “Who all is saying it was a disappointment?” (I copied and pasted that question, by the way.)
That’s what I found with seconds’ worth of effort.Report
When it comes to health care in the United States, you have two groups that are completely talking past each other and entrenched like combats at worst battles of WWI where each side fought like bloody hell to gain an inch. Only this time there is more than one goal for the believe in government health care side.
1. On the right-wing side, the belief seems to be a pure fanaticism for the FREE MARKET (TM) and that the best way to solve it is by ripping off all the bandaids now. End all the subsidies for employee backed health care, end any and all government backed or supplied health insurance (except for the seniors that vote for us);
2a. Medicare for all/universal health care people: Obvious what they want generally.
2b. Yes the government should help regulate health insurance and get people health insurance but we can’t get rid of private insurance totally for a wide-variety of reasons. Sometimes just looking at the polling, sometimes just trying to brandish realist, centerist credentials (TM).
# 1 position is what happens when you let true belief contradict with the desires of polling in democracy. Maybe #2a is as well. What is interesting to me about the health insurance fights is that it feels like a battle between two generational realities. The Boomers/Old Economy Steve and the post-recession economy known to Millennials. Both cohorts are very big. Our cohort (Generation X) is small and caught between whether our economic reality represents Old Economy Steve (true for older Gen Xers) or not quite Old Economy Steve but not quite post-recession insecurity either. Plus later Gen Xers (anyone born between 1978-1980) can’t decide whether they are Millennial or Gen X and debate it fiercely. Biden feels like his best political hopes are with Boomers. Other Democratic candidates with younger voters.Report
Remember Elysium? It was a movie that came out in 2013. Matt Damon, Jodie Foster… anyway, it was about a two-tiered society where the people on the crappy planet lived in squalor and the people up in Elysium had wealth, luxury, and, most importantly, Health Care.
These magical machines that you put somebody in and the machine rewrites their DNA or sprinkles fairy dust or whatever and you come out of the machine healed.
Well, of course these machines are coded so that only Elysium people can use them. If a crappy planet person tries? Wham. NO HEALTH CARE FOR YOU.
The entire movie was about Matt Damon trying to get his buddy to one of these machines and, at the same time, re-key the machine so that it reads him as a member of Elysium rather than a mere resident of crappy earth.
The movie ends with the freedom fighters re-keying *EVERYBODY* on crappy earth to be residents of Elysium so that *ALL* of them can use the magical health care boxes.
Anyway, all that to say, our problem seems to be mired in how much more moral it presents to treat health care as if it were a black box that you go in to on one side and you come out on the other side only weller. People who talk about health care as if it costs money sound so much more cruel.
And if you get someone who knows that it costs money but pretends that someone else will pay for it? They sound like a realist who is also very, very kind.
So Biden sounds pretty good here… except for the part where it was already demonstrated that his plan didn’t work *LAST* time. I am not seeing how it will work this time.
Worse than that, I’m not seeing how he’s seeing how it will work this time.
Which makes me feel like he’s lying.Report
I do… heartwarming when the little girl is cured.
I’m totally with them thinking those people are total dicks… only cruelty would make them hoard such tech. Then I wonder what the sequel looks like with mass rioting and killings as the magic faerie dust runs out (or the power consumption cannnot keep up with demand) and factions form to kill rival healing seekers. In the end, for the sake of humanity, the tech is banned, outlawed, cancelled and pronounced un-good. It is better to live and suffer together than kill each other for selective gains for the few.
Elysium III has a plucky scientist who re-invents the technology with, and this is *great* double the previous output… so they only give it to the good people not the bad people, that way there’s just enough to cover the good people. There’s an Elysium IV.Report
You may need to unpack the “it’s already demonstrated that his plan didn’t work *last* time.” bit. The ACA certainly improved on the situation that existed before it was enacted, as demonstrated by how negatively the electorate reacts to the idea that the GOP will just take it away and replace it with nothing. It certainly wasn’t a panacea but I think it moved the situation incrementally in a good direction at pretty modest cost. Certainly the detractors predictions universally crapped out- no death spiral (despite much sabotaging), didn’t break the bank or nationalize health coverage.
I doubt Biden is lying here; I would expect he genuinely believes that if he puts more resources into the ACA, repairs the damage from malicious sabotage and integrates the lessons that have been learned from its operation that it’ll probably be another incremental improvement without breaking the bank. And when you contrast his position with the other positions on offer I think it looks pretty decent in contrast.Report
You may need to unpack the “it’s already demonstrated that his plan didn’t work *last* time.” bit.
If I point to the “lie of the year” award, will that be sufficient for arguing that it didn’t work last time or do you need something more empirical?
Because all I meant was whatever they meant.Report
*shrugs* Yeah so Obama said at one point that if you liked your doctor you could keep it and has suffered for it since in certain circumstances you couldn’t keep the same doctor under the ACA. Sure seems like an incredible stretch to then take that and describe it as a total failure of the ACA. You’d think Trump and his minions would have had an easier time repealing it if it was such a failure. People would have been begging him to repeal it, no?
I mean, I grant you, there’s a policy position to be made for your own position of breaking the wages of health care providers down to the same level as the health care providers get elsewhere in the first world by opening the floodgates to have tons more of them. While we’re wishing for that one I’d also like a unicorn.Report
Sure seems like an incredible stretch to then take that and describe it as a total failure of the ACA.
