Michigan: Poetry, Prose and Single Payer

On November 8, 2010--right after the "Red Wave" midterm election in which Republicans picked up a jaw-dropping 63 seats in the U.S. House of Representatives, 6 Senate seats and 680 state legislative seats--Paul Waldman wrote, in The American Prospect:

In charting the last two years, from the euphoria of election night 2008 to the despair of election night 2010, I keep returning to Mario Cuomo's famous dictum that you campaign in poetry but govern in prose. The poetry of campaigning is lofty, gauzy, full of possibility, a world where problems are solved just because we want them to be and opposition melts away before us. The prose of governing is messy and maddening, full of compromises and half-victories that leave a sour taste in one's mouth.

...All else being equal, this means Republicans have an easier time getting elected and a harder time legislating the things they really want to do (other than tax cuts, which are never a hard sell), while Democrats have a harder time getting elected but ought to have an easier time legislating.

...But Americans like those programs, and herein lies the contradiction at the center of American politics. When an elderly man pokes a finger at his congressman's chest and yells, "Keep your government hands off my Medicare!" he embodies everything that is so wrong with our politics.

I think about the "campaign in poetry, govern in prose" line often. I thought about it a lot last night, when I had the Twitter exchange below with Abdul El-Sayed, the energetic young former executive director of the Detroit Health Department who's running a Bernie Sanders-style progressive campaign for the Democratic nomination for governor of Michigan (I've slightly reformatted the tweets to remove ASCII characters which my CMS editor doesn't care for and to tighten up the space use):

I’m fine with campaigning on it, and it’s a pretty impressive plan in many respects, as I’ve detailed.
I’m NOT fine with promising it WILL happen, especially when it’d require changing the state Constitution AND two different waiver sign-offs by Donald Trump’s CMS Administrator.

51% of Americans support it. 74% of Democrats support it. We need candidates willing to say the words: SINGLE PAYER.

and in Michigan we’re going to do it.

— Abdul El-Sayed (@AbdulElSayed) July 2, 2018

— Charles Gaba (@charles_gaba) July 2, 2018

So you prefer lukewarm commitments to half-hearted policies?
There’s a reason you don’t see teams take the field yelling “we’re here to play, and we have a fair chance at winning, but we might not - but perhaps we will. I hope we do.”

I play to win. We Dems should too.

— Abdul El-Sayed (@AbdulElSayed) July 2, 2018

This is an important question when it comes to campaign rhetoric. You’ve promised a State-based Single Payer healthcare system if elected. You didn’t say universal coverage, which is achievable via any number of methods...you specifically promised Single Payer, period.

— Charles Gaba (@charles_gaba) July 2, 2018

Unless there have been changes to your proposal since I reviewed it, in addition to a progressive Dem sweep of both the state House (quite possible!) and Senate (possible!), you’d also have to change the state Constitution to allow progressive taxation...

— Charles Gaba (@charles_gaba) July 2, 2018

...AND have the whole thing signed off on by Seema Verma (or whoever may replace her as Trump’s CMS Administrator) in order to shift all Medicare , Medicaid & CHIP funding over to MichCare. Do I have all of this correct so far?

— Charles Gaba (@charles_gaba) July 2, 2018

Now, if the game plan is to push for all of that with the expectation of getting a state-based public option and so forth, I’m fine with it...but you better make sure your supporters understand that as well. I understand lofty rhetoric, really...

— Charles Gaba (@charles_gaba) July 2, 2018

I understand that you need to start in the end zone if you want to end up on the 50-yard line. Just make sure your supporters understand and are ok with that as well.

— Charles Gaba (@charles_gaba) July 2, 2018

C’mon, we both know single payer is the most efficient way to universal coverage. That’s how we intend to get there.

I look forward to seeing what @bcbsm writes for @gretchenwhitmer. I’m sure it’ll cobble together a bunch of opt-ins (and make them $$, because hey, why not)

— Abdul El-Sayed (@AbdulElSayed) July 2, 2018

I agree it can be the most efficient if properly managed. Yet neither Germany, Switzerland, France, Japan, etc have true Single Payer systems. They’re all hybrids. To my knowledge only Canada, Taiwan and S. Korea have something close to your proposal, and still aren’t identical.

