Bernie Sanders

Health Care Concerns Run Deeper Than Politicians Realize

The current national political debate over health care reform may run deeper in the electorate than ensuring universal access to health insurance. Americans with health insurance are concerned about rising costs, surprise hospital bills and long-term care expenses.

The current national political debate over health care reform may run deeper in the electorate than ensuring universal access to health insurance. Americans with health insurance are concerned about rising costs, surprise hospital bills and long-term care expenses.

The national political debate on health care is stalled on access to health insurance. Politicians may be smart to stop and listen to concerns by Americans with health insurance about higher deductibles, rising medical costs, surprise hospital charges and uncovered long-term care expenses.

Americans are feeling the pinch of escalating health insurance premiums and medical costs. This expands the anxious audience to people with health insurance as well as people with no coverage.

The political potency of health care costs was demonstrated in the 2018 mid-term elections as Democrats swept back to control in the House. The issue is expected to loom large again in the 2020 presidential election.

The debate, which rarely descends below the superficial, pits Medicare-for-All against a vague promise from Republicans of something great and affordable. President Trump has pledged, as he has before, to unveil major health care legislation in the next few months. Expectations aren’t high.

Oregonians have learned that discussions about universal access to health insurance must be accompanied by a serious conversation about how to control health care costs. Access to an unaffordable health care system isn’t materially different from no access to health insurance when it comes to paying huge bills.

Former Oregon Governor John Kitzhaber provided teachable moments on confronting costs embedded in the health care delivery system – long-term care for low-income older adults, lack of behavioral resources, inefficiency in treating chronic disease and failure to address social determinants that lead to a lifetime of outsized health care costs.

As prescient as Kitzhaber’s perceptions have been, health care costs in Oregon and elsewhere continue to rise. And the health care delivery system remains uncomfortably uncoordinated and sub-optimized, as even health care professionals acknowledge. 

Democratic presidential candidates have jumped on health care as a seminal 2020 campaign issue. However, the political cure Democrats offer may miss the mark.

“The Democrats’ emphasis on Medicare expansion plans is partly a missed opportunity and partly a reflection of the slice of the electorate that participates in Democratic primaries,” according to pollsters and political strategists. The concern of a majority of actual Democratic voters in 2020 may center instead on issues such as the price of drugs like insulin, exploding co-pays, unaffordable health insurance premiums and the uncovered costs of long-term care for older adults.

The efficacy of health care on the campaign stump has prompted President Trump to return to the issue, which previously resulted in an embarrassing loss on the Senate floor when the late Senator John McCain torpedoed a GOP-backed repeal of Obamacare. It remains questionable whether Republicans can identify a center-point on how to move beyond the Affordable Care Act.

Democrats stand on the same political quicksand. Senator Bernie Sanders has pushed his Medicare-for-All legislation, which would cashier private health insurance, expand existing Medicare benefits and require substantial additional revenue. Moderate Democrats have pitched a public option under Obamacare to create competition for private health insurance plans. There are variations, often with vague details, somewhere in between. 

Rising prescription drug prices also have galvanized American political discontent. Trump has flirted with actions to reduce drug prices, but has achieved nothing definitive to brag about, at least so far, heading into the 2020 election. Congress is acting on bipartisan legislation to address prescription drug prices, but it is too complex to translate into news coverage or the national consciousness. Drug pricing has risen to the level of a special work group evaluating the US-Mexico-Canada trade agreement.

Tellingly, Senator Elizabeth Warren, easily the most cerebral 2020 Democratic presidential candidate, has a “plan for that” for almost every issue except health care. She has stopped short of embracing Medicare-for-All. Her hesitancy is perhaps the surest indicator that health care reform is a systemic idea requiring a sophisticated response that doesn’t fit on a bumpersticker.

The big idea for health care reform in Congress may remain a puzzle or, if known, a hidden secret. Chances are the ultimate successful idea will need the embrace of significant parts of both political parties. Its revelation is unexpected along the 2020 presidential campaign trail.

However, the 2020 electorate may erase any doubt Americans of all political stripes want a national health care system that is better than the patchwork system now in place. The presidential election may serve as a political sounding board that health care should rise above partisanship. A logical, sustainable response would require the forbearance of both political parties – and partisan apologists.

