Medicare for All.

Sanders and Warren advocate for Medicare For All. Don't wimp out. Go for it.

     “I don’t understand why anybody goes to all the trouble of running for president of the United States just to talk about what we really can’t do and shouldn’t fight for.”

                          Elizabeth Warren

"Medicare for All" vs. "Get real."

Democratic moderates say it is too big a lift. People don't want it. We don't have the votes. It costs too much. Preserve patient choice.

At last night's Democratic debate Bernie Sanders and Elizabeth Warren were in center stage, the poll frontrunners. They were arguing the Affirmative position on Medicare For All: Warren has a plan; Bernie wrote the damn bill, as he put it.

They were spirited, aggressive, and adamant. They advocated and defended Medicare for All against all comers.  They did not focus on gradual, staged implementation, implying that the change would be slow, not to worry, we don't really mean it. Quite the opposite. Each focused on its benefits, as fully implemented, as acknowledged change, disrupting an indefensible and broken system.

Nothing tentative. No apology.

Sanders cited the cost of insulin five miles away from Detroit, in Canada: one tenth the cost in the US. Warren said the insurance companies were leaching money from health care and putting it into insurance company profits. Their sole purpose was to say "no" to patients, and make money for themselves, she said. Each framed their argument as between good and bad, the victimized American people versus the corrupt insurance and drug corporate villains.

CLICK: NPR.

Warren offered no sham respect or deferral to the moderates on either side of her. This wasn't an issue of good versus better. It was between politicians with the courage to fight for what is right versus political timidity in the face of special interests.

Buttigieg, Delaney, Hickenlooper, Bullock, Ryan, Klobuchar, and O'Rourke spoke to problems:

  ***It was pie in the sky, unfulfillable promises. You don't have the votes.

  ***It was hopelessly expensive.

  ***It was too generous to the undeserving undocumented immigrants.

  ***It was unpopular. People like having choices.

  ***It takes away from union workers a hard-earned, negotiated benefit.

  ***It is taking away health care from 150 million people who currently are happy with what they have.

  ***It will add visible and unwelcome taxes on middle income people.

  ***It will validate Trump's already-begun accusation that this is "socialism."

Tim Ryan warned: We will lose the House and Trump will win in a landslide, winning 48 states.

Warren stood her ground, saying Democrats win when we forge ahead and advocate for what is right.

Positioning himself as first.

Takeaway Number One: Warren and Sanders are doing exactly what their base requires of them. Sanders and Warren are uncompromising by nature, and Warren has no room to negotiate. She is only credible as an alternative to Sanders if she appears to be exactly as intransigent.

Takeaway Number Two: Not much middle ground. Neither of the two sides are finessing this, looking for middle ground, except Pete Buttigieg. His position of "Medicare for people who want it" is combined with the statement that, in fact, people will want it and that it will force private insurance competitors out because the public option will prevail in the marketplace. 

Takeaway Number Three: Each position was well argued, by people who look credible as a presidential candidate. Warren and Sanders had that standing going into the debate. Buttigieg once again seemed mature and sensible. Klobuchar, Hickenlooper, Bullock, Ryan, and O'Rourke all got more visibility and came across as credible presidents. They said they can get things done. Bullock got elected in red Montana. Klobuchar and Hickenlooper were successful in purple states. Their stature as president was diminished by the fact that each is one of many, but some will drop out; the one or two who remain will look like the young, electable alternative to Biden.

Takeaway Number Four: Beto O'Rourke mentioned Texas and El Paso repeatedly. A personal strategy is emerging. He is running for Vice President, bringing with him the potential of Texas' 38 electoral votes.He brings provides youthful white-male balance to a candidate headed by a woman or person of color. In the post debate spin room and on Morning Joe this morning O'Rourke spoke to his popularity in Texas, his campaign in Texas' 258 counties, and Texas being in play.

[Note: 

Tomorrow, Debate Night Number Two.

Coming soon, a close look at Trump/GOP/RNC angles of attack against Medicare for All. The TV ads have already begun, citing costs, bad outcomes, government takeover.]