I didn’t describe it as a total failure of the ACA.
I said that his plan didn’t work last time.
And I’m wondering if this plan is like that plan, why this plan will turn out to work.
No matter how much Biden likes this plan, I’m not sure he can keep it.
I don’t know why I should assume that he’ll be able to.Report
Ok, so the ACA wasn’t his plan, fair enuff. So what was Bidens plan? Do you think there’s a different plan he should pursue? Surely not Medicare for All.Report
I don’t know what Biden’s plan *WAS*, I just know that his plan *NOW* means that if I like my plan, I can keep my plan.
But I don’t know that his plan will work. I have reason to believe that his plan will work about as well as Obama’s.
Do you think there’s a different plan he should pursue?
For what? If he wants to win, I have a commercial he can run.
Scene: A pair of hands holding a form, grabbing a large rubber stamp and then stamping “REJECTED” on it, then doing it to another form, then another, then another. Pull back and show a big business fat cat from central casting smiling as he rejects forms.
Voiceover: “Did you know that insurance companies have a policy of automatically rejecting the first request for payment no matter what the request? Even if it’s supposed to be covered?
I’m Joe Biden and, if you elect me, I am going to put these sons of bitches out of work. Under my plan, nobody will ever be denied the health care they deserve.
Pan to showing this same guy sitting at a highway off-ramp holding a sign begging for change.
Joe: Don’t worry about him. He’s got health care now.
I’m Joe Biden and you better believe I endorse this message!
Anyway, if he wants to win, he should run something like that.
As for what his medical plan *OUGHT* to be? Eh, free tuition for medical students or something, so long as they give X years to The State providing free health care to the needy as part of their residency. But it’s a balloon thing. If it’s a 5 year plan, you don’t get 20% off if you only spend one year. You get, like, 3% off for the first year or something and only by year 4 can you expect 20% off. The rest only kicks in after year 5 when, presumably, you’ve put down some sort of roots in the community.Report
Wow, that’s a lot more left wing than I expected. I didn’t think the dearth of doctors in the US was due to a dearth of people who desired to be doctors though.Report
There are plenty of people who could be doctors but would rather be something else because of money, money, money.
Take debt off the table and see who wanders over from some other career field.
(I hear stories of 24-32 hour residency shifts and think “four people could be doing that instead of just one”.)Report
I suspect what you really have to contend with in a crusade to triple the number of health care providers is the AMA and their ilk.Report
I don’t really have a solution for legislative capture.
Not even “vote for sufficiently progressive candidates” can overcome that one.Report
Oh and, yes, Elysium was knee slappingly idiotic. Especially when the magic medical beds fly in a huge sky blotting out fleet down to earth to cure the world’s woes. Or, really, anything at all about the economics of Elysium. What the hell did the Elysians provide that made the whole world labor to build them robot armies and ship all their luxuries up to them again?Report
If Elysium can maintain 100k people in perfect health then obviously it can do the same for 10 Billion. All you need to do is hit the right button.Report
If Biden wants to revolutionize health insurance within the context of the ACA, the change he should be pushing is to require all health care providers to accept the policies.
18 months ago my wife and I started a year where we knew we would have to change policies twice: first to an exchange policy, and then to Medicare. There were three doctors my wife would have preferred to keep. There was one exchange policy — a gold-rated one — that all three would accept. None of them would accept traditional Medicare. Each of them would accept exactly one Medicare Advantage plan, but no two of them accepted the same Advantage plan. All of this was a rude surprise compared to the decades with my previous employer-provided group insurance, which no doc had ever refused.Report
I wonder if it will really be true this time. That one line (lie) gave me reason to support the ACA.Report
the ACA suffers still two main problems:
1) Republicans don’t know how to win gracefully. See, the vast majority of the ACAs intellectual undeprinnings were written by the Heritage Foundation in response to HRC’s calls for universal healthcare when she was first lady. After meeting with democrats for 13 months, participating fully in 72 hours of committee testimony in both the house and senate and offering somewhere north of 1300 amendments – many of which got floor time and a good number of which made it into the bill – Republicans decided to try and deny Obama a signature win instead of crowing about how weak the Democrats were to have to pass a Republican idea for healthcare. I remain convinced that Republicans could have won on that platform alone, and without the current occupant of the White House, all the while ensuring that their insurance executive friends and neighbors maintained the lifestyles they had become accustomed to.
2) Democrats unwillingness to call Republicans out for rejecting Republican ideas embedded in the ACA. Democrats could easily have defeated any number of Republicans, and maintained their fighting for people stance had they simply and continuously hammered home the message that they had done what Republicans suggested, so Republican attempts to overturn the ACA were just sour grapes from a party that doesn’t care about ordinary people.
What all this has to do with Biden is simple – sure, the left would LOVE single payer. But more importantly we’d love to see Republicans hoisted on their own pitards for this one. Republicans basically wrote the ACA a decade before it was signed into law and they keep nibbling away at their own ideas to try and make them crash. Public shaming is too kind a response, and yet all the Dems are doing is rolling out more useless policy papers.Report
I have it from unimpeachable sources that the D’s are doing nothing but identity politics and won’t real issues americans have. Yet somehow we have D candidates pitching everything from ACA Part 2 The ACAing up to Bernie’s M4ALL. That almost looks like a full range of options for people to pick over and compare with the Trump HC plan.Report