Can you elaborate on this?
https://fivethirtyeight.com/features/americans-want-the-health-care-system-to-change-just-not-their-own-health-care/
Every high profile politician, particularly POTUS, is sensitive to and seeks a lasting positive legacy. Usually it's based on a very specific change/policy/scandal/accomplishment that impacted American society for the long haul. It's built into the individual sense of accomplishment, ego and vanity. And, if we are being totally transparent, since we are talking about professional politicians, we are also talking about the external validation usually desired by narcissists. And this is all politicians, no matter their viewpoints. People who love attention, love to fight over policy and are seduced by power are drawn to these careers.
Abraham Lincoln - Ended Slavery
FDR - The New Deal
Madison - Bill Of Rights
Woodrow Wilson - League of Nations (path to United Nations)
LBJ - Medicare, Voting and Civil Rights Acts
JFK - Youngest POTUS, assassination triggered the entire Republic
Nixon - Watergate
Jefferson - Louisiana Purchase
Humans all compete in life, someone as high profile as Obama is competing, legacy wise, against the accomplishment and failures of these men. For Obama, it's the Affordable Care Act, which was carefully marketed as "Obamacare" to make sure his name was infused into the policy.
If Obamacare's long term legacy is seen as negative and an eventual anchor on attempts at sustainable health care reform, then that tears down his legacy. I want to be fair to Obama, no single man and no single administration was going to absolutely fix the gigantic health care problem in the US. It was here before he was elected and it will be here long after. Politics are all built on the narrative of blame. Team Blue blames Team Red, and when they can't do that, they blame other factions in Team Blue. It's easier than compromise, it's more marketable, it galvanizes their individual base better, it serves political theater better and it's simply more profitable. In order for the US to transition away from the ACA, the brutal cost of shift away will, doing rough math in my head, will be north of 150 billion dollars. You are also looking at 25-30 million Americans who would be immediately cast into being uninsured to go in a different direction like Medicare For All. And that's just to start and the "best case" scenario. This doesn't include the fallout of the number of people who still were forced into medical bankruptcy and those who died without proper medical care and the crushing reality of the lack of practical "long term" care for the elderly under the ACA.
To shift to M4A, part of the political strategy is to blame Obama for all of that. The failures, the cost to change, the body count. He's out of practical politics, he has no biological political legacy ( Michelle Obama is not a contender, his children are too young), his loyalists are dinosaurs ( Biden) and/or fail a scrutiny/optics test ( Rahm Emmanuel, Eric Holder, Koskinen, Lansing, Cordray, etc, etc)
With the pandemic, the rising cost of health care and premiums under the ACA, general economic instability, rising number of people with mental health issues with no system to support them, the administrative/bureaucratic/paper mill nightmare of managing health care and an aging population, living longer than ever before, with no practical plan for long term care PLUS the undeniable media spotlight on the outright greed of Big Pharma and vast financial pork given to health care corporations,
Barack Obama right now is a big fat political softball. He's coming in real slow and right down the money making part of the plate and someone like Osario-Cortez is going to square up, blast his legacy to shreds and take him for a ride.
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This entire forum could talk about ACA and M4A and fill up 10,000 pages of facts, horror stories and general pulp. But let's shift the conversation to AOC in 2024 and pure political strategy. This would also cover the motives of the shots fired between The Squad and the Obama/Biden camp.
M4A would roll in the existing Medicare system in place (65 and older, etc) and add in prescriptions, maternity, pediatric, newborn and long term care. It would also relieve a tremendous amount of administrative burden/paper churn/legal woes associated with copayments, deductibles and premiums. ( Bramel and Genedoc would have a better ability to cover the full scope of this)
What are the benefits in terms of political narrative? It's simple. You are covered. Full stop. Period. End of story. What makes it hard to sell? Transition costs, people's desire to have choices, the unknown depth this could take in terms of taxes.
How does AOC use this?
First, if she gets pregnant when she runs in 2024, she can have her baby and film everything and drive it into the press. Look at me. I'm a mother. I was working class like you. I didn't come from money or a rich family. I believe in this so much that I put my own baby into the hands of this system. It will protect my child, it will protect your children. She has now engaged parents, single mothers, women in general, the critical suburban woman vote, minority women and limited close to all avenues of political attack. How do you get away with a smear campaign on a pregnant brown woman? You don't.