Debate Preview: Medicare For All

The health care policy that excites their activist base--Medicare For All--happens to be unpopular. 

That's a second chance opportunity for Joe Biden.

Affable, sure. But can he fight?

In tonight's Democratic debate candidates will attempt to stand out and be noticed.

Pre-debate commentary uses phrases like "the knives will be out." TV commentators are doing what they do, hyping and promoting the event, but it isn't false advertising. Every Democratic candidate saw Kamala Harris a month ago. To get noticed it isn't enough to break into Spanish. You have to "draw blood."

Candidates are auditioning for the role of prize fighter and warrior. Who can stand up to Trump?

That means that tonight's debate over health care policy is going to be acrimonious. You don't get noticed by being civil and reasonable. You get noticed by showing indignant moral certainty.

"How dare you fail the American people!?" 

Facebook and other social media chatter already reveal the division within the Democratic electorate. The progressive left, dominated by Bernie Sanders supporters, but now including apostates who support Warren or Harris as potentially more electable alternatives to the pure classic Sanders, say Medicare For All is the only acceptable route to universal, affordable health care.

Click Kaiser Family Foundation poll

Within the activist left, the ACA was a cop out. It preserved a status quo. It was a payoff to drug and insurance companies.

The issue has become a litmus test of moral virtue and progressive bone fides. It is a perfect issue for a debate knife fight. 

The media wants a knife fight. The public will watch a knife fight. 
The candidates want a knife fight.
I predict we will get a knife fight.

 It is Biden's chance to prove he is the Democratic candidate who can beat Trump. He does it by beating the Medicare For All candidates.

His advantage comes from the fact that a great many people both understand there is a national health care problem but are, themselves, actually in pretty good position. These are the millions of people secure in Medicare; veterans happy with the VA; people with secure jobs with benefits; union members. 

These people personally happy-enough with their situation skew toward being older, more stable, more educated. They are high turnout voters. They are the people who liked hearing Barrack Obama say that if you liked the health care you have you can keep it. They are comfortable with building on the ACA rather than replacing it with Medicare For All. A majority of Democrats--55%--favor that.

With the question asked another way, and Democrats identified as liberal vs. centrist a Pew poll showed that 57% of liberal Democrats do favor a single national health care system. Among moderate Democrats only 33% favor a single-payer program.  CLICK: Pew  Biden has a clear shot at those moderate voters, the only major candidate in his lane.

Note that a Public Option is very different from Medicare For All, and that will be a likely dividing line in tonight's debate. Public Option means choice, and 87% of Democrats favor it, even as polls simultaneously show greater numbers for single payer.

This is an opportunity for Biden to define the issue in terms that favor him. He wants choice and choice is popular. 

Tonight's debate will rough up both sides. Democrats have experience advocating for "choice" via the abortion debate: our bodies, our decision. Republican attack ads are already airing describing Democrats as "Socialists" who confiscate your money and take away choice. 

Choice polls better than socialism.

Biden came across as tepid when he was attacked by Harris in the first debate.He gets a rematch, and he comes into it with a policy advantage. He has an opportunity tonight to defend--and attack--from the higher ground of the more broadly popular position. If he can do it, he will reposition himself as the solid frontrunner. 

Democrats should not expect a great number of Republican votes, but even in this partisan environment, there are moderate voters, and they want choices. 

The make or break question for Biden is whether or not he is any good at fighting for choice.

The election will be rigged

The 2020 election outcome had better be a landslide.

Or else chaos.

Trump is famous for saying that the system was rigged. Democrats are saying it now.  There is bi-partisan agreement that elections are a rigged game. 

That is the setup for a crisis.

In 2016 Trump famously said that he would abide by the results of the election "if I win."  At that point in the campaign his victory was widely thought unlikely. Then he carried Pennsylvania, Michigan, and Wisconsin by a total of fewer than 80,000 votes, and became president.

Click, 2016: "IF I WIN"

We have a president who attacks the credibility of institutions of government including the judiciary, and calls "fake" the media and academic referees of government. Trump made his case, and a significant block of the public agrees. 

