Canada says no.

"These boots are made for walkin'
And that's just what they'll do"
     Lee Hazlewood, "These Boots are Made for Walkin'", made popular by Nancy Sinatra, 1965

President Trump is picking a fight with Canada. He taunts them. He says that Canada wants the advantages of being the 51st state without actually being one.

Canada's Prime Minister Mark Carney said,"No deal is better than a bad deal."

He had his negotiators walk out of the negotiations.

Click: YouTube

Then, in clear, mature, reasonable language he explained to Canadians and the world why the tariff negotiations ended. The contrast between Mark Carney and Donald Trump is profound. What is happening in America that we would pick a Donald Trump in a world that produces leaders like Mark Carney?

Sandford Borins is a college classmate. He is Canadian. Borins is Professor of Public Management Emeritus at the University of Toronto. In retirement he and his wife Beth Herst wrote Public Representations: Screen Stories, Narrative, and the Public Sphere, 

Guest Post by Sanford Borins

Resisting Trump’s Imperialism

While the U.S. and Canada accuse each other of making last-minute demands that led to the collapse of their recent trade negotiations, I want to step back to consider the Trump administration's actions in an historical context.

Canada evolved slowly from being a group of British colonies to nationhood. An act of the British Parliament, the British North America Act, united four eastern provinces (New Brunswick, Nova Scotia, Quebec, and Ontario) to establish Canada in 1867. Other British colonies joined later, most recently Newfoundland and Labrador in 1949. Initially, Canada didn’t have its own foreign policy and its highest court was in London. Canadian sovereignty developed gradually, and Canadians retain the distasteful memory of having been a colony.

 
Following the signing of NAFTA in 1994, the U.S., Canada, and Mexico became what then Prime Minister Jean Chretien called “the three amigos.” This was a period of free trade and increased economic integration, most notably in automobile production. Each partner respected the others’sovereignty. Canada participated wholeheartedly and suffered many casualties in the war in Afghanistan but took a pass on Iraq. Unlike the U.S., Canada and Mexico have always maintained warm diplomatic and economic relations with Cuba.

Been There, Done That

Canadians see the second Trump administration’s approach to its relationship with Canada as a desire to return Canada to the status of a colony and a negation of “the three amigos” era. President Trump’s juvenile “51st state” rhetoric and gaslighting and taunting of Canadian leaders poison the atmosphere but are not the essential problem. Our critical concern is the Trump administration's attempt to thwart Canada’s economic development and sovereignty, in effect to turn it into a vassal state. This is of a piece with other Trump administration initiatives to dominate the western hemisphere, such as the attempt to seize Greenland, the takeover of the Venezuelan Government, and the blockade of Cuba.

Why Canada Walked

There are several components of this imperialist approach, and they all appear to have come together in the recent negotiations. The Trump administration wants to weaken or destroy some Canadian industries, most notably automobile assembly, auto parts, and steel, all of which currently sell much of their output to the U.S., by implementing prohibitive tariffs. It hopes that dismantling Canadian manufacturing will increase manufacturing jobs in the U.S.

In resources such as oil, gas, potash, and critical minerals the Trump administration wants the U.S. to be the sole purchaser of Canadian output – the introductory economics term is “monopsony.” Hence the willingness of the Trump administration not to tariff Canadian energy producers, its desire to build the Keystone XL oil pipeline, and its demand that Canada not make agreements to sell these products to other countries. Clearly the Trump administration wants cheap, guaranteed supply.

 
These two approaches represent classic imperialism, in which the colony produces raw materials for the metropole and the metropole sells finished goods back to the colony. Late in the negotiations, the Trump administration introduced demands that Canada drop requirements that U.S. streaming platforms such as Netflix and Amazon Prime promote Canadian (including French-language) content to users in Canada and requirements for bilingual packaging of products sold in Canada. These demands represent an attack on Canadian cultural sovereignty and are particularly tone-deaf on the eve of an election in Quebec.