Then this spins into a full family narrative:
https://slate.com/human-interest/2019/03/aoc-mom-blanca-ocasio-cortez-daily-mail-interview-beautiful.html
"The family enjoyed a middle-class lifestyle until
(AOC's) father, Sergio, died of lung cancer in 2008 but fell into serious debt when he left unpaid medical bills and no life insurance to cover them. Blanca ( the mother) worked two jobs, including one as a housekeeper, to save their house....
.....Shortly before Sergio died, when he could no longer speak, he and Alexandria were sitting together watching an episode of Star Trek: Voyager. At one point, Sergio pointed to Captain Janeway and then at Alexandria, as if to suggest she, too, would be “someone in charge” someday. Later, the actress who played Janeway, Kate Mulgrew, made an appearance at one of Alexandria’s campaign rallies."
https://www.newsweek.com/alexandria-ocasio-cortezs-mom-nicknamed-boc-tells-how-husbands-death-inspired-1351829
"The family faced eviction from their home in Yorktown Heights twice following the death of Sergio. The small business-owner, who had provided a comfortable middle class existence for his family, had no health insurance. Over the course of two years of medical bills and with the money from his business dwindling, the family faced financial turmoil.
"It was scary," (Blanca)Ocasio-Cortez said. "I had to take medicine I was so scared. I had to stop paying for the mortgage for almost a year. I was expecting someone knocking on the door to kick me out at any time. There were even real estate people coming around to take photos of the house for when it was going to be auctioned. The worst is that I only had $50,000 left to pay on the loan."
"I was cleaning houses in the morning and working as a secretary at a hospital in the afternoon. I was working from 6 a.m. until 11 p.m. And I prayed and prayed, and things worked out," she added, explaining that she eventually reached a deal with the bank to fend off eviction....
"My daughter works from the heart," Blanca Ocasio-Cortez said. 'What you see is what you get. She saw how unfair the system is, and she wants to change that. She saw struggling parents putting their children through school, but also how difficult life was for people in the Bronx compared to Yorktown....She saw the difference in education and status between parts of the family, and she just wants everybody to have the same opportunities..."
Now if you are running the PR/Crisis Management section of AOC's campaign, you contrast this media friendly working class "family values" platform and hammer the living #### out of Barack Obama, and by extension, all of Obamacare:
https://www.townandcountrymag.com/leisure/real-estate/a30169311/barack-michelle-obama-buy-marthas-vineyard-house/
Obama buys a 12 million dollar mansion in Martha's Vineyard. Should the "common" people trust the ACA when Obama said on June 23, 2009 -
“We will keep this promise to the American people … if you like your health care plan, you will be able to keep your health care plan. Period.”
https://www.newsweek.com/malia-obama-harvey-weinstein-accusations-680950
Malia Obama got a privileged upbringing and got into Harvard and interned for the Hollywood "monster" Harvey Weinstein.
Look at the company Obama keeps. He sent his own daughter into the hands of a sexual predator and hobnobs with the social elite, even the disgusting ones. AOC can say I grew up like you, the average American, I did not grow up like the Obama's who foisted that insane ACA onto you.
https://www.npr.org/2017/05/07/527250396/obama-under-scrutiny-for-paid-speeches
Obama's gotten financial political pork from a 60 million dollar book deal and is paid up to 400K per shot in speaking fees. When a bill came to Obama demanding more severe restrictions on this kind of back end/post career pork, it was vetoed. AOC can say,
what does Obama know about the needs of the people? My mother almost lost our home in his insane medical system, I will fight for you because I am one of you. Any of you could end up like my mother and Obama will only care about the next 60 million dollar book deal.
https://www.usnews.com/opinion/articles/2012/02/17/the-five-biggest-failures-from-president-obamas-stimulus-law
https://nypost.com/2012/01/29/how-the-800b-stimulus-failed/
Then look at Obama's policy and spending. His 825 billion in stimulus faced massive backlash. Unemployment and poverty, including child poverty, went up.
Then Obama spent 35 billion on clean energy/Solyndra which all turned out to be a huge scam. This forms a springboard for AOC to talk Green New Deal as well. To be fair, some factors in the 2008 financial mess were in the works long before Obama, but he's in office, he has to carry the weight, that's just how the deal works. So AOC says, why stick to the ACA if the guy who created it screws up with your tax dollars so badly?