Democrats, too. It is now a bipartisan consensus. Government is rigged, especially elections.

Democrats generally acknowledge that the DNC rigged the 2016 Democratic nomination. Democrats and Republican both agree that Russia intentionally interfered with the 2016 election, the only dispute is over whether they changed the result. 

Meanwhile Elizabeth Warren uses exactly the words of Bernie Sanders regarding the American economic and political system, saying it is "rigged," rigged against almost everyone in order to benefit the very, very wealthy. 

Every Democrat says the economic and political system is unfair to women, to Latinos, to blacks, to the 99% of Americans who aren't wealthy. Every Democratic presidential candidate agrees that Citizens United and big money corrupts the political system. 

In 2020 there is a consensus: the institutions of American government are corrupt, and that is a credibility problem for the 2020 election. 

***The election shows every potential for being close. The election will likely come down to a swing voters and turnout in a half dozen swing states.

***It is entirely plausible that, once again, the majority popular vote will have a different result than the electoral college vote.

***There is a partisan split on how to combat 2020 foreign interference, with McConnell proudly blocking efforts by Democrats to demand audit-able paper ballots. Democrats say they are addressing the threat Mueller described; Republicans say that the laws in place now are adequate, and Democrats are trying to delegitimize Trump's 2016 election. Bottom line: no bipartisan consensus on foreign interference.

***Anything Russians can do in cyber warfare can be done by the Iranians, the Chinese, and, of course, by Americans. Both Democrats and Republicans have reason to suspect foul play.

***The US intelligence agencies lack credibility. Trump says they are corrupt. The resignation of Dan Coats as Director of National Intelligence and his replacement by John Ratcliffe exacerbates this. Ratcliffe proved his loyalty to Trump by arguing in the Mueller hearing that Obama, not Trump, should have been investigated, and that Mueller investigation should not even have looked into Trump obstruction of justice. Ratcliffe put his stake in the ground: he is a Trump loyalist.

***The Supreme Court nomination and appointment process solidified the image of the Court as a political branch, now voting 5-4 Republican, if necessary to meet partisan ends. 

Coming Constitutional Crisis. 

2016 Electoral Map

There is one sure way to avoid a crisis: a Trump landslide win. The economy is strong, Trump's racial talk has good traction with non-college whites in swing states, and Democrats are likely to nominate a person who appeals to the most progressive and woke partisans. That nominee may fail to assemble the Hillary coalition and instead only manage the McGovern one. If Trump wins big Trump will love it and Democrats cannot contest it. 

There is a second, sure path to avoiding the crisis: a Trump landslide based on Democratic division. If Democrats nominate a centrist and the Bernie/AOC-oriented left protest the nomination and sit out or vote for a third party, causing a Trump landslide, then the blame would focus on Democratic division, not corrupt interference, and Democrats could not contest the election.

Both of these are easily possible.

A less certain way to avoid one is a Democratic landslide, one that is predicted by polls and that is confirmed by a very strong showing in House and Senate races. This could happen, and a big win would have credibility, especially if confirmed with Susan Collins losing Maine, Bullock running and winning a Senate race in Montana and Hickenlooper doingthe same in Colorado, with McConnell unseated in Kentucky. Then the rejection of Trump would be so clear that the GOP establishment will not back Trump in protesting the election. 

The most likely outcome, though, is a close election, coming down to a few states with close outcomes. The vote count has already been de-legitimized. There will be enough room for doubt to demand recounts, to demand examination of the voting machines, to rue the fact that there are no paper ballots to audit, to complain about ballot design ,or long lines at the polling places, or absentee ballot irregularities. Both sides will doubt the result.

The worst outcome for the election's credibility would be a close Democratic victory tally on election night. Trump would not accept the result. It would get tied up in court. Trump, Fox, and GOP officeholders will object and file suit, hoping to stop any electoral college vote, in which case the election would go to the House, with each state casting one vote where Trump would win. Delay means the election switches from Democrat to Republican. Crisis.

