Bernie Sanders

Stepchild of Health Care Now Getting Overdue Attention

People are living longer and the population of older adults is growing, but long-term care remains a stepchild in debates over health care. That is beginning to change as presidential candidates offer options for expanding long-term benefits for older adults and people with disabilities. With only a small percentage of older adults who have private long-term care insurance, the challenge and costs of expanded benefits are daunting.

People are living longer and the population of older adults is growing, but long-term care remains a stepchild in debates over health care. That is beginning to change as presidential candidates offer options for expanding long-term benefits for older adults and people with disabilities. With only a small percentage of older adults who have private long-term care insurance, the challenge and costs of expanded benefits are daunting.

Long-term care has been the missing link in health care reform debates, but that is changing as 2020 Democratic presidential candidates offer options for addressing the arguably biggest gap in the US health care system.

The Medicare-for-All plan introduced by Vermont Senator Bernie Sanders and supported by several Democratic presidential candidates adds long-term care benefits to Medicare. Independent estimates place the cost for expanded benefits at $25 trillion over 10 years.

A House version of Medicare-for-All, cosponsored by Washington Congresswoman Pramila Jayapal and Michigan Congresswoman Debbie Dingell, which emphasizes policies that allow older adults to remain in their homes. "Instead of saying institutional care is the default, we say you should be able to get care at home, in your community," Jayapal says.

New Jersey Senator Cory Booker recently unveiled a proposal to expand eligibility for long-term care services for older adults and disabled persons under Medicaid. Roughly 20 percent of Medicaid spending goes toward long-term care. About 65 percent of nursing home residents are supported primarily by Medicaid.

Minnesota Senator Amy Klobuchar has a “Plan for Seniors” that seeks to expand long-term care facilities, add hearing, vision and dental care to Medicare and support training for long-term caregivers. Klobuchar wants to bolster Social Security by lifting the payroll tax from the current $133,000 income cutoff to wages up to $250,000. 

Political dialogue about long-term care has been sparked by data showing projected growth in the number of older adults in the US population. By 2035, there are expected to be 78 million people 65 years and older compared to 76.7 million people under the age of 18. As few as 8 million Americans have some form of private long-term care insurance. There also has been a strong push by disabled Americans to strengthen long-term care.

Older Americans make up one of the most consistent voting blocs and they tend to be more conservative than younger voters. Democrats sniff an opportunity to eat into a bedrock conservative cohort by advancing long-term care initiatives.

AGE+,  a new nonprofit, has formed to address long-term care issues holistically in Oregon with an emphasis on aging in place and addressing equity for underserved older adults in rural areas and minority communities.

AGE+, a new nonprofit, has formed to address long-term care issues holistically in Oregon with an emphasis on aging in place and addressing equity for underserved older adults in rural areas and minority communities.

Providing long-term care benefits under Medicare or Medicaid will be expensive. The dimensions of the problem go beyond money. There aren’t enough long-term care beds available, there are too few single-story homes where disabled and older adults could age in place and there is already a shortage of trained caregivers. Add to that isolation that can occur, especially in rural areas, and inequities in available long-term care options. Low pay is a barrier to recruiting more caregivers.

Gerontology researched Marc Cohen describes long-term care as the stepchild in the broader health care reform discussion. Nicole Jorwic, policy director for The Arc that serves people with disabilities, says, “If you don't include long-term supports and services, it cannot be considered a bill that is for all people because it leaves out huge portions of the population, including people with disabilities and aging Americans."

 


Medicare-for-All Debate Reflects Voter Interest in Health Care

Health care was a major issue in the 2018 midterm elections and promises to be center stage in the upcoming 2020 presidential election, as reflected by growing support for concepts behind Medicare-for-All legislation.

Health care was a major issue in the 2018 midterm elections and promises to be center stage in the upcoming 2020 presidential election, as reflected by growing support for concepts behind Medicare-for-All legislation.

Medicare-for-All has become a campaign battle cry, even though what it actually means is far from clear.

Senator Bernie Sanders made radical health care reform a top-rung political priority in his 2016 presidential bid. Sanders is running for president again and now has a lot of company in calling for a major health care insurance overhaul.

Senator Bernie Sanders made radical health care reform a top-rung political priority in his 2016 presidential bid. Sanders is running for president again and now has a lot of company in calling for a major health care insurance overhaul.

First off, the Medicare-for-All version espoused by Vermont Senator Bernie Sanders isn’t actually an extension of Medicare, which now covers 50 million Americans, but would be phased out over four years. His bill contains provisions, such as coverage for long-term care, that aren’t covered now by the landmark health insurance plan created in 1965. Sanders is short on details of how to pay for more robust and costly benefits.

Most advocates of “Medicare-for-All” are expressing support for a single-payer system under which the federal government would assume the role of a giant, publicly funded health insurer. Sanders and others want to see expanded coverage for current Medicare enrollees as well as universal coverage. An enlarged pool of patients under a Medicare-for-All system would give government officials even more leverage to negotiate lower and more consistent pricing for medical services and prescription drugs.

Elimination of all private insurance, including insurance policies provided through employers, has been branded as “socialism” by Medicare-for-All opponents. For context, opponents said the same thing about Medicare.

Some Medicare-for-All proponents would like to see an expansion of Medicare eligibility and benefits, but not necessarily elimination of all private insurance, which provides coverage for 150 million American workers and their families.

Democrats who pushed through the Affordable Care Act (ACA) in 2010 made a similar political calculation, though they stopped short of including a “public option” that would have provided a government-sponsored health insurance plan. Instead, they opted for expanding Medicaid eligibility on a cost-sharing basis with states.

Some present-day Democrats, including House Speaker Nancy Pelosi who steered the ACA through Congress earlier this decade, still prefer an incremental approach as the logical and politically achievable next step towards universal health insurance. That might involve increased federal funding for Medicaid expansion, restoration of the mandate for everyone to have health insurance coverage or creation of some form of reinsurance pool to smooth out the cost of high-cost patients.

These variations, combined with 23 Democratic presidential candidates running around the country talking about health care while attempting to differentiate themselves from the herd, have created understandable confusion among voters. That confusion is compounded by continuing efforts by the Trump administration to take the ACA (Obamacare) off the books.