The American solution to health care may not resemble anything anywhere else. Its test will be whether it delivers affordable and accessible health insurance, health care delivery, prescription medications and new technology. It is a tall order, but the person, political party or organization that conceives of that system may reign supreme in the public’s mind for a generation or more. 

As flawed as Obamacare may be, it stands as a testament that any improvement can be a legend-making milestone.


Lies, Damned Lies and Demographics

Demographics could be turned on their head in the 2016 presidential election by an unconventional candidate with unpredictable appeal in “flippable” states that could determine who wins in November.

Demographics could be turned on their head in the 2016 presidential election by an unconventional candidate with unpredictable appeal in “flippable” states that could determine who wins in November.

Demographics are just statistics with faces. But demographics are also statistics influenced by non-quantitative facts, such as political passion.

In presidential elections, demographics draw a lot of attention. This year is no exception, though some of the usual demographic lines have been scrambled, in large part because of the insurgent “outsider” campaigns of Donald Trump and Bernie Sanders.

Trump has attracted strong support from white men, including union workers in Rust Belt states, and evangelicals, despite a lack of credentials on dealing with social issues. Sanders’ “political revolution" appealed to many young voters, but it also revived the interest of older voters who had dropped off of the political map. Hillary Clinton, who has strong appeal for women voters, has managed to gather as strong or stronger support from African-Americans and Latinos than Barack Obama in 2008.

Despite high negative ratings and demographic predictions that Republican presidential prospects this year were circling the drain, Trump emerged from the Republican National Convention in Cleveland last week with a slight lead over Clinton.

According to, Republican presidential nominees do best among white voters without college degrees. But this demographic cohort is aging and declining by about 3 percent every four years. Meanwhile, whites with a college degree, who lean Republican but do cross over, are increasing by 1 or more percentage points every four years.

“In other words, Democrats’ coalition of non-white, young and well-educated voters continues to expand every election, while Republicans’ coalition of white, older and less-educated voters keeps shrinking,” said David Wasserman, writing for "It’s no wonder Democrats have an emerging ‘stranglehold on the Electoral College’ because of favorable trends in states like Colorado, Florida, Nevada and Virginia.”

However, that stranglehold seems a little limp in this election cycle. 

Nate Silver, founder of FiveThirtyEight, says demographics don’t favor Democratic presidential nominee Hillary Clinton as strongly as some might imagine.

Nate Silver, founder of FiveThirtyEight, says demographics don’t favor Democratic presidential nominee Hillary Clinton as strongly as some might imagine.

Nate Silver, the founder of FiveThirtyEight, says just a small percentage shift in voting could flip Colorado, Florida, Iowa, New Hampshire, Ohio, Pennsylvania, Virginia and Wisconsin to the GOP in 2016, providing enough electoral votes to capture the presidency.

Trump is stretching traditional demographic line by pushing his opposition to trade deals and a law and order agenda that hold appeal for disaffected voters in the Rust Belt and Middle America.

Of those states Silver identifies as “flippable," Sanders outpolled Clinton in Colorado, New Hampshire and Wisconsin. Sanders and Clinton were virtually tied in Iowa and Sanders came close to winning Michigan, another Rust Belt state with a lot of blue-collar union voters. A contributing factor in Sanders’ success was his opposition to trade deals, which he said left many American workers in the lurch.

The Clinton campaign is working hard at the Democratic National Convention this week to woo Sanders’ supporters. But Silver says it may be a fool’s errand because many Sanders’ supporters are new or irregular voters who may not even vote in November. He also says some Sanders’ voters are politically independent and “ticket-splitters."

The upshot is Clinton may be forced to hustle to retain union voters from Trump and Sanders supporters from a third-party candidate like Jill Stein of the Green Party.

Another demographic down note for Clinton is that her commanding lead among Latino voters may be deceiving in terms of its impact on the Electoral College. Silver says Latino votes are concentrated in states such as California, New York and Texas that aren’t in play. That is changing as Latino populations increase across the nation, which have led some to suggest that predictably red states like Arizona could become purple. However, the change may not occur this year.