A close election night tally for Trump, like the one in 2016, will be disputed, but Trump would have a better basis for the victory he would claim. He would hold the levers of legitimate power, and it would be a reprise of the 2000 election. The GOP establishment would back Trump up, saying sore losers, as would the Supreme Court, which would end the legal challenges. Crisis.

There is only one happy result for Democrats and the credibility of the election: a big, big win. 

"White-splaining" "Man-splaining."

How to lose an election.

Trump is personally disliked by 56-60% of Americans, yet he has a clear path to re-election. 

Why? 

Because a majority of voters dislike or fear Democrats even more than they dislike Trump. 

That can be fixed.

Democrats are communicating that they disrespect white people and men. "Don't white-splain." "Don't man-splain." 

White people and men hear that message of illegitimacy, and vote accordingly.

There are problems and grievances in America. In the winner-take-all market-empowering economy that developed over the past forty years, the rich have gotten richer. The rising tide of wealth let some people keep up: the professional classes. They have migrated politically to the Democrats. This blog has summarized the Democratic position on how young people can enter the middle class: go to graduate school and get a professional degree. The Democratic response to a closed steel factory or lumber mill is to tell workers to become a nurse or mechanical engineer. Then you will be fine.

It works for some people, but not others. There is an un-subtle message for people who find this route impossible: they are too stupid to learn or they aren't trying hard enough. "It's your fault" is an unwelcome message.

Republicans have a more palatable message: you are a victim of someone else. Under Reagan the villain was the Welfare Queen, with multiple IDs and Social Security cards, getting $150,000 a year scamming benefits. The working poor were being robbed by people who--wouldn't you know--just happened to be black. 

Declining, but still 73%

The Bush presidents  softened the focus, being kinder and gentler, but Donald Trump returned to its southern strategy roots with clear message: the problem is with foreigners from criminal Latin America. And dishonest trading rivals like China. And cheapskate globalist sissy NATO allies. Those outsiders are the ones stealing your money, jobs, and security. Trump wasn't anti-immigrant, per se, he said. People from Norway would be OK, but we had too many of the wrong people invading America, people who, wouldn't you know, just happened to be dark skinned and from shit hole countries. 

Trump won a overwhelming majority of votes from white people and men in 2016. White people are 73% of American voters. Men are 50%. Trump overcame every self-inflicted political obstacle, including the Access Hollywood tape, and still won. 

Democrats have adjusted, but are doing so by making their own situation worse, not better. Trump revulsion has pushed the Democratic message to being even more hostile to white people and to men. 

Democrats are talking about "reparations," which is a race conscious transfer of resources away from whites, paid for by whites. The white working class--the people Kamala Harris notes are living paycheck to paycheck and who did not have $500 available for an emergency--do not feel privileged, and certainly not flush enough to pay other people, even if they maybe deserve it. It is political disaster.

Democrats are correct to recognize that health care access insecurity is a powerful issue, but openly saying that they would offer free health care to people here in America illegally, when they themselves are struggling to afford it, sets Democrats up for the meme that Trump and Fox are already using: that Democrats put foreigners ahead of our own people. More political disaster.

The Franken defenestration and the Kavanaugh hearings sent a clear message that men do not deserve due process or benefit of doubt. Franken and Kavanaugh may well have misbehaved, but they also appear to many to have been set upon and pre judged and MeToo accusers are too quick, too judgmental, too certain. Kirsten Gillibrand faces a political headwind on that issue, even within the Democratic Party. Yet more political disaster.

Within Facebook progressive group chatter, there are two convenient put-downs that de-legitimize heretical opinion, when expressed someone presumed to be white or male, "man-splain" and "white-splain." It is the identity-conscious version of "Shut-up."  

A third of Latinos voted for Trump, notwithstanding his Latino-bashing. A majority of white women voted for Trump, notwithstanding their having heard Trump brag he just grabbed women's pussies. White people feel anxious about their own problems paying for health care. There is a message here, if Democrats will listen.

Financially insecure men and white people--and there are a great many of them--would rather vote for Trump than be told to shut-up.

Medicare option, or Medicare for All?