What’s clear is that some provisions of the ACA are very popular, notably preventing people with pre-existing conditions, often chronic illnesses or cancer survivors, from being denied affordable health insurance coverage. That has created a conundrum for congressional Republicans who tried unsuccessfully to repeal and replace Obamacare. Republicans express support for retain the pre-existing condition provision, yet they haven’t successfully landed on a larger platform to address health insurance access – and rising health care costs.

Beyond the debate over Medicare-for-All, health care in America is confusing. There are multiple public players (Medicare, Medicaid, Veterans Health Care, Indian Health Service, public health clinics, hospitals affiliated with public universities, public mental health clinics and public school clinics) and private players (for-profit corporations, nonprofit organizations, medical practices, medical laboratories, hospitals affiliated with private universities and integrated health care systems). 

The divide between health insurance and health care delivery is a blurred line. Many private health insurance policies come with their own networks that limit choice of medical providers.

Adding to this dizzying picture are soaring drug prices, with their own cast of characters that include pharmaceutical companies, pharmacy benefit managers, self-insured corporations, foreign-based internet retail outlets and prescription drug patent attorneys.

The end result is a health care system that is costly, suffers from a lack of coordination and isn’t equitable. One report concluded, “Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home.” 

Oregon has pioneered approaches to health care that respond to broader criticisms of the US system, or lack of a “system.” Under a federal waiver, Oregon has promoted increased in-home care for older adults and physically disabled persons that enables independent living and avoids more expensive institutional care. Oregon was among the first states to expand Medicaid eligibility, as permitted under the ACA, and has steadfastly defended that expansion despite rising costs.

Former Governor John Kitzhaber implemented coordinated care organizations serving low-income Oregonians to “bend the cost curve” through innovation and coordination. Since leaving office, Kitzhaber has pushed for investing to redress “social determinants” of health such as a lack of proper nutrition and early childhood education. Health care systems are striving to integrate physical and behavioral care to improve outcomes.

The Washington Legislature enacted this year a first-in-the-nation state-sponsored long-term care social insurance program. Under the program, Washington residents will pay 58 cents on every $100 of income, with the revenue flowing into a Long-Term Care Trust. Residents who pay into the fund for 10 years (three if a catastrophic disabling event) will be entitled to receive $100 a day up to a lifetime cap of $36,500. The money can be used for in-home care, installation of accessibility ramps, home food deliveries or transportation. The payroll tax is projected to generate $1 billion per year.

For many health care observers, actions such as Oregon’s and Washington’s are akin to bailing water out of a sinking boat. They call for a broader, more holistic approach to reform. That isn’t the same as calling for Medicare-for-All, which remains somewhere on the political spectrum between an aspiration and an abstraction.

What seems inevitable is that Americans have grown restive with gridlock as health care out-of-pocket costs and drug prices continue to rise much faster than inflation or wages. The 2018 mid-term election, which saw Democrats unseat GOP congressional incumbents and capture Republican-dominated seats, could be a bellwether of growing voter interest in tangible action on health care. Most prominent Democratic 2020 presidential candidates have apparently heard that message, which accounts for their support for Medicare-for-All or something like it that is significant and meaningful.

 

 

Coffee Mugs Wake up America, Portray Prexy Preferences

Every 2020 presidential candidate, and even a few who aren’t running, have commemorative coffee mugs to make their supporters swoon over a hot mug of java. No one better befits the coffee mug motif than Cup of Joe Biden.

Every 2020 presidential candidate, and even a few who aren’t running, have commemorative coffee mugs to make their supporters swoon over a hot mug of java. No one better befits the coffee mug motif than Cup of Joe Biden.

Twitter is thick with tweets about trade problems with China, escalating Iranian threats and congressional subpoenas. You also can order your favorite mug from a 2020 presidential challenger.

Other than campaign buttons, coffee mugs are the most common medium to convey your current political convictions. And candidates are more than willing to oblige.

What might have been outrageous in 2016 seems placid in 2020. Trump’s re-election offers platinum contributors a ceramic coffee cup with the pedestrian “Trump 2020/Keep America Great.” You also can get a Trump bobble-head with an extra-long red tie or a Manhattan glass with “Give me another.”

John Delaney, one of the lesser known Democratic presidential hopefuls, offers a coffee mug where you can improvise your own text. Like, “Are you crazy. John Delaney for President.”

Bernie Sanders has the second-most quoted campaign slogan that emblazons his coffee mugs, “Feel the Bern/2020.” There is a subliminal alternative that features The Bern with Nixon “V” signs and a Trump-like extra-long tie. There also is the clever, “Hindsight is 2020.”

Beto O’Rourke can be celebrated with a mug that creatively says, “Beto.” The coffee mug for Mayor Pete Buttigieg is slightly more exciting, “Pete/2020.” On trendier websites, you can find “Pete is Neat” mugs and more mugs that say “Beto.”

For the less particular, yet highly motivated voter, there is the “Literally Anyone Else” coffee mug. Other options include “He’s not my President” and “Impeach Donald Trump.” 

The Kamala Harris mug echoes her campaign stump speech, “Kamala Kamala Kamala Kamala.” To show her Twitter cred, there is also a mug that says, “Kamala for Ptus.”

Elizabeth Warren’s presidential coffee mug is actual a set of encyclopedias. For the politically incorrect crowd, there is a Warren/2020 mug with an Indian arrow. For the true Warren believers, there is the mug, “PERSIST, Elizabeth Warren/2020.”

The Jay Inslee presidential mug is a disappointment because it doesn’t come with a Starbucks sleeve. 

To please people who will be distracted through much of the 2020 presidential contest, there are special mugs – “November is Coming” and “Pratt/Reynolds.” For self-medicating voters, you can grab a mug that says, “Kanye for President.”

The coffee mug motif is built for Biden. Despite the funny mugs with Biden’s name and a pair of hands groping the 0s in 2020, there are some cabinet-ready candidates, though none better than “Cup of Joe.” It is reminder of those Folger coffee and Dunkin’ Donut ads.