Defense is a third aspect of the would-be imperialist relationship. The U.S. wants substantial Canadian participation in its vision of North American defense and also wants to make sure that Canada buys American weaponry. Increasingly, Canada sees the Trump administration as an unreliable military partner. The flashpoint now is whether Canada will complete a major order of F35 fighter aircraft, which the Trump administration has been demanding. In his statement the morning after Canada walked away from the trade negotiations, Prime Minister Carney made it clear that the concessions the Trump administration was asking for amount to an unacceptable incursion on Canadian sovereignty, in effect an attempt to establish a new imperial relationship.

The Empire Strikes Back?

Carney has announced that Canada will put in place a program of support for Canadian producers who will be hurt by the additional U.S. tariffs that just went into effect and will also impose counter-tariffs on September 8, the day after Labor Day. In some instances, the counter-tariffs are a logical response to the U.S. tariffs. For example, both the U.S. and Canada produce steel. If U.S. tariffs make it impossible for Canadian steel producers to sell in the U.S., not imposing counter-tariffs would allow U.S. steel producers to continue to sell in Canada. The counter-tariffs level the playing field for Canadian steel producers selling in Canada. The slight delay in implementing counter-tariffs permits additional negotiation, if both sides are so inclined.

Trump’s typical response to opposition is social media taunts and escalating threats. The taunts have already started. The threats are likely to come soon.



[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.]

Chris Beck Meet and Greet in Grants Psss

Josephine County voters: 

      Chris Beck wants to hear from you.

Chris Beck is the Democratic candidate for U.S. Congress in Oregon's second district. 

It is a good invitation, but it isn't the one I suggested to the event organizers. Read the invitation. Attend if you live somewhere close to the event. 

The event organizers sent me a draft of this invitation. It emphasized the point that Chris Beck wanted to hear from you. He is there to listen, it said. 

I suggested a different emphasis. That invitation was too passive. Instead, position Beck's election as a message of protest against an unsatisfactory status quo. Urge people to show up to see the guy who will be their "no" vote on Trump and our Trump-enabling GOP congressman, Cliff Bentz.

They tweaked the invitation to add that we can send a message that we want a change in leadership. 

But maybe this invitation was exactly right in its original form: Beck will be there to listen and learn. The point of an invitation is to get people to show up. Maybe the best draw was their first instinct, the chance for voters to tell Beck what they think. 

I probably overthink this.  

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.] 

Easy Sunday: Scenes from Washington, D.C.

     "Ask not what your country can do for you. Ask what you can do for your country."
         JFK inauguration speech, January, 1961

I felt the same feeling of national pride as did Jack Mullen, today's guest post author, back in 1976. 

President Kennedy's words were still fresh. Moreover, the country had just decided that a president who lied about a burglary, then obstructed justice to cover up the lie, was not fit to be president. Republicans agreed. America was better than that, the country's leaders decided, so we cleaned house.

That era seems so remote. President Trump openly and proudly enriches himself, demands he be exempted from IRS audits, sells pardons, robs gullible investors, obstructs justice, and is corrupt at a level unimaginable 50 years ago. It is a take, take, take world for Trump, and the country is ripe for the taking. Republican voters seem OK with it. 

Trump has put his stamp on America. He has also put his stamp on the 250th celebration of the country's founding. Jack Mullen grew up in Medford, worked with me in local orchards, attended the U. of O., served in the Peace Corp, had a long career in publishishing, and is now retired and living in the District of Columbia, where he is an eyewitness to our capital city in this era of Trump.

Guest Post by Jack Mullen

I remember the pride felt at the 1976 bicentennial parade in Ashland, Oregon. Locals cheered bands and local officials as they marched down Siskiyou Boulevard to Lithia Plaza. I live in our nation's capital, and hoped to rekindle that feeling when America's 250th birthday occurred. I have watched in disgust as President Trump pushed aside long-planned events, and decided to do things his way.