Donald Trump: "Nobody knew health care could be so complicated."

Actually, almost everyone knew, especially practitioners in the health care delivery system.

Today we will hear from one.

Democratic presidential candidates know there is a problem. Americans pay more for health care than do people in other countries, have worse outcomes, and some people fall through the cracks and aren't served.

Candidates are jostling with each other about how to assure everyone has access to health care. "Medicare for All" is popular and easy to understand--until people are asked if they want to give up their current private insurance. Then it becomes unpopular. People happy with the status quo see change as a threat, not a benefit.

There is also the problem of costs and who will pay them. Taxes are visible and disliked, while health care costs imbedded in ones employment compensation are largely invisible. That creates a political hurdle. 

The health care industry is pushing back. Medicare patients and their payments to health care providers provide scale and cover most of the overhead, but are generally far less than adequate to cover the actual costs. Patients with employer-paid health insurance pay more and subsidize the Medicare and Medicaid patients. Hospitals don't want to lose that income.

And, of course, drug companies resist cost controls and health insurers resist being put out of business. They have billions of dollars to spend on lobbyists, on campaign contributions to legislators, and on political advertising.

William Rosenberg knows full well healthcare is complicated.  He is a healthcare advisor with a 40-year career in senior positions guiding public, private, and not-for-profit health systems. He was a Director at PricewaterhouseCoopers specializing in health care and employee benefit strategy, design, development and implementation. He was a college classmate who furthered his education at the University of Michigan’s School of Public Health. He is retired now, does a little consulting on the side.

He offers something too complex for a political speech, but the kind of information candidates and the people who advise them need to know. Voters, too.

Rosenberg

Guest Post by William Rosenberg

     "When all is said and done, I think "Medicare for All who Want it" is the way to go."

I spent about 40 years trying to help "manage" health care costs and failed completely (but was reasonably well rewarded nonetheless). I ran a Certificate
 Of Need (CON) program in Rhode Island, was an officer in a large group health insurance company, and consulted with insurers. There are some important facts that are often omitted from the discussions about CON and administrative costs.

On administrative costs: There is no question that Medicare administrative costs are lower than those for "private insurance," but comparing Medicare to "private insurance" is not apples to apples and there are factors that would cause the comparison to be skewed both ways, e.g.:

1. About 15% of the total Medicare population of 60 million are eligible due to disability, while most private plans are employment based, and therefore the disabled enrollment is small and the comparisons of cost are not directly comparable.

2. About 36% of the Medicare population are in Medicare Advantage plans, which are essentially private HMOs and, to a lesser extent, PPOs. The Medicare agency, CMS, contracts with them and typically pays more than the average per capita cost of traditional Medicare, and in some cases 15% more. A good chunk of this is administrative costs.

3. The amount CMS pays private Medicare Advantage plans can include bonuses of "high quality" or "efficiency" based on measures to which plans can manage, but which may not be valid.

4. "Traditional" Medicare, which has about 38 million enrollees, and the benefit plan design of Medicare allows beneficiaries to get care from any participating doctor or hospital, and almost all doctors and hospitals are participating providers in Medicare. Medicare Advantage plans, however, typically have a much more limited network of participating providers.

5. On the question of benefit plan design, Traditional Medicare is one plan with one set of rules. One of my clients, for whom I managed a large chunk of Affordable Care Act compliance, had over 50,000 different plan designees that they administered. The variability and complexity of private insurance plans not only frustrates and adds to the administrative costs of doctors and hospitals (at additional administrative expense), but also fragments the purchasing power of those plans. There are probably over 100,000 different private health insurance plans out there for 150 million employees with coverage, or 1,500 "lives" per plan, vs. the 36 million for Traditional Medicare. A typical hospital cannot survive without Medicare revenues (40-50% of their total revenue) but often can survive without a typical private insurer plan.  As a result, Medicare pays about 50% less than does private insurance.