Of course, votes, not coffee cups determine the outcome of elections. Maybe none do as much justice to that ideal than cups bearing “Save us, Michelle” and “Alexandria Cortez-Ocasio.2024.” Sometimes coffee just needs to age.

Presidential candidate coffee mugs.jpg

 

 

Fine Day to Read the US Constitution

There is no better day than Independence Day to find a copy of the US Constitution, read it and join the decades old debates about what it says, what it means and how we should interpret it in our own time.

There is no better day than Independence Day to find a copy of the US Constitution, read it and join the decades old debates about what it says, what it means and how we should interpret it in our own time.

To celebrate the nation’s birthday, The New York Times published the US Constitution and its 27 amendments (in print form only) with annotated comments from prominent Americans and a preface by historian Garry Wills.
 
Even though the Constitution is the bulwark of American rights and liberties, many Americans are unfamiliar with the document, its origins and the debates over its meaning that have spiraled through our national history.
 
Washington Senator Patty Murray points to the Seventeenth Amendment that requires the direct election of US senators. Previously, senators were elected by state legislatures. Murray, who launched her political career by resisted state legislative efforts to cut preschool funding, said, “If these words hadn’t become law, I would almost certainly not be in the US Senate today.
 
Utah Senator Mike Lee, who just published his latest book titled Written Out of History: The Forgotten Founders Who Fought Big Government, underscores the importance of the very first clause in Article I of the Constitution that says “All legislative powers granted shall be vested in a Congress.” Lee observed, “Sadly, in the 20th Century, members of Congress started to give away lawmaking authority to the executive branch because they did not want to be held accountable to the people for unpopular laws.”
 
Vermont Senator and unsuccessful presidential candidate Bernie Sanders wrote, “At a time when the President is actively working to undermine the foundations of American democracy and openly admires the world’s strongmen, autocrats and dictators, we must, regardless of party and say, ‘This is not what our constitutional democracy stands for.’”
 
Times Supreme Court reporter Adam Liptak offers perspectives about the Constitution and capital punishment. He says the Fifth Amendment doesn’t help death penalty opponents by calling for grand juries involving “a capital or otherwise infamous crime.” However, the Eighth Amendment bans “cruel and unusual punishment.” Liptak quotes a dissent by Supreme Court Justice Stephen G. Breyer in 2015 who said flaws in the modern administration of the death penalty make it unreliable, arbitrary and warped by racism, which he equated with cruel. He also cited the late Justice Antonin Scalia who accused Breyer of spouting gobbledygook. “Capital punishment presents moral questions that philosophers, theologians and statesmen have grappled with millennia. The framers of the Constitution disagreed bitterly on the matter. For that reason, they handled it the same way they handled other controversial issues. They left it to the People to decide.”
 
Scalia’s observation about the death penalty and founding father disagreements is an interesting segue to the contemporary debate over originalism – – the view that the Constitution should be interpreted in the context of the time and mindset of the men who wrote it.
 
In the preface, Wills questions the wisdom and utility of an originalist interpretation of the Constitution. “Finding original intent,” Wills wrote, “is more complicated than just looking up words in dictionaries of the 18th Century. It means re-entry into a lost world.”
 
Take the Second Amendment, for example, which has generated an irreconcilable debate over gun rights. Wills says James Madison, who played a central role in drafting the Constitution and the critical role in adopting the first 10 amendments to the document, wrote the Second Amendment to pacify southerners, especially slave owners who wanted to maintain armed state militias to suppress salves and quell a slave insurrection. “The original intent consideration of the Second Amendment,” Wills said, “shows just how far the poison of slavery pervaded the Constitution” and has little to do with the modern-day debate over owning assault rifles. Ironically, Madison didn’t feel it was necessary to protect an individual’s right to own a gun because almost everyone in his time owned one.
 
Lee, who is a leader in the congressional Freedom Caucus, wrote an earlier book titled Our Lost Constitution: The Willful Subversion of America’s Founding Document. In both his newest and first book, Lee makes the case for federalism, with power shared by the central and state governments. It was a debate waged vigorously at the constitutional convention and, as Scalia observed, was spelled out with characteristic constitutional ambivalence. Which explains why both political parties argue the issue inconsistently. Conservatives want less federal oversight on environmental rules and voting procedures, but favor a federal ban on abortion. Liberals see an important federal role in education and enforcing anti-discrimination, but favor allowing states and cities to pursue anti-carbon policies consistent with the Paris Climate Accords.
 
Most people don’t carry a copy of the Constitution in their pocket, so Independence Day is a great day to find and read a copy. You might be surprised at what’s in there. And remember that the men who wrote it didn’t always agree on what it said and what it meant. We don’t always need to agree either, which may be one the most underappreciated legacies of our Constitution.

Senate To Turn into Three-Ring Circus Over Health Care Legislation

More Capitol Hill drama as Senate Majority Leader Mitch McConnell is pressing for a vote before the July 4 break on an Obamacare replacement, as fellow Republicans balk at the lack of any pubic process, hearings or debate and Democrats gird to shut down Senate business.  Photo Credit: J. Scott Applewhite/AP

More Capitol Hill drama as Senate Majority Leader Mitch McConnell is pressing for a vote before the July 4 break on an Obamacare replacement, as fellow Republicans balk at the lack of any pubic process, hearings or debate and Democrats gird to shut down Senate business.

Photo Credit: J. Scott Applewhite/AP

You can exhale because there shouldn't be any Capitol Hill activity this week on President Trump and possible collusion in Russia. But take a deep breath as the Senate moves toward a highly contentious and audacious pre-July 4 vote on a health care bill that still hasn’t seen the light of day.

Senate GOP leaders reaffirmed plans to bring forward an Obamacare replacement measure in the next two weeks as Senate Democrats promised to bring all legislative action to a screeching halt, starting with talk-a-thon Monday night to list the deplorable provisions anticipated in the still-secret Republican bill.

Reports circulating on the Hill indicate there isn’t a consensus among Senate Republicans on key issues such as the level of Medicaid spending, addressing the national epidemic of opioid addiction and lowering health insurance premiums under the new plan for patients with pre-existing conditions. Senate GOP leaders have implied the bill, being drafted by a small workgroup behind closed doors, will get a vote whether or note there are enough votes for it to pass.