This also tanks Biden's association with Obama if he tries to run again in 2024. By proxy, this also neutralizes Kamala Harris for rolling with Biden. Then the only person in America who can control their own political destiny, Oprah Winfrey, takes a hit if she even considers running for being so aligned with the Obamas.
https://www.forbes.com/sites/brucejapsen/2013/05/25/obamacare-will-bring-drug-industry-35-billion-in-profits/?sh=24dc97a034a5
"Despite expiring patents on blockbuster drugs and a wave of new regulation from the Affordable Care Act that will cost drug makers,
the pharmaceutical industry will reap between “$10 billion and $35 billion in additional profits over the next decade,” a new analysis shows.
The health law, which will bring millions of uninsured Americans health benefits beginning in January 2014, will be a critical boon to pharmaceutical industry balance sheets, increasing revenue by one-third by the end of the decade, according to a new report from research and consulting firm GlobalData of London.
That means the U.S. pharmaceutical industry’s market value will mushroom by 33 percent to $476 billion in 2020 from $359 billion last year....
“Companies will have to make a few financial sacrifices when the new reforms come into force,” Owide said. “However, they have been able to engineer the new legislation to minimize the negative impact on their profitability. Overall, the ACA will leave the industry with anywhere between $10 and 35 billion in additional profits over the next decade, which is a significant boon at a time when patent expires are heavily undermining the efforts of the pharma industry.”
https://www.aeaweb.org/research/regulating-health-insurers-aca-medical-loss-ratio
https://www.politico.com/interactives/2017/obamacare-non-profit-hospital-taxes/
https://finance.yahoo.com/blogs/the-exchange/who-s-getting-rich-off-obamacare-132645613.html
https://www.forbes.com/sites/theapothecary/2016/01/18/how-the-obama-administration-raided-the-treasury-to-pay-off-insurers/?sh=27e8be06164d
"In 2013, a little-known rule in the Affordable Care Act had health insurers terrified, reported the Washington Post. The Obama White House bragged that the so-called 80/20 rule was holding insurance companies accountable and saving Americans billions of dollars in premiums.
As the ACA’s ten-year anniversary draws near, it’s now clear that this particular rule did almost nothing to bring down premiums...
Rather than lower premiums, insurers searched for other ways to come into compliance. Initially, there were efforts to relabel some administrative costs as “quality improvements”—like lobbying to count spending on nurses’ hotlines as part of the 80 percent.
But the easiest route to meeting the requirement was simply to let medical claims increase. That companies opted to do this, instead of lowering premiums, didn’t come as a surprise to the authors.
“An instrument like this looked very familiar to me from my work on utility regulation,” Cicala said. “And it was kind of incredible that something like it had been adopted [by the ACA].”
The electricity sector, for instance, uses regulations similar to the 80/20 rule, but there are regulators that monitor utilities and sign off on “legitimate” costs—a key difference.
There was no such oversight for the health insurance industry..."
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So there's two other pathways here. First, there is Trump and the issue of individual mandates under his time as POTUS.
https://www.npr.org/sections/health-shots/2019/10/14/768731628/trump-is-trying-hard-to-thwart-obamacare-hows-that-going
This doesn't help Obama/Biden's position.
Second, there is this
“But we have to pass the bill so that you can find out what is in it – away from the fog of the controversy.” - Nancy Pelosi during the fight to get the ACA passed.
But AOC will truncate it to :
“But we have to pass the bill so that you can find out what is in it...”
Which infers a lack of transparency ( though the overall full context is more complicated than that) and makes Pelosi look and sound tone deaf, elitist and generally horrible. That's a natural legacy path to hit Pelosi again and again, and by default, neutralize her nephew, Gavin Newsom, a 2024 DNC contender.
Obamacare was designed to expand coverage with insurance exchanges and lower costs. We can go into lots of context, but I'd say it failed. Both in reality and with political optics.
Medicare For All is designed to reduce costs by increasing taxes to pay for the program's coverage, but the natural fallout is reducing payments to healthcare providers such as hospitals and physicians. It has to be said that M4A could eliminate the private health insurance system as we know it.