Regarding the Certificate of Need, as a method for controlling costs:

As a reformed regulator, I am skeptical of Certificate Of Need's effectiveness for the following reasons:

1. The determination of what is "needed" is inherently political, and in only a few states is it connected to what is "affordable." Some states, like RI, MA, MD, had hospital budgeting processes and disputes would ensue over what was budgeted for and needed. Think of public utility regulation and ask yourself if that would do the job.

2. Regulations always have unintended consequences. In the early years of CON, hospitals seeking capital expansion approval would cite their lower than average length of stay in the hospital This was a response to assertions then that many patient days in the hospital were unnecessary. So the average length of state in US hospitals declined during the years (1974-1984) when CON was very active. Since the most expensive days in the hospital usually are the first few days (tests, surgeries, recovery rooms), the effect of shortening length of stay was to increase dramatically the average cost per day and to make room for more admissions. The result was an acceleration of total expenditures on hospitals.

3. Another unintended consequence of CON, helped by safer anesthesia, was the growth of stand-alone ambulatory surgery and imaging centers owned by physicians. Then unregulated, they took the "easy" patients away from hospitals and left the high fixed costs of 24/7 hospital coverage, with fewer patients over which to amortize the cost of high cost equipment, e.g. the MRI machine.

My conclusion: when all is said and done, I think "Medicare for All who Want it" is the way to go.  

The 150 million people in private insurance are used to having plan option choices and, with its price and administrative cost advantages, Medicare should be an attractive option that the 150 million will select over time. Simultaneously, Medicare can continue to work on better ways to control costs, while providing broad access and reasonable quality.

One way to mitigate the effect of transition to Medicare price levels would be to calibrate the new populations' provider payment rates as a percentage of Medicare, based on market share.  I'm assuming that most Americans would accept the idea that "volume discounts" are as American as apple pie, so, the "New" Medicare enrollees' rates might not reach parity with Medicare rates until their proportion of the market is equal to that of the Traditional Medicare enrollees. If this were based on revenues, the market share based on head count would have to be much higher than the Medicare percentage of population, because Medicare enrollees account for a much higher amount of revenues per enrollee.

Something could be negotiated.

Mayor Pete in Portland

Up close at a Portland fundraiser.

Pete Buttigieg can raise money.  He has a donor constituency.

He startled political observers with his fundraising, announcing shortly after the June 30 end to the second quarter that he had raised $24.8 million. He announced immediately after the quarter ended, and it set a standard. Everyone else raised less. 

That repositioned Pete Buttigieg in the credibility horse race of the campaign. It makes him "top tier," along with Biden, Sanders, Warren, and Harris. He doesn't poll as well, but he raises money better. 

Put it together, it makes him a contender.

I drove to Portland to watch how he does it, and participate. My wife and I each donated $500, getting the last two of the $500 tickets, the cheapest available when attempted to register.

I only learned about the event by happy accident. A local Democratic activist emailed me to ask if I were going to Portland for the Mayor Pete fundraiser. I said I had not heard about it. He forwarded the email invitation he had received, and I responded promptly. 

Early attendees.

The campaign apparently did not use public lists filed with the Federal Election Commission of donors to Jeff Merkley, Ron Wyden, or Kate Brown, where my name would have appeared as a donor. The invitation distribution was apparently hit-or-miss,--sent to friends of friends--but that appears to have been more than adequate, since the event location was filled to capacity. A bigger venue would have drawn more people.

As is now common practice in political fundraisers of statewide and national candidates, invitations to fundraising events tell one the city and time, but not the exact address, with the exact address coming only two days prior to the actual event. I presume this is intended to confound opposition protesters.

The event took place at a large beautiful home in Northwest Portland, with overlooking a view of the Willamette River. It was owned by a male attorney and his husband. I counted about 150 people in attendance. 

Attendees were urged to come dressed in "business casual attire" and to take a Lyft or Uber to the event, since street parking would be scarce. 

About 150 attendees

There was no media inside the event, but a camera crew from the Portland ABC affiliate, Channel 2, was outside the event, hoping to get some video comments from Buttigieg after the event. 

The email communication from the campaign was signed by people using the titles "West Coast Investment Director" and "Deputy West Coast Investment Director."  Pete Buttigieg, in  his opening remarks, thanked and introduced his "National Investment Director" and pointed to the man shown here, who appears to be no older than 30.  The torch is being passed to a new generation. 