A website carried an elaborate explanation of how Senate Majority Leader Mitch McConnell might even might manage to limit floor debate when the GOP health care bill emerges from the work group. According to the explanation, McConnell could put a placeholder bill on the Senate floor calendar and let it suck up most of the 20 hours of allowable debate time. The real plan would be introduced as an amendment with little time left for a drawn-out floor debate.

Whatever the procedural strategy is, criticism is building for addressing contentious and emotionally charged health care legislation without a public hearing. The House, before it narrowly passed its version of an Obamacare replacement, didn’t hold any public hearings. It did come to the floor our of House committees, however, which apparently won’t be the case in the Senate under the current legislative scenario.

The secretive bill-writing strategy probably relates to the unpopularity of what the House passed, as reflected in public opinion polls and in raucous town hall meetings held by GOP lawmakers who voted for the bill. Trump, who initially praised the House bill, has since called it “mean" and urged senators to be more “generous.”

It doesn’t appear all Senate Republicans, including Florida Senator Marco Rubio, is on board with rushing a health care bill through a floor vote without any hearings and little debate. However, Senate GOP leaders are telling fellow Republican caucus members, this may be the one and only chance to vote to repeal Obamacare – a promise seven years in the making – before moving on to other legislative priorities.

Unlike the House, Senate Republicans want to have their heath care bill scored by the nonpartisan Congressional Budget Office before a floor vote. Reportedly, pieces of the new legislation have already been shared with CBO, though no results have been disclosed.

Democrats are doubtful that whatever emerges will be generous enough. They are hatching their own procedural strategies, including objecting to all requests to proceed with business on the Senate floor that requires unanimous consent or 60 votes to continue. Another tactic will be an attempt to force the referral of the House-passed American Health Care Act to a Senate committee.

Both sides will be frequently in front of microphones at press conferences and active on social media. Senators Bernie Sanders and Elizabeth Warren held a Facebook Live event to whip up opposition. Other Obamacare repeal opponents are urging a flood of emails and other constituent communications to sweep into Senate GOP offices.

Last week, Vox ran a story based on interviews with eight Senate GOP senators in which none of them seemed to have a glimmer of an idea what was in the Republican health care plan or the policy rationale for the provisions they couldn’t articulate. Those may be hard perceptions to shake if the Senate springs its health care bill for a vote with little notice and virtually no debate.

Electorate Sour on Candidates, Primary Process

American voters are definitely interested in the 2016 presidential election, but many feel disaffected with the front-running candidates, the primary process and the electorate’s own “political wisdom.” 

American voters are definitely interested in the 2016 presidential election, but many feel disaffected with the front-running candidates, the primary process and the electorate’s own “political wisdom.” 

Voter turnout this year rivals the record-setting 2008 presidential election, but it has produced two candidates with historically high negative ratings and a sour taste about the primary process.

When Donald Trump and Bernie Sanders complain that the primary process is rigged, a majority of voters apparently agree with them. According to the Pew Research Center, only 35 percent of registered voters think the primary process produces the best qualified nominees. For Democrats, it’s a meager 30 percent.

Trump supporters are the most glowing in appreciation of the nominating process at 60 percent. Clinton’s backers have more positive views than Sanders’ supporters by a 37 percent to 25 percent margin.

But discontentment with the process and the front-running candidates hasn’t doused interest. Pew says 89 percent of Republicans and 82 percent of Democrats have given the 2016 election a “great deal of thought.” Those percentages exceed voter interest in the 2008 open presidential race.

Another interesting finding is that a majority of voters are frustrated, not angry, about government. Pew found 59 percent of voters express frustration, while only 22 percent admit to being angry. Seventeen percent claim to be basically content. 

Of those who are angry, 25 percent are fed up with politicians for failing to keep their promises or acting in a self-serving way, 18 percent are disgusted with political gridlock and 15 percent think politicians are out of touch and not working on their behalf. Four percent are angry because of President Obama, 3 percent because of Wall Street and big business influence and 3 percent because of taxes.

As might be expected, Republicans are more likely to be angry with a Democrat in the White House. Democrats were angrier during the George W. Bush White House years.

A discouraging perspective that emerges from the research is a pervasive view that life in America today is worse than it was 50 years ago and that it will be even worse for the net generation of Americans. Research indicates 46 percent of all voters – and 54 percent of white voters – think things in America are worse for “people like them.” That contrasts with only 17 percent of African-American and 37 percent of Hispanic voters who share the same view. There is more agreement across racial lines that things will be worse for the next generation.

It is reassuring that 68 percent of registered voters believe personal insults are “never fair game” in politics. Democrats hold that view more strongly than Republicans, but even Trump supporters agree by a 51 percent to 47 percent margin. Clinton and Sanders supporters are equal in their distaste for personal insults.

Voters by a 75 percent majority believe news outlets have given Trump too much coverage. That is less true, as you might imagine, with Trump supporters, who by a 55 percent majority think his coverage is “about right.” Supporters of Trump’s GOP rivals felt their candidates drew too little earned media coverage. Ohio Governor John Kasich’s backers were the most displeased, with 82 percent saying their candidate got less coverage than he deserved. Overall, 53 percent of GOP voters agreed. Even 42 percent of Trump supporters thought Kasich was shorted.

The study also shows Americans’ confidence in the “political wisdom” of the electorate sharply eroding through the 21st century. As recently as 1997, 69 percent of Democrats and 59 percent of Republicans expressed confidence in the political wisdom of the American public. Now only 35 percent of Republicans and 32 percent of Democrats have a great deal or good deal of confidence in the public’s political wisdom.

The Unsettled Presidential Election

Donald Trump and Hillary Clinton have their respective party presidential nominations sewn up, but their general election campaigns face a lot of uncertainty and unfamiliar political terrain.

Donald Trump and Hillary Clinton have their respective party presidential nominations sewn up, but their general election campaigns face a lot of uncertainty and unfamiliar political terrain.

By default or delegate count, the 2016 Republican and Democratic presidential nominations appear set. However, the campaigns and party unification processes are anything but settled.

