After Democrats missed the mark in another special election, Matt Yglesias writes that Democrats “could use a substantive agenda” if they hope to get voters to look past petty issues of cultural politics like Kathy Griffin’s antics and decide Democrats’ policies will actually make their lives better.
I agree with Yglesias that Democrats need to tell people how they will make their lives better, specifically. Even as Democrats lead significantly in poll questions about how people will vote for Congress next year, only 31% of respondents are telling CBS News they think a Democratic takeover of Congress will improve their lives. But I think the problem runs deeper than he suggests.
Democrats haven’t simply forgotten to develop a substantive agenda. The Democratic Party is divided between two substantive visions of what government should do, and either of those visions is doomed to alienate a majority of the electorate.
But I think there is a convincing way forward for the party. Roughly, it involves being less like Hillary Clinton and less like Bernie Sanders, and instead being more like Elizabeth Warren.
Warren sees a way to make credible policy promises in a time of low voter trust
A lot of people lump together a Sanders-Warren wing of the party, but this conflation leaves out a lot. Franklin Foer hit on a good explanation of why in the most recent Atlantic:
“Although [Warren] shares Bernie Sanders’s contempt for Wall Street, she doesn’t share his democratic socialism. ‘I love markets — I believe in markets!’ she told me. What drives her to rage is when bankers conspire with government regulators to subvert markets and rig the game. Over the years, she has claimed that it was a romantic view of capitalism that drew her to the Republican Party — and then the party’s infidelity to market principles drove her from it…
“At the core of Warren’s populism is a phobia of concentrated economic power, an anger over how big banks and big businesses exploit Washington to further their own interests at the expense of ordinary people. This fear of gigantism is a storied American tradition, descended from Thomas Jefferson, even if it hasn’t recently gotten much airtime within the Democratic Party. It justifies itself in the language of individualism — rights, liberty, freedom — not communal obligation.”
The idea of “concentrated economic power” is a bit abstract and probably doesn’t rate high on a lot of voters’ list of concerns. But large and small manifestations of concentrated economic power — high drug prices, companies treating their workers like interchangeable widgets, mushrooming airline fees — are very real voter concerns, and Democrats could make a lot of hay by focusing on them.
Democrats should make a list of corporate practices that grind people’s gears and ask whether there’s a compelling economic rationale for them. If there isn’t, they should propose to prohibit them, penalise them, or at least have the government stop subsidizing them.
And they should explain how doing so will make it easier for people to buy the things they need to live the way they want, with their own earnings.
This approach isn’t neoliberal and it isn’t socialist, either. It’s about treating markets as a means to an end and using the government to ensure those markets serve the interests of regular people. And it doesn’t have to involve growing the government or asking people to trust it with more of their money.
Clintonism and Sandersism both require too much voter confidence in government
The central proposition of Clinton-Obama progressive economics can be boiled down like this: We’ll tax rich people to give you a tax credit to help you buy expensive things like healthcare and education. These technocratic approaches are doomed to be widely perceived in the middle as “benefits for other people.”
Obamacare’s poll numbers are up now that people are pondering the potential horrors of Trumpcare, but the Affordable Care Act is still dogged by the very real sense that it doesn’t do nearly enough to make healthcare affordable for enough people, especially in the middle of the income spectrum.
The central proposition of Sanders economics is more ambitious: We’ll tax everyone — with an emphasis on rich people, but also including people like you — to pay for big, broad universal programs. There’s a lot of enthusiasm for this on the left right now.
But consider the arguments you would end up having to make once it becomes clear how much money the government would actually have to lay out to provide such big new benefits.
Sandersism is too expensive to fly right now
Moving nearly all healthcare expenditure onto the public ledger would require a huge increase in federal tax revenue. The federal government would need something like one-third to one-half more revenue than it collects already.
Sanders’ plan to finance single payer involved big new taxes on the rich, but any program that big is mostly going to have to be financed by broad-based taxes on workers, and indeed Sanders proposed new income and payroll taxes totaling 8.8%. Still, that would likely have put him trillions of dollars short of the real cost of his plan.
Of course, single payer doesn’t just have costs for the public, it also has benefits. You would need to sell it this way:
“Yes, we’re going to impose a big new tax. But we promise we’ll use that money to provide you an excellent new healthcare benefit you’ll really like. And because your employer won’t have to pay for health insurance anymore, we expect him to give you a big raise, and also be inclined to hire more people. Oh, by the way, you won’t be able to keep your current private health plan, even if you like it.”