I had never heard the term "investment director" used to describe a fundraiser, but that is the Buttigieg campaign usage.

Calling political donations "investments," seems very modern and Silicon Valley tech, to my ear, but I am 69 and am fading into irrelevancy.

It was a multi-tiered event, by which I mean that people like myself, who donated less than the maximum $2,800 per person, stood on the lovely lawn and visited with others while Buttigieg met privately with the maximum-donors inside the house. Typically people would have photos taken with the candidate, and I am guessing that happened. He was alone with them for about a half hour. 

National Fundraising Chief

Buttigieg came outside, spoke for fifteen minutes. He acknowledged Kate Brown, Oregon Governor, and Tobias Reed, Oregon State Treasurer, who were in attendance, along with a dozen or so other elected officials.

He spoke for about fifteen minutes and then answered exactly four questions, and then circulated with the crowd. Many people were using their video recorders to record his planned remarks. 

The homeowner-host asked people to stop recording during the question/answer portion. This request is unique in my experience, and I have watched about 35 different presidential candidates, Democrat and Republican, in two presidential cycles and in over a hundred events, and never have people been asked to stop recording for a Q & A, until now. 

By this point in the campaign candidates are ready to answer any question with deft self assurance. There are no surprise questions, and in any case there are certainly no surprise answers. 

Candidates answer the question they want to answer, picking up a word or two in any question, and responding to the subject area of that word. No matter how the question is phrased, if it mentions "health care," the candidate is ready with a response on his or her health care position. The word "veterans" elicits the prepared veteran policy. And so on. Candidates don't get tripped up. They don't answer spontaneous questions. They respond to key words. 

Audiences don't seem to notice or mind.

Post speech photos

Mayor Pete has a Portland support group up and running, the people who prepared the lawn signs and buttons that were available to pick up at the event.  The photo to the right is my wife Debra and me, each wearing such a button. A group leader told me the group attends Farmers Markets and other open air gatherings, to distribute signs and buttons and generally to show support for Buttigieg. 

Group members were very much in appearance in the audience at this gathering. I guess/presume that many members of the group identify as male and homosexual. 

Buttigieg spoke smoothly and with confidence. People who have seen him on TV had no surprises. He is calm. He seems reasonable. He seems emotionally mature. He speaks in complete sentences in a matter of fact manner. 

People in this crowd of prosperous professional people seemed very happy with him. The post event chatter was very positive.

The Medicare for All policy debate is currently dividing Democratic voters. Buttigieg reiterated his position: "Medicare for all who want it." He said he thought that taking private health insurance from people who were happy with their current situation would make this politically impossible. He said he thought it likely that over time health care delivery would trend toward Medicare for All, and "Medicare for those who want it" was a transition.

A question from the audience related to black Americans, so the question triggered Buttigieg's current response to the issue. 

We need to do more and better to address the concerns of black Americans, he said, in a tone that was earnest but unapologetic, acknowledging and owning a problem, but not acting defensive. The tone and manner are reminiscent of the Dukakis campaign, practical and technocratic rather than ideological. Government is supposed to do good, and problems are not a matter of moral blame so much as issues to be examined and fixed. Buttigieg is warmer and more empathetic than Dukakis, but there is some of the same businesslike, roll-up-ones-sleeves matter of factness to him.

Post speech greetings

His clothes express that. In Portland, as in New Hampshire, he is dressed in dark slacks, brown shoes, white shirt with sleeves rolled up, and a necktie. Mayors deal with real problems he said in his talk, and he is presenting himself as someone serious about solving them.

I could not count the number of people in the $2,800 room, but the outside crowd swelled when Buttigieg exited, from which I would guess there were 75 people who donated at that level and who had been inside, and another 75 who donated less, an average of $500. That would imply that the event raised perhaps $200,000.

A campaign staffer told he he is spending 20% of his time in Iowa, 20% in New Hampshire, meeting people in Town Halls, and that he is drawing big crowds. So far, his polling is less impressive than his fundraising, but the early indication is that Buttigieg's campaign will not falter because of lack of money.