Presumptive GOP nominee Donald Trump faces high-profile defections from prominent Republican leaders and Democratic presidential frontrunner Hillary Clinton keeps losing primary elections to Bernie Sanders.

Trump meets this week with House Speaker Paul Ryan, who has withheld his support from Trump. For Trump’s part, he claims he is ushering in a new-look Republican Party that may make party unity efforts a nice, but not necessary sidelight. That new look also may not include conservatives who say they won’t vote for Trump or Clinton.

Clinton has turned her political guns on a general election showdown with Trump, despite a still vigorous challenge by Sanders. However, just when it appeared Clinton would trounce Trump in a landslide, a poll by highly regarded Quinnipiac shows Clinton is in a dead heat or losing to Trump in the key swing states of Ohio, Florida and Pennsylvania. Sanders’ double-digit win in West Virginia this week added further doubt to whether Clinton can attract votes from disaffected white voters and political independents.

Trump and Clinton have the shared distinction of being the two most disliked presidential candidates in recent history. As such, both are having trouble appealing to their respective party bases.  Trump has shaky support on the conservative right and Clinton on the progressive left.

The Trump-Clinton race may come to a battle of identity politics. Trump scores with male voters, while Clinton does well with women and minority voters. Trump does poorly with establishment Republicans. Clinton flunks with younger Democratic voters.

In previous presidential elections, the candidates' experience and what they stood for counted most. In 2016, not so much. Trump touts his lack of political experience and has lurched around on issues like a bumper car driver. Clinton has been criticized for her experience and her wonkish policy views.

After Ted Cruz and John Kasich bowed out following Trump’s decisive primary win in Indiana, Trump told NBC News he looked forward to a principled general election campaign centered on policy. The next day, Trump returned to form and resumed his “Crooked Hillary” refrain. He hasn’t let up since.

Clinton immediately put up attack ads pointing out Trump’s outlandish statements and dubious policies, only to be warned by supportive political observers that getting into a gutter fight with Trump was a losing strategy. Strategists said Trump methodically disposed of GOP opponents who attacked him,  who famously noted that he could shoot someone on New York’s Fifth Avenue and it wouldn’t cost him a vote.

Perhaps a more troubling concern in the Clinton camp is the political viability of “outsider” messaging, especially when it comes to international trade and “rigged” systems. A West Virginia voter told a reporter after he voted in his state’s primary that he cast his ballot for Sanders because he “spoke the people.” The only other person running for president he would vote for is Trump.

One Democratic pollster said the problem boils down to a good “origin story.” Trump and Sanders pinpoint what and who is to blame. Clinton tells a more complex and conflicted story. Trump has mastered sloganeering. Sanders has powerful sound bites. Clinton has nuanced, detailed policy papers.

Presidential nominating conventions are more than a month away and there are still a few primaries left, including contests in Oregon and Washington. The eventual nominees are clear. How their campaigns will unfold and the odds on either’s ultimate success remain as unsettled as ever.

Taking the Political Bite Out of Trade

Opposition to international trade deals has welled up in both presidential primaries, but few realistic proposals have surfaced to address worker security in the face of unstoppable globalization and technological change.

Opposition to international trade deals has welled up in both presidential primaries, but few realistic proposals have surfaced to address worker security in the face of unstoppable globalization and technological change.

International trade deals have been trashed by presidential candidates in both parties, but realistic alternatives that would do more good than harm have been scarce.

Economists admit globalization of manufacturing and distribution, huge cross-border capital flows and accelerating technology changes have taken their toll on jobs and job security. However, they warn scrapping trade deals and trying to erect trade barriers will create worse economic problems without protecting workers they seek to shield.

A better approach, according to economists, is to increase support, especially in terms of job training for workers who lose their jobs because of globalization or trade deals that favor some sectors at the expense of others.

The Trade Adjustment Assistance program exists to provide that support, but is woefully funded compared to dislocated worker programs in other industrialized nations. It also isn’t very practical. The program pays for job training, but unemployed workers still need to earn money to pay a mortgage and put food on their family table.

Increasing funding for Trade Adjustment Assistance hasn’t been a political priority, but the deep discontent that has welled up by working class families all across the nation, as reflected by their votes for “outsider” presidential candidates strongly opposing trade deals, may change that.

Another idea kicking around in economist circles is called wage insurance. This involves wage subsidies to workers who lose their jobs so they can afford to take lower-paying jobs while obtaining job training. President Obama mentioned wage insurance in his final State of the Union address earlier this year.

Bolstering the Trade Adjustment Assistance program or enacting some type of wage subsidy doesn’t have the same raw appeal on the political stump as GOP frontrunner Donald Trump saying he will cut better trade deals with China, Japan and others. But his promise, based largely on his negotiating skill as a hotel developer, may not be worth the risk of a costly trade war that triggers a global recession.

Democratic contender Bernie Sanders has criticized former President Bill Clinton for pushing through the North American Free Trade Agreement, which has resulted in the transfer of U.S. manufacturing jobs to Mexico. Both he and Democratic frontrunner Hillary Clinton have expressed opposition to the Trans-Pacific Partnership, a key Obama priority. But neither Sanders nor Clinton have articulated a clear alternative to the TPP, which Obama defends as a roadmap for economic development in the Pacific Rim written by the United States, not China.

Free trade policies have been problematic for labor-backed Democrats and now appear to be a challenge for big business friendly Republicans, too. Protectionism also faces headwinds because American consumers are savvy enough to know that would mean higher prices for goods. Businesses, farmers and workers in states like Oregon and Washington that have export-dependent economies realize protectionism would hurt them.

As a result politicians on both sides of the aisle may be forced to pursue policies that produce tangible improvements for middle-class workers who have been and likely will remain vulnerable to new economic realities.

It is one thing to rail about trade policy on the campaign stump (Obama certainly did in his 2008 campaign), but it is another to stare at the hard realities. The United States remains the dominant world economy, but it no longer commands a position where it can call all the shots. The global economy is more intertwined so a hiccup on the Chinese stock market or refugee flows into Europe can impact the U.S. economy.

Just about everyone has a stake in figuring out trade policy. It may be the most fundamental middle-class American issue. It matters to young people who must navigate careers that don’t have life-time job guarantees. Those at the top of the economic heap may face growing unrest and a sharper shift to the political left if more isn’t done to provide greater job security to a growing group of Americans.