The America250 celebration spans the entire summer. The kick-off event, a UFC cage fighting event on the South Lawn of the White House, occurred June 14th, Trump's 80th birthday. I had no interest in attending the fight. However, my curiosity got the better of me, and I set out to catch a glimpse of the massive overhead steel structure of the fighting arena, nicknamed by locals "The Claw."

My trip to grab a glimpse of "The Claw" led me to unforeseen obstacles. A fortress of security roadblocks forced me in circles, which eventually led me across Memorial Bridge and into Arlington, Virginia. Since I was already in Arlington, I decided to contemplate and, in a way, celebrate America's 250-year history by revisiting the resting place of generations of American soldiers at Arlington Cemetery.

The Memorial Bridge, which led me to the cemetery, was designed to connect the Virginia side of the Potomac River and Arlington Cemetery to the Lincoln Memorial. The bridge was built to symbolize the reconciliation of the North and South after the Civil War. This visual connection of Civil War soldiers to President Lincoln will soon be lost if Trump is allowed to build a 250-foot granite "Arc de Trump" (officially the United States Triumphal Arch).

The "Arc" is meant to commemorate America's 250th birthday and has nothing to do with Lincoln or the cemetery. A Trump-appointed commission gave preliminary approval to the design in July. The National Park Service dutifully requested public comments on the structure, which were overwhelmingly negative, 99% against. The comments will be ignored, and another commission vote may occur on September 3. But there is hope that ongoing litigation and Congressional opposition will at least slow the construction down or reduce the arch's massive size.

A week later, my wife and I decided to take advantage of a balmy Saturday and re-visit the newsworthy Reflecting Pool at the base of the Lincoln Memorial. Members of the National Guard patrolling the area never bothered us as we took a few photos to pass on to friends. The pool was coated with green, and workers were standing in waders skimming it off. There was no evidence of the “American Flag blue” coating. Shortly after our visit, Park Police, at Trump’s urging, arrested several people for supposedly vandalizing the pool by removing small pieces of the coating that were floating to the surface. Bet on it – there will be no convictions. Soon after, Trump erected dark covered fences around the pool, just one more pockmark in our nation’s capital. Meanwhile, the Justice Department just renewed its investigation of possible vandalism.

Mercifully, the “America 250” celebration officially ends this weekend when the 2026 Indy Car race takes place on the streets of Washington. 

 

Billed as “America Speed, America Greatness for One Week” by the White House, the race will consist of 147 laps around the 1.7-mile course down Pennsylvania Avenue (but not in front of the White House) and around the National Mall at speeds up to 175 mph. The National Gallery of Art has braced some of its more fragile works for the vibrations from the race.

I’m not sure where the pit area exists where drivers refuel and change tires, or stop if they encounter mechanical problems. My curiosity will be rewarded if I tune into Fox’s complete race coverage this Sunday morning.

When we Washingtonians return to our normal lives on Monday, August 24, half of the 5,000 National Guard personnel used to patrol American 250 celebration will return home and the District of Columbia will be left, until January 2029, with the regular 2,500 Guard personnel patrolling streets and picking up litter. Total cost to taxpayers $1.4 billion.

 

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.]  

Melons, Grapes, and Puncture Vine

It isn't all politics, all the time, everywhere.

Part One: Melons.

(I will catch you up on grapes and the noxious puncture vine in subsequent posts. If posts about melons bore you, skip reading now.)

I still grow a few melons in a small patch next to the vineyard. I grow them out of habit and inertia. 

Jerry Evans, with a sample of the melons we picked Tuesday morning

Southern Oregon residents will recognize Jerry Evans, the owner-operator-host of the fine-dining restaurant The Jacksonville Inn, now retired. It was a great restaurant. It served presidents, senators, celebrities of all kinds, billionaires, poor people, and teens on prom dates. He came out to the farm to look over my grapes and melons.

My father, brother, and I started growing melons in about 1961, when I was 11 years old. We sold them to local produce markets and to Sherm's Thunderbird, who made the effort to buy local produce. My brother and I each banked $1,000 every summer. That amount was over half of the tuition at Harvard; it was $1,760 my freshman year. Melons got me though college debt free.