— Charles Gaba (@charles_gaba) July 2, 2018

Again, I like your plan a lot. If you win the General I look forward to seeing it become law. If your tweet had said “I intend to push as hard as possible for SP”, I’d be fine with that. But promising unequivocally that it WILL happen, period, strikes me as a bit reckless.

— Charles Gaba (@charles_gaba) July 2, 2018

El-Sayed's second response was actually irrelevant. The issue at hand here isn't to get into yet another pissing match about whether Single Payer is the most awesome healthcare system in the world or not. It was our original exchange which is the larger point: At what point do campaign promises and sloganeering cross the line from being inspirational and motivational rhetoric to your mouth writing checks that your ass can't cash?

Many in the media (as well as many El-Sayed supporters I've talked to) seem to be dead set on trying to turn the Democratic primary race between former state Senate Minority Leader Gretchen Whitmer and El-Sayed into yet another proxy battle rehash of the 2016 Hillary Clinton/Bernie Sanders race. This is silly in many respects; Whitmer (46) is a generation younger than Clinton, while the 33-year old El-Sayed is two generations younger than the 76-year old Sanders, and so on.

Having said that, there are some similarities in terms of their respective attitudes towards policy. Like Bernie, El-Sayed is pushing for dramatic changes to the status quo in several areas, and his single payer healthcare plan (originally called "MichiCare", later shortened to "MichCare"), which I wrote a deep-dive analysis on a few weeks back, is probably the highest profile and most ambitious for obvious reasons.

Whitmer's healthcare proposals announced so far, meanwhile, are smaller in scope and admittedly more vague in nature:

Everyone in Michigan has a right to quality health care they can afford, and that means expanding coverage and lowering costs. We are reaching a critical point where the cost of health care plans – with skyrocketing premiums and deductibles – is too high for most families, seniors, and hardworking Michiganders. While I’m proud of the work I did to expand health care in Michigan, we have a long way to go. No one should have to choose between paying the rent or filling a prescription. As Governor, I’ll stand up to Washington when politicians try to take health coverage away from people, and I’ll work with anyone who wants to expand coverage, and lower costs of health care, starting with prescription drugs.

• Expanding Medicaid. As Senate Democratic Leader, I led negotiations to expand access to healthcare to more than 630,000 Michiganders through the state’s Medicaid expansion. Healthy Michigan added 30,000 jobs per year to our state and $2.3 billion to our economy.

• Protecting our care. We fought too hard to let Washington raise costs on seniors, families, and hardworking Michiganders. As Governor, I will defend our health care from these attacks, but we must keep fighting to address the cost of health care and lower the cost of prescription drugs until everyone in Michigan has access to an affordable health plan and can afford their treatment.

• Restoring funding to Planned Parenthood so that women and men in low income and rural areas have access to preventative care like screenings and checkups, contraception, and maternity care.

• Access to care in rural Michigan by enlisting technology, bringing people together, and harnessing the incredible talent of our state to find solutions to the challenges faced by rural hospitals and care providers. I’m ready to bring people together to find solutions so that every Michigander, no matter where they live, gets the care they need.

Why is Whitmer's healthcare rhetoric relatively tame when the Democratic base in Michigan, as well as nationally, is clearly moving sharply towards, if not necessarily single payer itself, at least a considerable expansion of taxpayer-funded healthcare coverage? She certainly has plenty of progressive chops, after all: Besides pushing through Medicaid expansion, she's long been a strong advocate for women's rights (reproductive and otherwise), civil rights and so forth.

Well, El-Sayed is pretty obviously suggesting that Whitmer is a tool of the heath insurance lobby (specifically, Blue Cross Blue Shield of Michigan, where her father was once president). She caught some flack for a fundraiser email blast sent out by some BCBSM executives to employees back in February, although it didn't violate any campaign finance laws.