You may think that’s a great idea. Do you expect it to win a political argument, at a time when people’s trust in the government to deliver what it promises is unusually low? There’s a reason state efforts to implement single payer keep falling apart over cost.
Consider, especially, that Democrats are trying to win back power in a time of extreme negative partisanship. One of the things keeping enough Trump sceptics from voting Democratic down the ballot is a deep cultural mistrust of Democrats. Do you think you will win these people back by proposing to tax much more of their income and promising to spend it on things they will like?
A better approach: Un-rig the system so people can afford the things they want
Instead of proposing to tax a small slice of rich people to give subsidies to poor-to-lower-middle-income people, or proposing to tax everyone to have the government take over sectors of the economy, what if Democrats ran on fixing broken markets so middle-income people could afford to buy more of the things they need in their daily lives — with their own earnings?
What would that mean, in particular? Well, to start with the healthcare sector, here are some examples of things that could be on the agenda:
- Impose price controls on prescription drugs.
- Block hospital-system mergers, so healthcare providers have less power to raise prices.
- Offer a Medicaid-based public option, so people can buy insurance that enjoys Medicaid’s low negotiated payment rates — and that can therefore offer more affordable premiums and deductibles.
- Break up state medical cartels. Force states to allow nurse practitioners an appropriately broad scope of practice, to recognise other states’ medical board certifications, and to honour foreign medical degrees. Abolish “certificate of need” requirements that make it hard to open new medical facilities. Issue more visas to foreign doctors and nurses. These changes would make it easier to find a medical provider and put downward pressure on prices.
- Ban surprise medical bills. A hospital that’s in your network shouldn’t be able to stick you with an astronomical bill for an out-of-network anesthesiologist you didn’t even know was going to treat you.
- Move more drugs and medical devices over-the-counter. Warren and Sen. Chuck Grassley, a Republican, have a bipartisan bill to allow some hearing aids to be sold without a prescription. Some forms of hormonal birth control could also be made available OTC.
For decades, healthcare policy has mostly been about who gets what: Who will be eligible for free or subsidized insurance, how big the subsidy will be, and who will be taxed to pay for it. People are terrified they will come out on the losing end of changes to that system. They are wary of handing control over the allocation of those resources to their cultural enemies.
The great thing about this cost-reducing agenda is it makes anyone who consumes healthcare into a winner.
This easily beats the Republican ‘patient centered’ agenda
Republicans like to talk about “empowering patients,” but what they mostly mean by that is leaving people on their own to pay for whatever, forcing them to use complex spending accounts and comparison-shop along the way, as though people enjoyed pricing out a needed surgery in the way they would a new car.
The approach I outline above would actually empower patients, making it easier for them to buy what they need without imposing new burdens on them. It would be easy to point to concrete ways regular people would benefit, it wouldn’t involve another wholesale shakeup of the health insurance system, and it wouldn’t require any new taxes — it would actually cause public expenditure to go down.
If you’re uninsured, lower costs will mean lower premiums closer to your reach. If you’re insured — even if you have high-quality employer-based insurance you really like — lower costs will mean lower payments toward your premium and lower out-of-pocket costs.
It’s an agenda that doesn’t require voters to take a leap of faith to understand how it would help them, personally.
Plus, these ideas are also pretty simple. Democrats have bemoaned the fact that many people who benefit from provisions of Obamacare don’t even know they’re benefitting. But everyone can understand the idea of forcing drug companies and hospitals to stop gouging you.
So, why don’t Democrats run on this?
You can do this way beyond healthcare
When proposing to improve any sector of the economy, ask: Before we propose new taxes and spending, is there anything we can do to give more power to workers and consumers by taking it away from oligopolistic firms, so they’re better able to take care of themselves?
In a lot of cases, you’ll find the answer is yes.
Make non-compete agreements unenforceable. Ban just-in-time employee scheduling, or make companies pay their employees overtime rates when they use it. Close scammy for-profit colleges. Withhold federally-subsidized financial aid from colleges that don’t provide good value for tuition. Prohibit airlines from charging fees for carry-on luggage. Make phone companies quote their rates inclusive of taxes and fees. Let automakers sell directly to consumers, like every other industry, instead of requiring customers to go through an auto dealer. Make financial institutions pay for the guarantees the government makes on their behalf. Recalibrate monetary policy to emphasise full employment over inflation prevention.
And so on, and so on.
These sorts of policies would sum to a substantive agenda Democrats could sell as materially benefitting ordinary people — low-income people, middle-income people, affluent people, left-wing people, centrist people — even in these low-trust times.
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