My farm roots may have allowed me to win election to the county commission as a Democrat, notwithstanding the Reagan landslide election of 1980. My election opponents described me as a fish out of water, a local boy ruined by an east-coast education. But I was authentically poor. I drove an old truck. I got dirty working. I was proud to call myself a truck farmer. And people saw my melons, rubber stamped "SAGE" in stores. 

When I was freshly retired from my career as a financial advisor in 2015, I experimented with growing a large field again and I invited people out to see the melon field.

I had fun watching parents and kids eating watermelon.

Roy and Barbara Saigo

There was a problem. I had aged out of doing field work. Carrying multiple loads of 60-pound buckets of melons became more than my back could handle. 

I still host people at the melon patch, but do so a much smaller scale. My niece and nephew got a small taste of the farm six years ago.

My nephew, now age 18, is a huge help with the vineyard as we put up bird netting. More about that shortly.

There is an art to picking a ripe watermelon and there is some guesswork. The proof is when one cuts it or drops it.

But most of the other varieties of melons that I grow have an unmistakable look when they are ripe. Cantaloupes turn color, from greenish-buff to tan. The field is best picked every day to catch them at that first day when they will "slip." Refrigerated, they may last a week. On a kitchen counter they are still perfect for about three days.

The best way to have a melon that looks great on the shelf in the mass-market supply chain is for the grower to pick it a few days before that moment of perfect ripeness. The result is an OK melon. That is changing, though. Plant hybridizers have created a melon variety, the Tuscan-style melon, which is rather forgiving of being picked early. I am a melon snob, but admit that even when picked a bit green, they are pretty good. The ribbed melons being held by Roy and Barbara Saigo and the melons in the grey bin are Tuscan style melons. 

The yellow and green melons in the Saigo's hands are a Spanish melon called Piel de Sapo, sometimes called "Santa Claus" melons. In the U.S. at this latitude you would see them starting now. Look for this and try them:

They are astonishingly sweet and "melon-ish" in flavor.  They are my favorite. 

Melons are in season now. Ten months of the year you are doomed to eat, at best, pretty-good melons. Now is the time to eat a very, very good melon, especially if you buy them in a place that sources local fruit.

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.] 

"Answer the question!"

    "Is there anything President Trump could do that you could see yourself opposing?"

          Retired journalist Alberto Enriquez, to U.S. Rep. Cliff Bentz

  "Yes, but don't ask me for a list."

           Bentz, at the Medford Rotary Club, August 18

It turns out that that was his answer. All of it.

He said "yes," telling the audience that he was not a mindless sycophant and enabler of Trump, while simultaneously giving himself deniability. So Trump does illegal, immoral, dangerous things? Don't blame Bentz. He said he didn't agree with everything Trump does, right there at a Rotary meeting. But as a loyal part of the GOP caucus, he enables Trump to do anything and everything Trump wants simply by consenting to it.

If even a half-dozen GOP congressmen objected to a Trump action, a House majority would be there to impede Trump. Bentz does nothing. He cannot shed accountability by saying he dislikes things that he then allows. Bentz cannot hide from the power of his office.

Bentz's answer is unworthy of an elected representative.

Bentz makes no objection to Trump making war on Iran without consulting Congress. He makes no objection to Trump imposing tariffs, a congressional responsibility. Nor does Bentz make a peep of objection to Trump's preposterous, pretextual justifications for the tariffs. Nor to the $1.776 billion legal settlement with himself, a blatant self-dealing theft from the public treasury. Nor to the crypto self-enrichment scheme that provided an open-ended way for favor-seeking individuals and governments to invest in a Trump crypto coin that sends money directly from them to Trump. Nor to Trump openly celebrating their loyalty with a recognition dinner, so they know Trump got the message of their tribute. Nor to Trump's active stock trading, with investments in companies whose fortunes rise and fall on Trump's own announcements. Nor to Trump selling early notice of presidential announcements for personal financial gain. Nor to Trump selling pardons. Nor to the DOGE cuts to the Forest Service. 

