Perhaps it’s irony, perhaps coincidence, or perhaps we’re both interpreting the tom-toms the same way but Ruy Teixeira’s latest post calls out Democrats for lacking what George H. W. Bush once called “the vision thing”. Here’s a snippet:
Cast your mind back to the halcyon days when American politics revolved around George H.W. Bush and his delightful locutions. A quintessential Bushism was when he referred to his (hard-to-define) overarching goal as the “the vision thing.” He wasn’t sure what it was and neither was anyone else.
Today’s Democrats have a similar problem. Nobody really knows what they stand for besides being really, really against Trump. That makes it hard to have a recognizable vision for the country since it’s a purely negative politics. What kind of society are Democrats aiming for and how would ordinary people find their place in it?
I don’t think there’s a lack of vision among Democrats. I think there’s a multitude of them.
Elected officials of both parties imagine an America that provides them with permanent sinecures garnished with cushy pensions when they retire while they devote their attentions to enriching themselves through “pay to play” and getting donations for their re-election campaigns.
The progressives at whom Mr. Teixeira levels his fire are vanguardists. They imagine themselves leading the ignorant masses to some ever-receding destination but there are far fewer willing followers than I believe they fancy.
The post is full of graphs of the results of polling data which illustrate a common conclusion: Americans see the visions of that latter group pretty clearly and recognize that they have little appeal to them. Here’s one of the graphs which I think makes the point pretty well:
Healthcare is the one interest that average folks and Democrats have in common but there’s a rub, quoting Nate Cohn:
Health care hasn’t been front and center for years. In the final New York Times/Siena poll of the 2024 campaign, less than one percent of voters said health care was the most important issue to their vote [open-ended question]…Ever since Mr. Trump came down the escalator, the basic political conflict between the two parties has changed to something very different than the one that put health care at the fore…
[H]ealth care is unlikely to return to the center of American politics—not anytime soon.
Furthermore, as I have noted increasing subsidies in the absence of increasing supply has the unfortunate effect of raising prices which in turn impels more subsidies. Democrats need to get their minds around that issue.
The cohorts following the Boomers are getting progressively smaller. Consequently, the market demands for medical care and education at all levels will gradually decline. The work force will also gradually get smaller, as will tax revenues. All that should put downward pressures on medical and educational costs, at least in aggregate. Individual institutions might ride out the declines, but their competitors might just disappear, Harvard vv Northeastern, eg.
Judging from Japan and South Korea, the sociological and psychological effects of population decline on young people is disastrous.
We have had about a 10-15 year hiatus with total health care spending stay essentially level. However, predictions are that it will increase as more boomers retire and we are seeing personnel cost issues continuing after covid. Rural areas are being hit pretty hard but I think those people are totally committed to Trumpism so I can see them complaining but not changing their votes. Trump, or whoever follows, will just devote some money to some very visible rural areas and claim it will soon arrive everywhere else. It wont but it will allow them to keep votes for a while.
More broadly, I think Rui is kind of correct and the GOP has major advantages. It’s much easier to garner votes by peddling hate and anger. Hating immigrants and trans people are now core values. In theory people should not be happy that we are killing civilians in boats but they are brown so no one cares.
Where I see some room to garner votes would be to address stuff like housing. People like living in cities with lots of cultural attractions and first rate universities, but if housing is too expensive they will move elsewhere. Getting rid of or drastically changing the EPA rules and other regs that slow housing and increase prices would help. I also wonder if they need more grassroots communication efforts. Driving south to visit my daughter I listen to right wing talk radio. The lies they spread are pretty outrageous but it must work as you then those lies being spread online elsewhere. I dont think many dems listen to talk radio but maybe there is a medium that would work just as well.
Steve
That might be true if the healthcare sector operated under the constraints of anything even vaguely resembling conventional supply and demand but it doesn’t.
Physicians prescribe courses of treatment. It is courses of treatment that govern demand. The supply of care does not respond to increased demand.
steve:
Could you share with us what you mean by “total health care spending stay essentially level”? I don’t think that matches what’s actually happening based on conventional usages of terms.
I am referring to total healthcare spending as a percentage of GDP. Go back and look at estimates of where total health care spending was projected to be by now when we were talking about creating the ACA. Most estimates had us in the 20%+ range. There is a line of thought that says the wealthier we become the more stuff like health care we can afford, but I think that’s only true to a point and I dont think we are close to being wealthy enough that we would be better off if 25% or 30% of GDP was spent on health care.
I also think the way you envision things is a bit more complicated. Docs can order whatever they want but the insurers decide what gets paid for and how much they pay. The system is also pretty sensitive to demand. We had a lot of boomers retire and coincidentally medical schools have added geriatrics into their curriculums. We also increased our abilities to provide elder related care like total joint replacements. To be clear, I think physician induced demand (PID) is real and is a factor in health care costs but its becoming less of a factor as more and more physicians are employed. How much care and what kind of care is delivered is being increasingly controlled by the insurers and large networks.
Steve
Doesn’t your preferred statistic support my contention about healthcare and refute yours? Over the last 15 years the percentage of the population that is over 60 has risen by about 6 percentage points.
BTW between half and two-thirds of workers are covered by insurance programs in which their employers self-insure. That is, the “insurance companies” bear no risk; they are essentially administrators. Since they are, in general, paid a percentage of costs, they have no incentive to minimize costs. Hospitals (who now employ the majority of physicians), healthcare networks, etc. have no incentives to minimize costs.
IMO right now the greatest incentive in the system as a whole to minimize costs is provided by the desire to avoid regulation. That pertains to employers, insurers, hospitals, physicians, etc.
I asm not sure what you are contending. I am simply pointing out that total health care spending has been remarkably stable even in the face of an increasing number of people over 60. It’s been just a bit over 17% of GDP.
My corporation was looking at self insurance since we had grown quite a bit. All of the major carriers had preset programs that we could buy and they would administer for us. However, AFAICT from the billing side, the self-insureds paid at the same rates that our major state carrier paid ie Blue Cross.
Steve