Activist labor programs could be the best defense against worker frustration, the least statist policy and the most popular political talking point. There is a general election coming up this fall to try out this approach.

A Day for Frontrunners to Forget (Except UConn)

Except for the UConn women’s basketball team, it was a bad day for frontrunners as Donald Trump’s march to the GOP nomination got trickier and the cloud grew grimmer over Hillary Clinton’s candidacy as the Democratic nominee.

Except for the UConn women’s basketball team, it was a bad day for frontrunners as Donald Trump’s march to the GOP nomination got trickier and the cloud grew grimmer over Hillary Clinton’s candidacy as the Democratic nominee.

The only frontrunner to win Tuesday was the University of Connecticut women’s basketball team, which captured its historic fourth straight national championship. Meanwhile, the Republican and Democratic presidential frontrunners lost in Wisconsin, and not by buzzer beaters.

Ted Cruz and Bernie Sanders each racked up more than 50 percent of the vote in the Wisconsin Republican and Democratic primaries, respectively. Their wins on Tuesday mean more intrigue in the nominating process, which already has had more twists and turns than whodunits.

The Cruz victory could be the turning point for the “stop Trump” movement. The delegates Cruz won in Wisconsin make it that much harder for Donald Trump to accumulate the required delegates to capture the GOP nomination before the national convention in Cleveland this summer.

The Sanders victory – his sixth straight triumph over frontrunner Hillary Clinton – may not derail the Clinton locomotive to the nomination, but it raises questions about how high her campaign can fly in the fall general election, especially if the young voters activated by Sanders skip voting.

The storylines in the two parties are comically different. The GOP presidential primary has careened from reality show to peep show. The Democratic primary has resembled a coronation disrupted by a grumpy janitor with an agenda.

However, in many ways the nomination process in both parties is eerily similar. “Outsiders” such as Trump, Cruz and Sanders have drawn more votes than anyone would have predicted before the Iowa caucuses in January. Yet, the unpredictability of the outsiders has added an element of suspense that has largely been absent in recent presidential primaries. 

Cruz may block Trump’s march to the nomination, but he may not be the beneficiary of his success. There is rampant talk of a white knight – AKA Speaker Paul Ryan – riding into a contested convention and leaving with the prize in his saddlebag. Even the conservatives who are bent on denying Trump the nomination don’t have much faith in Cruz as a viable national candidate. Lindsey Graham endorsed Cruz, after saying "if you killed Cruz on the floor of the Senate and the trial was in the Senate, nobody would convict you.”

Sanders’ insurgency has a different effect on Clinton. His outsider campaign emphasizes her insider connections. His plainspoken criticisms of Wall Street, big business and drug companies has underlined her cozy relationships. His bluntness contrasts sharply with her finesse.

Sanders' at times wobbly command of details, as reflected in his interview with the New York Daily News, gives some of his supporters pause. Even though the policies Sanders advocates seem unachievable to most observers, he still comes across as more honest than Clinton. In fact, exit polling shows Clinton failing the honesty test for a hefty chunk of Democratic voters.

Despite the mathematical improbability of Sanders winning enough delegates to elbow aside Clinton at the convention, his string of victories poses more than an inconvenience for the Clinton camp. Sanders only netted a 10-delegate gain from his win in Wisconsin, but that isn’t the real significance of his victory – or victories to come in other states. Democrats have to wonder whether Clinton is too bruised to win in November.

The way the races are shaping up in both parties, Oregonians may be treated to an actual primary contest in May. Sanders has set up a campaign office in Portland and others are likely to follow. We may actually see the candidates and shake their hand while eating an ice cream cone instead of catching a glimpse as they limo in from the airport to a closed-door fundraiser.  

All this means the craziness of the 2016 campaign season will continue into the foreseeable future. There will be more Trump tweets and perhaps even more positions he adopts on the abortion issue. Cruz will step up his crusade against Trump, even as his pessimistic supporters push a “Lose with Cruz” meme. Clinton will have to keep answering questions about a slow-motion FBI investigation into her private email server while secretary of state. Sanders will have to keep explaining how he will turn America into Norway with Medicare and free college tuition for all.

It is a rollercoaster ride that just won’t stop.

Gary Conkling is president and co-founder of CFM Strategic Communications, and he leads the firm's PR practice, specializing in crisis communications. He is a former journalist, who later worked on Capitol Hill and represented a major Oregon company. But most importantly, he’s a die-hard Ducks fan. You can reach Gary at  garyc@cfmpdx.com and you can follow him on Twitter at@GaryConkling.

Staying the Course May Be Off Course

Hillary Clinton may be the most experienced and well-versed candidate in the presidential field, but she faces the unpredictable headwinds of an electorate that has given up on the status quo and gone in search of political outsiders.

Hillary Clinton may be the most experienced and well-versed candidate in the presidential field, but she faces the unpredictable headwinds of an electorate that has given up on the status quo and gone in search of political outsiders.

Presidential hopeful Hillary Clinton painted herself in the last Democratic debate before the Iowa caucuses as the candidate who would defend President Obama’s legacy. That message faces stiff headwinds in this election cycle where voters on the political right and left have lost patience with the status quo.

The evidence is in the strength in the GOP presidential primary of Donald Trump and Ted Cruz, who thumb their noses at anyone in the political mainstream, including members of their own party. The surge of support for Bernie Sanders, who calls for a political revolution and makes unvarnished attacks on big banks, big drug companies and big campaign donors, suggests voter unrest resides in both major parties.

In the space of a week, anyone paying attention was treated to three pictures of America, which could easily be described as three alternate realities.

Obama’s final State of the Union address to Congress touted his administration’s achievements in health care, the economy and diplomacy. The Republican presidential debate was coated with an apocalyptic tone that depicted American leadership as feeble, feckless and failing. The Democratic presidential debate walked through a host of specific issues, leaving an impression that progress had occurred, but nearly enough, especially on health care reform, breaking up big banks and curbing the power of billionaire political donors.

Allowing for typical political hyperbole in an election season, the chasms between the three visions were stark and startling.