Immediately after the non-answer, Bentz began a three-minute period of pressured speech — a non-stop ramble of constant sound that blocked any opportunity for interruption. He began by blaming the state of Oregon for high gasoline prices. Then Democrats in the U.S. Senate — the minority — for causing forest fires. Then Iran, saying that their leaders hated America and that they shouldn't have a nuclear weapon (leaving aside the fact that Iran is in a far stronger position now than before the war, and that since the war demonstrated our inability to protect Saudi Arabia and the other countries of the region, they are strongly incentivized to get nuclear bombs themselves. What could go wrong?). Then, not missing a beat, he said that "Trump One and Trump Two" generated more fossil fuel, not mentioning that U.S. oil production went up under Biden. Then he said, "Thank you for your question," in the way speakers do to show that they are done.

A woman in the audience shouted out, "Answer the question! You didn't answer the question!"

Bentz:

"I did. At the very beginning. He asked if there was anything that I would vote against. I said yes. There it is."

The woman made a sound of protest. The audience made restless, jostling sounds. The room started to get away from him.

Bentz:

"Why would I guess whatever he is going to do?"

[Unsaid: Why would I reveal what I object to, but fail to stop, when I can give myself an out, and tell you troublemakers to pound sand?] 

Enriquez spoke up again, saying that 2,000 homes burned in Phoenix and Ashland, Oregon, in the Almeda Fire. That wasn't a forest-management problem, Enriquez said, it was a climate-change problem.

Bentz scrambled again, with more pressured speech. He said that in hearings when he was in the Oregon legislature, he learned that climate change was "baked in." It is real and unstoppable. It is too late to change anything:

"We have to acclimate. We have to protect ourselves from the consequences of hotter, warmer, dryer. That's what's happening."

He said maybe Medford could build a biomass facility and make kerosene out of wood chips, then said an abrupt, "Thank you very much" and left the lectern.

I think Cliff Bentz's performance is shameful. Bentz found career success in politics. He is, after all, an incumbent congressman. He is a below-average public speaker, but he gets through material approximately as articulately as did Joe Biden in 2020, a low bar, but good enough. You don't need to be a great political athlete if you're in the right place at the right time, and Bentz was. Pundits call this a safe seat for Bentz. It is safe in part because he blows off accountability, brushing off constituents with non-answers, while doing exactly what Trump demands.

It seems like a waste of a congressional seat, but he likely gets to keep it. He is a good boy, keeping his head down.

Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.] 

Death with dignity: A physician's perspective.

"And now, the end is near
And so I face the final curtain . . . .
I did it my way"
          "Comme d'habitude," translated into English by Paul Anka, made popular by Frank Sinatra, 1969

Sometimes people have had enough. 

Of almost 4,000 posts over 11 years, the post with the widest distribution was the one where I described helping my friend die.

It was a solemn, emotionally-charged day for me. It was a quiet relief for my friend. I wrote about it from the point of view of the helpful friend who could legally acquire and mix the prescription medicine that would end his life, then hand it to the patient. Bill Southworth read that post. He writes today sharing a physician's perspective on end-of-life care.

Bill Southworth became a licensed physician in Oregon in 1979, then worked and practiced in Ashland, Medford, Yreka and other locations. When he retired 2003, he changed his Oregon license to “active emeritus status” which allows him only pro bono volunteer work. He told me he follows the rules and answers to Oregon law, to the Oregon Health Authority (OHA), and follows best practices and reporting requirements of the Academy of Aid in Dying Medicine.

Guest Post by Bill Southworth, M.D. 

I am now 85 and see only terminally ill patients seeking access to MAID. The term Physician Assisted Suicide is discouraged (I consider it pejorative.) Assisting a suicide by a physician or anyone else is a felony in all U.S. jurisdictions. The cause of death recorded on certificates of patients who have met all eligibility requirements for obtaining and using a legal MAID prescription carry the diagnosis of the underlying disease that allowed them to qualify.