Some of Clinton’s strongest support in the primary came in Southern states where African-American votes dominated Democratic voting. Normally they wouldn’t turn Red states blue, but conservative voters upset with Trump could produce surprises in states such as North Carolina and George, where polls show Trump even with Clinton. Another election-day surprise could be Utah, dominated by Mormons who are offended by Trump’s politics. Clinton is holding her own there, too.

Polling Misses Mark in Oregon Presidential Primary

A major public opinion poll conducted before the Oregon primary showed Hillary Clinton outpacing Bernie Sanders by double digits. Actual election results were almost the exact opposite.

A major public opinion poll conducted before the Oregon primary showed Hillary Clinton outpacing Bernie Sanders by double digits. Actual election results were almost the exact opposite.

A well publicized public opinion poll conducted between May 6 and 9 showed Democratic frontrunner Hillary Clinton leading challenger Bernie Sanders in the Oregon primary by a 48 to 33 percent margin. Actual election results were almost the opposite, with Sanders carving out a double-digit victory.

How could a poll be so out of whack? One frequent reason is failure to account for voter turnout. However, the Clinton-Sanders poll took higher-than-average turnout into account, which showed Clinton’s lead narrowing to 45 to 38 percent. Still wrong, by a wide margin.

The same poll, which interviewed 901 likely Oregon voters, under-predicted Donald Trump’s vote count. He received 45 percent of the GOP presidential vote in the poll, but almost 65 percent of the actual vote. Another big miss.

Telephone surveys have become somewhat less reliable if they don’t include a percentage of cell phone users, which ensures that younger and minority voices are heard. While that sampling flaw might understate the vote in Portland or college towns like Eugene, it doesn’t explain Sanders’ strong showing in rural Wallowa and Lake counties or his dominance in all but one of Oregon’s 36 counties.

Candidates usually do better in states where they campaign in person. Sanders appeared in Oregon four times before the primary. Clinton made no appearances, but did send Bill Clinton to campaign. That’s a hard factor to capture in a public opinion poll, but it is a question worth asking to see if being here breaks someone’s vote one way or another. 

The Los Angeles Times carried a story over the weekend about the intense Democratic push in Oregon to register new voters as Democrats before the April 26 deadline. Many of the new voters were automatically registered as a result of Oregon’s Motor Voter law, but not affiliated with any political party. Secretary of State Jeanne Atkins reported a larger than normal registration switch, which favored Democrats. These factors would have been hard to track in a poll, but they may have been worth asking about to gauge the velocity of a late shift toward Sanders, who predicted he would win if the turnout was large. He obviously knew what he was talking about. 

Polling is a tough business, and it is getting tougher. Fewer people are willing to be interviewed by phone, which means pollsters need to make more calls to achieve a representative sample, which is more costly. Respondent reticence means polls have to take less time and include fewer questions, sometimes the questions that would be useful in improving confidence in poll findings.

While Sanders’ success in Oregon is not a huge surprise, it may be more telling than at first glance. His victory points out the foibles of one-off polls and the political benefits of an intensive ground game. 

More significantly, the results in Oregon show Sanders’ message packs some punch, and not just where you would expect.

Crazy Political Polling Season (Again)

Election winners aren’t always the leaders in pre-vote polls, especially in the beginning of the crazy political polling season.

Election winners aren’t always the leaders in pre-vote polls, especially in the beginning of the crazy political polling season.

Donald Trump perpetually trumpets his lead in national polls. Bernie Sanders points to his surge from obscurity to a virtual tie in Iowa. Marco Rubio tells his supporters his showing in the Hawkeye State surpassed polling predictions.

Yes, it’s that crazy political polling season again.

Polls serve a purpose, but you have to take them, certainly at this point in the presidential campaign, with a grain of salt.

Trump outpolled rival GOP contender Ted Cruz in Iowa, but the ground game Cruz put together won the day in caucus sites. Were the polls wrong or did they just miscalculate the impact of Cruz staffers going door-to-door to nail down supporters who would brave winter cold to caucus? Turnout in elections is hard for polls to predict accurately.

Last-minute candidate surges can trick polls. They can be overstated or understated. Or missed, like Rubio’s in Iowa. Even weekly polls can be too slow to track fast-moving voter impressions.