It fell to Hillary Clinton to add perspective, noting that the largest abyss is between the Democrats and Republicans running for President. She characterized her candidacy as one of building on Obama’s achievements, not tearing them down and starting over, especially the Affordable Care Act and the Dodd-Frank financial reforms.

However, defending the status quo may make Clinton vulnerable in an election year where reality and facts matter less than fiction and fear.

By almost any measure, Clinton is the most experienced and well-versed presidential candidate in either party. When asked about the big issues, she gives the most specific answers, often laced with personal involvement in the issue as a former First Lady, U.S. Senator and Secretary of State. Though appealing in most elections, that kind of knowledge runs counter to the current mood.

Vox published a piece last week titled, “The GOP debate described a terrifying world that doesn’t actually exist.” Examples it points to included the Cruz plug for “13 Hours,” the new movie that depicts the 2012 Benghazi attacks based on a debunked conspiracy theory, exaggerated descriptions of ISIS and the threat of domestic terrorism.

“For perspective: The number of Americans killed per year by terrorism is the same as the number crushed to death by their own furniture,” noted Vox reporter Zach Beauchamp. That contrasts, he added, with 33,000 deaths caused by firearms, which GOP candidates failed to mention in their zeal to defend the 2nd Amendment.

Sanders’ call for a political revolution centers on reversing the Citizens United Supreme Court ruling, which paved the way for Super PACs and large individual and corporate campaign donations. While many Democrats agree with him, old political hands don’t see that happening soon – or at all.

Breaking up big banks, which Sanders says control a huge proportion of the U.S. gross domestic product, has been discussed and, according to Clinton, is possible under existing provisions of Dodd-Frank. Moving to a single-payer universal health care system, as Sanders advocates, has been debated, too. Neither idea passed when Democrats held the presidency while maintaining control of the House and Senate. They are less likely to get anywhere under the split government control of today.

Manufactured threats or overblown ambitions haven’t dissuaded voters. They flock to rallies for Donald Trump and Bernie Sanders. Trump’s supporters tend to be angry white people who see their security slipping away, while Sanders appeals to restless young people who worry about inheriting an uncertain future.

Political convulsions, while painful to watch and experience, can produce momentous change. That appears to be what many Americans from across the political spectrum want. And even though Hillary Clinton might be the best prepared to navigate major change, she may be viewed as too wedded to the past to be given the chance.

The Search for an Obamacare Alternative

Congressional Republicans have failed so far to offer a comprehensive alternative to Obamacare, but there is a surge of support on the campaign trail to look at a single-payer health care system.

Congressional Republicans have failed so far to offer a comprehensive alternative to Obamacare, but there is a surge of support on the campaign trail to look at a single-payer health care system.

While congressional Republicans continue to look for an Obamacare replacement, others are stepping up with alternatives they may like even less but may appeal to a significant segment of the U.S. population.

Democratic presidential candidate Bernie Sanders has been a consistent voice for a single-payer national health care system, which could be a simple as having everyone enrolled in Medicare. His support for a single-payer health care system is credited by some political observers for his strong showing in early Democratic presidential polls as he challenges Hillary Clinton, who also has a reputation for health care reform.

The single-payer system Sanders has supported on the presidential stump is estimated to cost $15 trillion over 10 years. But Sanders and like-minded supporters say a single-payer system would eliminate $5 trillion in “administrative waste" in that same period. The plan would be paid for by what is described as a “progressive” payroll tax

A Colorado group has placed Initiative 20 on that state's 2016 general election ballot to create ColoradoCare. Under this universal health care coverage proposal, people who live or earn money in Colorado could choose their providers, but medical bills would be paid by the state.

Backers of the Colorado initiative would pay for ColoradoCare through a 10 percent payroll tax, which would generate an estimated $25 billion per year. Under the plan, employers would pay two-thirds of the 10 percent payroll tax and employees the remaining one-third. Self-employed individuals would pay the entire 10 percent on their net income, according to The Denver Post.

The concept of a national single-payer health care system has been floated before and generally beaten back because of fears of an even larger federal bureaucracy, increased health care costs and higher taxes. Hillary Clinton’s proposed health care reform measure stopped short of a single-payer system, as does the Affordable Care Act, which tries to reduce the number of people without health insurance by creating a government-managed marketplace.

While it is easy to point at warts in Obamacare, it is much harder to come up with a plan to replace it, which is why congressional Republicans have voted scores of times on repeal and zero times on a substitute. One reason for the difficulty is that the U.S. health care system has lots of parts. There is the part where workers and their families receive health insurance offered through their employer. Then there is Medicare, Medicaid, the Veterans Administration, Indian Health, federally funded clinics, school clinics, psychiatric care and alternative care such as naturopathy and chiropractic.

The complex health care system and health insurance coverage only partially overlap, which sometimes leads to awkward and expensive health care delivery, such as children from low-income families being forced to seek care in a hospital emergency room instead of a school clinic or people suffering from mental illness receiving prescriptions for psychotropic drugs from primary care physicians.

One of the underlying appeals of a single-payer system is its promise to consolidate the silos in the health care delivery system and eliminate (or at least shrink) the disparity between health care delivery and health insurance.

Skeptics question whether a single-payer health care system would live up to its promise in the United States, where many people are accustomed to a broad range of choices in providers and some providers decline to serve patients in a public health program because of lower fees. Skeptics also doubt Americans are willing to pay higher taxes and hand over more control of their lives to the federal government.

While those arguments have prevailed in the past, progressives such as Sanders and the Initiative 20 backers in Colorado are saying that tinkering with the health care system is not enough to stem rising health care costs and ballooning insurance premiums. They say if you want an alternative to Obamacare, here’s one to consider.

In the absence of another comprehensive alternative, the single-payer system appears to be gaining some momentum as a policy option.

Untypical, Unelectable Politicians Prospering

Anti-candidates and unconventional politicians once thought unelectable now are dominating political polls, suggesting politics as usual and traditional American optimism may be in for a vacation.

Anti-candidates and unconventional politicians once thought unelectable now are dominating political polls, suggesting politics as usual and traditional American optimism may be in for a vacation.

Politics-as-usual has never been popular. In the coming election year, it may be lethal.

