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In listening to the Democratic presidential debates, we might conclude that “Medicare for All” is a legislative possibility. It is not, and any presidential candidate with a scintilla of self-respect must admit that fact. A recent Kaiser Family Foundation poll found that just 30 percent of Americans “strongly favor” a plan in which all of us get medical care from a single government plan, while 33 percent of us “strongly oppose” such a major change. Moving public opinion and persuading a deeply divided Congress to enact life-altering changes, the prospects of which understandably scare many congressional constituents, is tough, controversial, politically hazardous and even a career-threatening challenge. It will not be magically achieved — in fact, it is made less likely — by its advocates’ regularly asserting their moral superiority over those not on their side.

A quick review of post-World War II American health care reform efforts might be helpful. President Harry Truman advocated universal health insurance coverage, but opponents, led by the American Medical Association, branded it “socialized medicine.” President John Kennedy unsuccessfully backed legislation to provide health insurance to those over 65. President Lyndon Johnson’s landslide victory gave him the congressional muscle to pass both Medicare and Medicaid in 1965. The most ambitious efforts of Presidents Jimmy Carter and Bill Clinton to expand coverage to all Americans were defeated, and it was not until 2009 — some 60 years after Truman pushed it — that President Barack Obama, over all-out partisan resistance, was able to sign the Affordable Care Act passed by Democrats in the House and the Senate — a vote, let it be noted, that cost the Democrats their congressional majorities in the very next election. It would take a full nine years — when a new Republican president pledged to repeal the Obama-era health law — before a majority of Americans registered their approval of that controversial Democratic law.

Don’t pretend changing the law on health care is going to be easy or painless. Where is the 2020 reincarnation of Bill Bradley, the former New Jersey senator and Princeton All-American? History will show that he was the architect-engineer and father of the memorable 1986 Tax Reform Act that dramatically lowered American tax rates while abolishing most deductions and loopholes. Bradley had begun four years earlier, by relentless study, to seek out experts in order to master the tax code.

He wrote a well-received book on his Fair Tax idea. He spoke to hundreds of business, civic and university groups on the decidedly unsexy subject. He did interview after interview with editorial pages and reporters (I can attest) and radio stations. He proselytized Republicans as well as Democrats, and the tax plan he co-authored with then-Rep. Dick Gephardt of Missouri grabbed the attention of then-President Ronald Reagan, who announced a presidential task force to respond to Bradley’s tax reform. Bill Bradley persisted. Without fanfare, away from the spotlight and the cameras, he did the hard work of going to House members’ offices; answering questions one-on-one; and courting, with candid information, Congress’s two chief tax writers: Rep. Dan Rostenkowski, the tough Chicago Democrat, and Sen. Bob Packwood, an Oregon maverick Republican. Thus was born tax reform.

Where is the Bill Bradley of Medicare for All or Medicare for Some who is willing to do the tough, tiresome, painful, unapplauded work of reaching out, enlisting supporters, answering doubts and being the workhorse instead of the show horse? I haven’t seen him or her on the debate stage yet.

To find out more about Mark Shields and read his past columns, visit the Creators Syndicate webpage at

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Reprinted with permission from Alternet

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