How well candidates fare with key cohorts of voters can be missed, too. Hillary Clinton’s “upset” victory over Barack Obama in the 2008 New Hampshire primary was traced to polling samples that under-represented lower income voters who didn’t have or take the time to respond to telephone polls. The same problem can occur now if pollsters don’t include respondents only reachable on cell phones.

National polls can obscure state-level electoral leanings. Bernie Sanders may thrive in New Hampshire, which has a very liberal, white Democratic base and is next to his home state of Vermont. Hillary Clinton may have a clear advantage in South Carolina where African Americans dominate the Democratic base. Even though Cruz trailed Trump in national polls, he concentrated his efforts in Iowa on Christian evangelical voters who have a history of determining who wins the GOP vote there.

Polling techniques can have subtle influences on outcomes, which is why different polls taken at the same time with equivalent samples and sample sizes produce varying results. One of the factors in polling discrepancies is “tactical voting” or undecided voters declaring a preference they really don’t mean. When you have a lot of candidates, this factor grows in significance.

Then there is the confusion between polls and probabilities. Nate Silver of FiveThirtyEight earned a reputation – and skeptics – for basing candidate predictions on a different statistical analysis, not on the candidate's poll numbers. In a tweet following the Iowa caucuses Monday night, Silver said, “Polls in general elections = pretty good. Polls in primaries = much less accurate. Iowa caucus = especially tough.”

In a blog before the caucus, Silver said poll numbers don’t lie; they just don’t tell you the truth. “Could Marco Rubio win the Iowa caucuses despite not having led in a single poll here?” Silver wrote. "Sure. Rick Santorum did that exact thing four years ago.”

So if you are influenced by poll numbers in the early going of the presidential race, you might want to reconsider. The political polling crazy season is just beginning (again).

Trump's Appeal as Honest Asshole

Why do people like Donald Trump? The answers might surprise you.

Why do people like Donald Trump? The answers might surprise you.

Few would argue that Donald Trump came out on top of the first GOP presidential debate last week or in interviews afterward, but post-debate polls show his popularity continues to rise. Why are people favoring a candidate who comes across so disagreeably? searched Reddit for posts that offer some glimmer of an explanation or, more accurately, a picture of why. Trump's brash, politically incorrect comments about his opponents, war heroes, women and news people constitute a one-finger salute to the status quo.

Some people expressing support for Trump on Reddit say they like him because he is honest. He says what he thinks, without much of a filter. "He's an asshole, but at least he's honest," wrote one Trump sympathizer. This accounts for the correlation between Trump insults and his rising poll numbers. 

Another contingent of Trump supporters appreciates that he "can't be bought." One especially colorful comment suggested that Trump's ruthlessness and financial independence is what is needed to shape up Washington where money buys influence and corrupts. This perhaps explains why Trump mentions his personal wealth so often.

A third group likes Trump because he pencils out as a bad President, which America "deserves." As one person put it:

"I'm seriously thinking about voting for Trump, and here is why. I firmly believe that our system of government is deeply flawed, if not completely broken. Yet we still keep voting for the same type of people. If Trump wins, there's a good chance the whole thing will collapse from his absurdity. Then maybe we could start over and build something better that works. A vote for Trump is a vote for full system breakdown, which I believe is exactly what we need."

Or: "He's not the President we need, he's the President we deserve. I'm older than most of you. I remember when politicians worked together sometimes for the greater good. Now, with MSDMC and Faux News controlling the conversation, this country is so divided, nothing gets done. The whole system is what it wasn't supposed to become. The only way to fix it is if the entire system emplodes so we can start over. That's what Trump would do."

There may be more than madness to Trump's often apocalyptic analyses. He has messianic intentions to become the country's Great Destroyer.

Taken together, these reasons to vote for Trump begin to take shape as something other than the rants of raving lunatics or disgruntled political trolls. They form a sort of deformed logic – our government has become so inept that we need and deserve a champion who will blow it to smithereens.

When combined with surging crowds at rallies for Democratic presidential contender Bernie Sanders who calls income inequality the nation's number one issue, the pro-Trump movement shouts that many Americans of all political stripes are fed up and want a different brand of change.

Of course, the heat of summer gives way to cooler times when voters begin to pay closer attention and actually make up their minds. For now, the presidential candidates not named Trump or Sanders might do well to revise their campaign talking points to touch me of those frayed voter nerves.