I became exclusively a MAID provider in 2016. Since then I have counseled around 100 patients, and have written prescriptions for 40 or more, around 10 per year. I attend ingestions and deaths when asked or needed. I taught a class at OLLI (Osher Lifelong Learning Institute) on DWD/MAID, which was well attended. This has been the most important and deeply satisfying work I have ever done. It is time-consuming to visit patients in homes or places of care, examining them, reviewing records, seeking a confirming consultation, communicating with family members, to establish eligibility according to the DWDA. Add to that record-keeping and reporting requirements. I’m not held to productivity goals and cannot send bills. I don’t know how I would have fit this into an office schedule. Most of the patients I see are too ill to leave home easily and be transported to an office. I have received more expressions of gratitude from patients and families than I ever did during my previous practice years. I don’t hide what I do. Even a couple of my conservative friends, probably Trump voters, have said MAID is a good thing, consistent with their ideals of freedom of choice.

I learned about caring for dying patients as an internal medicine resident in 1975 during my rotation on hematology-oncology. I learned more in the 1990s as an office-based internist when I referred several terminal patients to hospice programs. I continued to follow them at home or in nursing homes. Hospice agencies have greatly improved since then. MAID and hospice are not either/or choices. I require admission to hospice before issuing a prescription.

I encourage an effective advance directive and sometimes refer to the federally enacted 1990 Patient Self Determination Act (PSDA). In recent years more local community physicians have become comfortable with prescribing for their own dying patients and accepting referrals, no longer afraid of the “doctor death” stigma or attacks from militant moralists. Clinic-based specialty physicians have become more willing to provide the confirming consultation to enable another doc to prescribe, though some groups forbid their member physicians from prescribing.

Other pro bono MAID providers around Oregon believe the option rightfully belongs within the range of services provided by hospice for patients who ask for it. Several already have in Washington and California. Their medical directors can now prescribe MAID drugs. I’ve been told by an unnamed source that two Oregon hospice programs include MAID, but so far none in our part of the state.

I wrote in support of Oregon’s DWDA in 1997 when the initiative was on the ballot. Several respected and sincere colleagues at the time wrote in opposition, citing adherence to the Hippocratic Oath and religious values. When I graduated from UCSF School of Medicine in 1969 my class of 120 was asked to stand and recite the oath in unison. I remained silent. I thought it was a perfunctory exercise, pledging to mythical Greek gods to abide by an archaic ethical code. It was never enforced in modern times anyway. The AMA code of medical ethics still said that lethal medication to end a dying patient’s suffering was incompatible with a physician’s role as healer. That has changed. It’s now a matter of individual conscience, and in a 2017 issue of JAMA (Journal of the American Medical Association) a secular pledge of responsibility to patients was published based on the World Health Organization’s 1948 Articles of Geneva for Health Care Professionals, emphasizing patients’ rights to self-determination and privacy.

All local hospice programs provide professional and compassionate bedside care. The MAID cocktail is not included with hospice comfort medications, nor covered by insurance. Hospice personnel are not expected (in most cases prohibited) to mix or handle the MAID medications, but their continuing bedside support of dying persons and their families following ingestion is essential. Unconscious and in deep coma after 5-10 minutes, 80 percent of deaths occur within two hours after voluntary ingestion, but occasionally it may take several hours. Patients are never left alone.

Bedside support and guidance by trained volunteers is encouraged through End of Life Choices Oregon (EOLCOR), a non-profit agency with local teams based in several regions including in Southern Oregon. They are proficient in finding cooperating physicians (don’t ask for a list) and handling the compounded powder, mixing it at the bedside, relieving family or hospice personnel of that task with steady hands. I’m counting on them to be there should the need arise.

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.] 

Medicare for all is mainstream now.

The U.S. healthcare system is expensive, inefficient, and full of gaps. Americans rank 33rd among 35 developed countries in longevity.

