Sunday, March 17, 2019

Who Wants to Be the Last to Go Bankrupt Before Medicare for All Kicks In?

Pete Buttigieg (it's not actually that hard to pronounce) has been getting attention from a number of people I respect, and from some I don't.  Buttigieg is the mayor of South Bend, Indiana, a city I lived near for the first twenty or so years of my life and lived in for two of those years, so I'd heard of him before he decided to run for the American Presidency.  He came to my attention first because he's gay; getting elected to a traditionally Republican*, Roman Catholic city like South Bend is an impressive achievement for a gay man, even a married one, even a veteran.  It recently occurred to me that none of the right-wing Christian frothers I'm friends with on Facebook freaked out when he was first elected, even though some of them live in South Bend.  How'd he do it?

Recently a lefty tree-hugger friend of mine, an IU alumnus but now resident in the Bay Area, linked to Buttigieg's recent appearance on Stephen Colbert's Late Show.  My friend was highly impressed by Buttigieg's performance; I was more concerned that a homophobic "centrist" Obama toady like Colbert found Buttigieg acceptable.  Then Glenn Greenwald began praising him, which I take more seriously.  Greenwald is temperate in his praise:
There are specific policy views expressed by I disagree with, but have been very impressed by him from the moment I began paying attention. I couldn't put my finger on why. Part of it was his heterodox thinking. But now I see the crux: he only speaks authentically...
As he links to Buttigieg's statement to South Bend's Muslims in the wake of the Christchuch massacre.  Fair enough, I guess, but this really just strengthened my doubts.  First, while he doesn't use the word, it seems that Greenwald is impressed by Buttigieg's charisma -- and he should know as well as I do the dangers of charismatic politicians.  There's an uncharacteristic lack of focus on Buttigieg's actual positions here ("I couldn't put my finger on why"), focusing on the claim that he "only speaks authentically".

To speak as authentically as I can, I'm not sure what that means.  Buttigieg's statement is fine, the kind of thing that any halfway experienced politician should be able to produce in his or her sleep.  That many such can't do so wide awake, with their staffs working on it at white heat, only means that the bar is pretty low.  (Compare this appalling screed by an Australian Senator to see how low the bar can go.)  Mayor Pete clears that bar, but it's not a sterling achievement.

Greenwald also wrote of Buttigieg's "heterodox thinking."  Heterodoxy is relative only to a respective orthodoxy, and I wonder which one Greenwald has in mind.  So I began looking for some of Buttigieg's specific policy positions, and found this interesting summary of his performance at a recent CNN town hall, reprinted in the Chicago Tribune from the Washington Post.  Notice that it's the work of Jennifer Rubin, a far right-wing writer, which makes her positive take on Buttigieg all the more disturbing.
He was asked about Venezuela. "Well, the situation in Venezuela is highly disturbing. And I think that the Maduro regime has lost its legitimacy," he explained. "That's why it's not just the U.S. but 50 countries that have declined to recognize the legitimacy of that regime."

He continued, "That being said, that doesn't mean we just carelessly threaten the use of military force, which is what it appeared the national security adviser was doing at one point, kind of hinting that troops might be sent to South America."

... "I don't mean to disagree that we need to support democratic outcomes in that country. And so to the extent that sanctions can be targeted and can be focused on trying to bring about new free and fair elections so that there can be self-determination by the Venezuelan people, that puts in a government that I think has that legitimacy, then we should do our part not through force but through the diplomatic tool kit in order to try to bring that outcome about."
Rubin gushes, "That might be the best answer on Venezuela I've heard from any Democratic candidate — maybe the best foreign policy answer, period."  Really?  It looks to me like the standard "centrist" answer to questions about US interference in Venezuela, and it's anything but "heterodox."  Buttigieg disavowed "carelessly threaten[ing] the use of military force" (maybe careful threats are okay?), which the other Dems would agree with, while endorsing the use of sanctions to starve the mass of Venezuelans into submission.  The kinds of sanctions that might target only government elites would probably also affect the wealthy, right-wing creoles of the opposition, and that would not go down well.

As far as "free and fair elections," Venezuela already has them, and that's why the US wants to overturn them: they produce outcomes we don't like.  Buttigieg says that "the Maduro regime has lost its legitimacy."  First, it never had any in the eyes of the US government, its lackey states, and its tame media; nor did Chavez' "regime," which the US began trying to replace with more corporate-friendly authoritarians from the time Chavez took office.  Second, the most recent election Maduro won was certified fair by international observers; presumably Buttigieg, like the rest of the US mainstream, chooses to forget that.  Finally, the US' designated hitter Juan Guaidó has no legitimacy whatsoever: he has won no election, has no mass base, and only has a platform because of US support.  He also says he's "not afraid of civil war" and hoped to incite US military intervention by staging provocations at the border with Colombia.  Whether Buttigieg likes it or not, that's the "self-determination" he's calling for and supporting.  This is not a minor issue either, because it indicates what Buttigieg's approach to other official enemies (such as North Korea, Iran, or Syria) would look like.

Next Rubin quotes Buttigieg's position on Medicare for all.  He praised the Affordable Care Act, which he said "made a great difference."
"That's why I believe we do need to move in the direction of a Medicare-for-all system. Now, I think anyone in politics who lets the words ‘Medicare-for-all’ escape their lips also has a responsibility to explain how we could actually get there, because as you know, from working on this day in and day out, it's not something you can just flip a switch and do.