But here's the thing: Whitmer also worked as the Senate minority leader for years under a completely Republican-controlled state government, and the state Senate in particular has remained in Republican hands for at least 26 years. She's seen first-hand exactly how unreasonable and extreme the Michigan Republican Party has become. In 2013 she was somehow able to successfully negotiate a modified version of Medicaid expansion under the ACA, which was an impressive accomplishment by itself...and that was only because we had a rare Republican Governor who supported it as well. Four years later, that same GOP Senate and Governor passed and signed a law which will strip away Medicaid from tens of thousands of Michiganders. In other words, Michigan state Senate Republicans have gotten even more extreme over the years.

Whitmer has been in the trenches of actually attempting to push through legislation and knows damned well that even if she wins, and even if the Democrats retake the state House (which they actually have a fairly good chance of doing), the state Senate is extremely likely to stay in the red column for at least her first term of office. And she knows that there's zero chance of a Republican state senate agreeing to even hold hearings on any single payer proposal, much less passing it.

There's more: Even if there's a massive blue wave which sweeps Dems into control of the Governor's office, the state House and the state Senate, as I noted in my responses to him, El-Sayed's plan as currently structured would also require the state Constitution to be amended and not one but two different federal waivers to be signed off on...by Donald Trump's CMS Administrator, Seema Verma. Needless to say, none of these things are likely to happen, to put it mildly.

With all of that in mind, her less-sexy policy goals start to make a whole lot more sense. She's unwilling (or at least far less willing) to make promises that she isn't certain she can keep. Does this make her "timid" or "pragmatic"? Depends on your perspective, I suppose. Conversely, do El-Sayed's promises make him "fearless" or "reckless"? Again, it's a matter of POV.

Let's take another look at El-Sayed's twitter response to me:

"There’s a reason you don’t see teams take the field yelling “we’re here to play, and we have a fair chance at winning, but we might not - but perhaps we will. I hope we do.”

OK, sure. Of course NFL coaches for both teams always say stuff like "YOU'RE GONNA GET OUT THERE AND WIN!" in pep talks knowing that, obviously, one of them is going to end up being wrong.

On the other hand, I don't think too many prospective coaches guarantee that they're going to win the Superbowl the following season during the job interview...especially if they know that the scorekeeper doesn't work for the NFL and has no intention of allowing their team to win the Superbowl down the line, and that there's not much they can do about it.

Maybe El-Sayed is counting on a Democratic President starting in 2021. If so, then I suppose it's conceivable that MichCare could happen after all; it would just have to wait until his third year in office. Someone on Twitter suggested including a "trigger" clause which allows the bill to be passed earlier but lets the state wait to submit it to the HHS Dept. for waiver approval until a time of the Governor's choosing. That might make sense, since it would probably take a year or so just to hash out the details and put it through both the state House and Senate process anyway.

I don't know. Perhaps I'm wrong about all of this. After all, Donald Trump managed to get elected anyway after promising universal healthcare coverage paid for entirely by the government...otherwise known as Single Payer healthcare.

El-Sayed rightly notes that it's a lot more inspirational to tell voters "Elect me, and I will do (insert lofty, game-changing major policy)" than it is to say "Elect me, and I'll work as hard as I can to achieve (insert incremental improvements)". I get that, I really do. And yes, sometimes you have to shoot for the stars even if you know you'll end up having to settle for the moon.

The biggest question to me is whether the voters understand this or not.

Let's suppose El-Sayed wins the nomination and the general election, tries to push through his ambitious MichCare proposal, and comes up short. Perhaps he ends up with a robust public option instead. Personally, I'd be fine with that as the outcome...but consider what happened to President Obama and the Democrats when they weren't able to include the national public option which was part of the early ACA proposals: They got shellacked two years later, losing the House, the Senate, and hundreds of state legislative seats...and Obama hadn't even promised Single Payer to begin with.

If you're going to campaign in poetry without any guarantee that you'll be able to govern in poetry as well, you better make goddamned sure that the voters understand and accept that you'll be governing in prose.

Put another way, if you mean to be taken seriously but not literally, make sure everyone gets that.