U.S. Senator Ron Wyden says it's time to stop trying to repair a flawed system. It's time to reimagine it.

Wyden says we need "Medicare for all."

Wyden was in Medford, Oregon, on Monday finishing up field hearings on health care in America. Health care professionals and patients testified to what was wrong.

-- Hospitals were closing because they couldn't get paid enough to provide the services they offer.

-- Rural areas and small cities couldn't recruit physicians to practice there, forcing people to travel long distances for care.

-- Patients couldn't get insurance approval for life-saving drugs.

-- Mental health care was hard or impossible to access.

-- Uninsured and underinsured people delayed preventive care, leading to higher costs when treatable problems became critical.

-- Health insurance premiums have become unaffordable, made worse by the cuts legislated in the "Big Beautiful Bill."

-- Health care workers are unhappy. We train enough nurses, but we still have shortages, because people leave the profession.

-- Physicians spend their time and energy on billing, coding, and negotiating with insurance companies rather than seeing patients.

Wyden's support for Medicare for all is a shift in the political environment within the Democratic Party. This looks like another iteration of Ernest Hemingway's observation on bankruptcy: it happens gradually, then suddenly. 

In 1993, First Lady Hillary Clinton tried to shape a health care program to provide universal coverage — the Health Security Act, known as "Hillarycare." It faced strong opposition from lobbyists and Republicans, and it contributed to a disastrous 1994 midterm election defeat for Democrats. Barack Obama's 2008 election brought Democratic majorities, which made enactment of the Affordable Care Act possible in 2010. It was a patchwork mixing private health insurance, Medicare, Medicaid, and private insurance bought through exchanges. Joe Biden famously called it a "big fuckin' deal," but the program was new and complicated, and the rollout was ragged. The result was another midterm wipeout for Democrats in 2010. Republicans ran on platforms of "repeal Obamacare."

But the political tides were shifting. Voters, including Republicans, liked the provision that allowed businesses and their uninsured employees to buy health insurance through the exchanges. They liked the provision that required insurers to accept customers with pre-existing conditions — a provision that freed people who had stayed in unsatisfying jobs because if they left they would be uninsurable and at risk of catastrophic medical expenses.

President Trump did not argue that Americans should be self- reliant and take their chances in an unregulated marketplace. He said he supported a bigger, better, cheaper health care program. Trumpcare would be better than Obamacare. Trump is selling wishes, not a program; he has never offered an alternative plan of his own. But Republicans now understand that there needs to be some kind of national program: either the flawed Obamacare they oppose, or some magical better one that they are forever positing.

Bernie Sanders' 2016 campaign moved the ball forward with his call for Medicare for all. It was simple to explain. Medicare already existed, and most participants liked it. Republicans derided it as unaffordable socialism. Democrats were divided. Labor unions, some of which had negotiated excellent health plans, opposed it, because their special paid-for benefit would become available to everyone. Moderate Democrats looked for a middle ground. Pete Buttigieg called for "Medicare for all who want It," and that became the middle-ground position among Democrats. The middle-ground position presumed something inevitably complicated: a mix of private plans, union-based plans, and needs-based plans, with a variety of subsidy formulas designed to keep plans affordable for both taxpayers and the insured.

Wyden: Centered, but ideologically left

Ron Wyden's adoption of the phrase "Medicare for all" signals a shift in what will become commonplace Democratic policy. Wyden is a liberal — by some measures, roughly the 10th-most- liberal U.S. senator — but he has served in the Senate for decades and risen to ranking member of the powerful Senate Finance Committee. Wyden works effectively with Democratic colleagues and Republicans to get legislation through the committee and passed into law. In that sense, Wyden is the establishment: a senator who operates within the group that reflects majority opinion. He isn't an outsider insurgent; he is in, and creates, the majority.

Wyden's move signals a change in the Overton window, that measure of whether an idea is revolutionary, merely edgy, or mainstream. Medicare for All is mainstream for Democrats now. 

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.]