With Obama's political legacy at stake, what he's doing is backchanneling "Medicare For All Who Want It" via Pete Buttigieg. Which is basically a patch job. It's Obamacare with a "public option" that tries to update the biggest holes in the ACA. It's a Service Pack for a bad OS. I don't see it working or being much of a political reality, just another media misdirection to ward off incurred ill will and blame for the ACA.
https://www.law.berkeley.edu/press-release/new-health-care-study-public-option-would-generate-more-benefits-savings-than-projected/
https://www.healthleadersmedia.com/finance/dueling-reports-show-benefits-problems-public-insurance-option
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What is solid political strategy?
You choose an issue that
1) Makes you look strong and builds a narrative you can control
2) Makes your enemies look weak and builds a narrative they can't control
3) Makes others do the vicious brutal legwork for you, make your enemies fight your other enemies before they fight you
4) Take in a massive short term political benefit to your platform
5) Set up a long term political benefit that creates legacy
With driving M4A , AOC does all of this. She simply says
I can do this for you, the American people, if you put me as POTUS. Look at my newborn child, look at my mother, look at my story. I lived in this, I suffered through this, I'm going to fight this. Fight with me.
AOC is a socialist. She makes this politically viable by making Americans believe that the 2024 POTUS race should be
an argument about class division, not partisan division. It's why she has no problem with Defund The Police wiping out DNC stalwarts. The ones being lost weren't going to help her anyway. The most the Biden/Harris/Obama camp would give her, if she played their game, is a progressive shill like Tammy Baldwin who is beholden to loyalty to the old guard.
AOC is using her platform to support other candidates, she did in this cycle and will keep doing it.
https://www.cnn.com/2020/02/21/politics/alexandria-ocasio-cortez-pac/index.html
In terms of political strategy,
AOC is using classic asymmetrical warfare. She can't match that legacy DNC financial warchest. They buy commercials, she buys social media ads. They have established influence in big business, she uses her young base as a ground assault, using speed, flexibility and blitzing tactics with door to doors and youth outreach. They have established power bases in critical states, she is building her loyalists in small fanatically loyal cells that engage the critical group of disenfranchised minorities, Gen Z and digital natives.
https://www.cnn.com/2020/07/24/politics/aoc-ted-yoho-cspan/index.html
It's not the 8 plus million people she reaches on Twitter nor the 6 plus million on Instagram that terrifies the old guard DNC.
It's the exponential growth of her platform in her short time in Congress. She's young, she was a bartender and she spent most of her life in school, there is no real room for scandal for Obama/Biden to hang her on. That she can sometimes
dominate the daily media cycle at will is going to scare the living crap out of someone like Pelosi, who thought her "Spice Girls Of Politics" pet project would not spin out of control.
Politically, AOC is completely and totally lethal. I don't like her personally, but I have to give credit to any straight up killer who likes to punch people in the mouth.
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M4A sells in a country built on freedom of choice by convincing Americans they have no choice. With the pandemic driving the economy and stability into the ground, AOC is building that very narrative - Buy In Or Die.
As I know you are a Christian, Joe, it's only fitting to use C.S. Lewis to encapsulate AOC's M4A practical messenging -
“Are you not thirsty?" said the Lion.
"I am dying of thirst," said Jill.
"Then drink," said the Lion.
"May I — could I — would you mind going away while I do?" said Jill.
The Lion answered this only by a look and a very low growl. And as Jill gazed at its motionless bulk, she realized that she might as well have asked the whole mountain to move aside for her convenience.
The delicious rippling noise of the stream was driving her nearly frantic.
"Will you promise not to — do anything to me, if I do come?" said Jill.
"I make no promise," said the Lion.
Jill was so thirsty now that, without noticing it, she had come a step nearer.
"Do you eat girls?" she said.
"I have swallowed up girls and boys, women and men, kings and emperors, cities and realms," said the Lion. It didn't say this as if it were boasting, nor as if it were sorry, nor as if it were angry. It just said it.
"I daren't come and drink," said Jill.
"Then you will die of thirst," said the Lion.
"Oh dear!" said Jill, coming another step nearer. "I suppose I must go and look for another stream then."
"There is no other stream," said the Lion.”
― C.S. Lewis, The Silver Chair