A new Washington Post-ABC News poll reveals 72 percent of Americans believe politicians can't be trusted and 66 percent think the country's political system is dysfunctional. Not exactly a solid foundation to run for re-election. Twenty-one percent want a President who will tear down the current system and start over.

This perhaps explains voter attraction to anti-candidates such as Donald Trump and Ben Carson and unconventional politicians such as Bernie Sanders. Policy positions matter less than style. Deliberate thought takes a back seat to brash talk. Compromise is scorned and anger is rewarded.

The mood has shivers running down the back of incumbents. Even establishment outsiders have felt the chill. Jeb Bush is still treated in the media as the likely winner, even though 60 percent of Republicans prefer someone from outside the political establishment. South Carolina Senator Lindsay Graham has been stonewalled in his home state. Wisconsin Governor Scott Walker has gone from pack leader to a camp follower in the Republican presidential primary.

The non-politicians are playing to this electoral discontent with dark rhetoric, as laid out in a story in the Sunday New York Times.  Trump calls America a "hell hole" run by "stupid" leaders who are steering the nation toward becoming a "third world country." Texas Senator Ted Cruz sees menaces from without and within, as evidenced by the "lawlessness" of jailing a Kentucky county clerk for refusing to issue marriage licenses to same-sex couples under "authority from God."

The trend is confounding GOP pollsters who have pushed candidates to follow Ronald Reagan's example and stress optimism. Bush and Ohio Governor John Kasich have generally optimistic messaging, but they are drowned out by strains of negativism.

"Today, conservatism is much more mean spirited, angry, not optimistic and much more viscerally divisive," according to Matthew Dowd, a former top strategist for President George W. Bush.

Bill Kristol, editor of the conservative Weekly Standard, told the New York Times, "I know everyone should be optimistic, should be sunny and cheerful. And there's something weird and wrong if you're not. But really? Is the country on the right track or the wrong track?"

The Washington Post-ABC News poll shows the wariness of voters has taken its toll on Hillary Clinton's credibility as her private email soap opera has continued. According to poll results, less than 50 percent of Democrats want Clinton as the party's nominee and the largest defections from her earlier support are among white women. The beneficiary of Clinton's decline has been Sanders, who pushes his liberal economic agenda in convincingly earnest tones that seems to connect with disaffected Democrats.

For the first time, Clinton finds herself neck-and-neck with Trump in a prospective general election battle, which challenges mainstream logic about Trump's electability. That same belated realization about who is electable and who isn't could give Sanders another bump, pushing him into the lead.

For those who still believe the 2016 presidential election will pit the family dynasties of Clinton versus Bush, there is the overwhelming election of Jeremy Corbyn as leader of Britain's Labour Party. Corbyn's far-left agenda may not appeal to rank-and-file Labour Party members, but their voices were swamped by more than 100,000 new voters who weighed in on the choice. Not long ago, Corbyn was considered too liberal to gain power. But politics as usual seem to be out of favor in a lot of ways and a lot of places.

A Presidential Race with Unexpected Suspense

The ranks of Democratic presidential candidates could soon swell, making the the 2016 election more suspenseful than expected with a Clinton and a Bush in the running.

The ranks of Democratic presidential candidates could soon swell, making the the 2016 election more suspenseful than expected with a Clinton and a Bush in the running.

The GOP presidential primary field now totals 17 candidates, but suddenly there are signs the Democratic candidate list might swell as well.

There were hints Vice President Joe Biden might honor his dying son's request to make a bid for the White House. And New York Times columnist Maureen Dowd tossed the hat into the ring of the Lord of Lattes, Starbucks CEO Howard Schultz.

Rekindled interest in the 2016 Democratic presidential nomination follows polls that show frontrunner Hillary Clinton's favorability ratings dropping, especially in critical swing states that she would need to win election next fall. [Clinton will be in Portland this week for a small-group "conversation" with supporters.]

Vermont Senator Bernie Sanders has demonstrated unexpected appeal on the political stump as he espouses a more full-throated defense of stronger government action to address issues such as income inequality and climate change. Few observers believe Sanders can win the nomination, but his strong showing will push Clinton and perhaps other Democratic candidates more to the political left. Last week, Clinton called for a "fairness economy" that pushes up wages for middle and lower income workers and closes corporate tax loopholes.

Biden's decision to enter the race would have an emotional tag. On his deathbed, Beau Biden urged his father to run. Biden is no stranger to campaigns tinged with personal tragedy. His first wife and a 13-month-old daughter were killed in a car accident a few weeks after he was elected to the U.S. Senate in 1972. He considered resigning, but was persuaded to serve. Biden was sworn in at a ceremony attended by Beau Biden, who was injured in the accident.

In a weekend column, Dowd touted a Schultz candidacy because of his passion as a CEO to repair what he calls the "fraying American dream." She says colleagues have urged Schultz, who grew up in Brooklyn housing projects to enter the race. Schultz wrote a book about the treatment of U.S. veterans that carried the message of making government work again and finding "authentic, truthful leadership."

The burst of candidates on the Democratic side comes on the eve of the first GOP presidential debate this Thursday. There will actually be two debates to accommodate all the candidates, with a prequel for the candidates whose poll numbers are lacking and the main stage for the top 10 challengers, led by Donald Trump.

Trump's brash statements have generated a lot of feedback, both pro and con, and appears to have incited other candidates to amp up their rhetoric. Trump has shown little hesitation to trash-talk others in the field, which could lead to a debate that is more like a food fight than a discussion of policy issues.

Trump managed to suck more air out of the GOP balloon by reserving the right to mount a third-party candidacy if he fails to win the GOP nomination. Pollsters and columnists seized on that possibility to predict Trump would siphon off enough votes to guarantee a Democratic victory in 2016.

However, the actual caucuses and primary elections that count are still a fair distance off. It is not unheard of that candidates emerge from the back of the pack or political obscurity to take command. Barack Obama emerged by surprising the Democratic frontrunner in 2008 – Hillary Clinton – in Iowa caucuses.

If the Democratic field for the 2016 nomination expands, there may be a lot more suspense than anyone could have predicted or expected with a Clinton and a Bush in the race.