"In my view, the best way to do that is through what you might call a Medicare-for-all-who-want-it setup. In other words, you take some flavor of Medicare, you make it available on the exchange as a kind of public option, and you invite people to buy into it. So if people like me are right that that's ultimately going to be more efficient over time and more cost-effective, then you will see that very naturally become a glide path ..."
Ah, the "public option."  Again, that's hardly a "heterodox" position, any more than his gradualist "move in the direction."  Medicare itself was "something you can just flip a switch and do," both in the US and Canada.  Yes, it will take planning, but my impression is that the politicians who are spearheading the drive to Medicare for All are working on the planning and the details.  But it's not really hard to explain "how we could actually get there," since we could learn a great deal from Canada's implementation, not to mention the fact that we already have Medicare in this country for people 65 and older.  It's extremely popular with voters, as is the idea of a national single-payer system.  The basic infrastructure is already in place; it would not be a radical move to expand it.  I'd have a bit more respect for Buttigieg's gradualism if he balanced it by noting how much money and energy we waste on, say, the military.  Instead he went on to say:
"You know, we as a country pay out of our health care dollar less on patient care and more on bureaucracy than almost any other country in the developed world. And so it's very clear that we've got to do some unglamorous technical work. Actually, some of the benefits of automation could come in this sense. You think about how many hands have to touch a prior authorization sometimes. And the right answer to that should be zero, but we're not there yet. So we've got to do that, that kind of unfashionable technical work within (the Centers for Medicare and Medicaid Services) to make the system more efficient."
This is extremely misleading.  He may not have meant it that way, but in context Buttigieg gave the impression that the "bureaucracy" that runs up the costs of healthcare in the US is located within "the Centers for Medicare and Medicaid Services," so we need "to make the system more efficient."  I have no doubt that the Medicare administration has room for improvement, but it's hardly obscure that the wasteful bureaucracy that runs up costs so that too "many hands have to touch a prior authorization sometimes" belongs to the private insurance companies that Buttigieg wants to preserve until the Messiah comes.  A smart technocrat, as he presents himself to be, must know that. Again, there's nothing heterodox here, it's just centrist boilerplate.

I'm going to skip his remarks on impeachment, which are more safe on-one-hand/on-the-other hand stuff, perfectly compatible with the Democratic establishment.  Speaking of Buttigieg as smart technocrat, though:
"As to what Gov. (Mitt) Romney was talking about, look, we do need to work to make government more efficient. One of the things we did when I came in, in South Bend as mayor was — kind of a banned phrase around the county city building was 'We do it this way because we've always done it this way.'"

"We subjected everything we do to rigorous analysis, because at the city level, I don't get to print money. We legally have to balance the general fund budget. And if I want to do more, we just have to figure out a way to do what we're doing more efficiently or else we'll have to do less of something else. And sometimes that's the right answer, too.

"So I think that on-the-ground knowledge of how to get something done that I maybe began to get in the business community, but really put to work in public service at the local level, will be useful at a time when, frankly, in federal budgeting we're being told we can get something for nothing. And things that are completely unaffordable, like the tax cuts for the wealthiest, are being passed off as though they're worth just as much as things that if we ever do deficit spending would be a better use of it, like investing in infrastructure and education and the things that we know have a payback and will pay for themselves in the long run."
"We've always done it this way" is of course a stumbling block in private enterprise too, regularly attacked in books on management.  Wherever Buttigieg got his "on-the-ground knowledge of how to get something done," it wasn't "in the business community."  Beyond that, these remarks are standard centrist prattle about running government like a business, you can't get something for nothing, we have to balance the budget.  Many arguments can be made against these slogans, but the key point is that they are not heterodox, not bold path-breaking authentic proposals that no one has had the guts or imagination or passion to advance before.  Far from it: they're routine parts of every election cycle as far back as I can remember.

Maybe Buttigieg is better than these remarks indicate, but again, he made them on his own, in a showcase where he evidently felt free to say what he thinks.  Contrary to Glenn Greenwald, I don't see a lot of exciting authentic substance here.  When my Bay-Area friend was upset by my skepticism toward this shiny new guy, I made it clear that I don't think he's totally evil, he might amount to something someday, but I really think he should at least run for a legislative office, state or federal, before aiming at the Oval Office. Much of the excitement I see over Buttigieg, like the excitement I see over Robert "Beto" O'Rourke, whom he resembles, is based on his presentation, his aging-elfin cuteness, his undeniable intelligence rather than his positions, which I think are ground for concern rather than celebration.  O'Rourke has been compared to Obama in his vacuousness, but thanks to his political history O'Rourke's unsavory record is there for scrutiny for those who care.  But many don't care: they'd rather daydream at their desks, practicing writing their married name in their notebooks (guys, Mayor Pete already has a husband).

Which brings up what is by now a familiar paradox: smart liberals who denounce Joe and Jane Sixpack for focusing on personalities rather than issues, generally have very little interest in issues but swoon over personalities.  If a candidate has no personality or a repellent one, no problem -- they'll work very hard to persuade themselves that he's really the most charismatic candidate ever!  Pete Buttigieg doesn't have that problem, he's evidently an engaging person.  Speaking seven languages, I admit, is a refreshing change from the monolingual Trump and Obama.  If you like a candidate, invite him to dinner, ask her out for coffee, paper your room with posters, but that is no reason to overlook his policies, let alone a reason to vote for him.  It bothers me, because it's so reminiscent of the rise of Barack Obama over a decade ago, to see this pattern repeating itself among people who really are smart enough to know better.

*CORRECTION: I've learned since I wrote this that South Bend's mayors have been Democrats for decades.