He has a donor base.

CLICK: Two minute video clip

Good land use planning doesn't just mean saying NO

It also means we empower people to do the things we have planned for. 

Not In My Back Yard, in Medford, Oregon. A thousand people signed the petition: No neighborhood grocery. No gas station. No car wash.

There is something big at stake: the credibility of a city's zoning.

Site of future development

The whole idea of zoning is to allow people to make informed choices about real estate decisions, and to protect the overall safety and enjoyment of a community. Zoning doesn't just mean saying no. It also means saying yes

Some uses of land are inherently troublesome, some more than others.

A simple example is rock crushing for the purpose of making gravel. Crushed rock is a key ingredient in roads and in concrete. Every street uses it. Every home uses it. No one can conscientiously "oppose crushed rock" because construction is impossible without it. But rock crushing is noisy and usually dusty and the facilities are serviced by large dump trucks. They are bad neighbors for a residence, yet essential for those residences. The zoning solution is to forbid rock crushing facilities in residential neighborhoods, but to allow them in open spaces that have rocks suitable for crushing, and then to protect the ability of the rock crushing to take place in those areas zoned for them. It isn't just saying 'no.' It is saying 'yes,' too.

By having permitted uses of certain activities in certain zones people can make rational decisions about buying and selling land, and deciding where to live. A person who wants to build a store or gas station or rock crushing facility can find land where that is an acknowledged use, and pay the price for the land knowing that permission has been granted in advance for that. Simultaneously, a person wanting a single family home has a heads up on what activities might be permitted and forbidden on their neighbor's land. They can also observe the obvious: whether their street is a quiet circle or whether it is an arterial street, and whether the city has prepared a vacant area for a park, for more single family homes, or for something commercial.

McAndrews Road at Springbrook. Vacant land doesn't stay vacant forever. (Unless you buy it and decide you want to keep it vacant. Then it does.)

For years there was a large vacant lot at the corner of two large and busy streets. The property was fenced with a farm-type wire fence. From time to time a horse was pastured there, a holdover and reminder of the rural nature of the area sixty years prior, before a big high school was built and the homes around the vacant lot were developed. The area has been filling in, single family residences replacing vacant land, and recently a 4 story assisted living residence.

On one side is McAndrews Road, one of the large east-west collector street, four lanes in that area, bringing people from residential neighborhoods on both sides of town down to the commercial business district, the malls, the state highways and the freeways. On another side Springbrook Street goes north-south, a wide two lane collector, bringing people to the High School and the east-west arterials. The corner has high traffic count and the infrastructure to support it. Wide streets, curbs, gutters, storm drains, signals.

On their way to something

After public hearings and public deliberations the one-plus acre parcel was zoned for a commercial development. This was no secret. The zoning was public knowledge,  and the growth of the city made this the obvious future. The area was filling in. A development was proposed: a grocery store, gas station, and car wash.

The neighbors said NO. Not In My Back Yard. NIMBY. People in the neighborhood organized opposition, gathered signatures to a petition and attended hearings in mass. The objecting neighbors buy food, buy gasoline, and wash their cars, but they didn't want a facility that provides those services next door to them. Down the street might be really handy, but next door, no. 

They appealed to the Site Plan Architectural Commission, the city body that reviews architectural features for developments, and there the weight of an aroused public had influence. The SPAC body denied the project. The project appealed to the Medford City Council, which held a hearing. The council chambers were filled with aroused citizens, and all the voices speaking up were in opposition. 

They are deciding what to do. The temptation will be to accommodate the neighbors. Twenty years prior the citizens in NW Medford recalled a Council member who voted to allow a drug treatment center to expand, over the objections of the neighbors. (Every other city council person voted to disallow it, citing traffic the ten-person facility might cause, notwithstanding allowing a Costco to be built down the street. It was a total, cynical cave-in.) As a practical matter, a grocery, gas station, and car wash will likely reduce traffic, since currently people in a two mile radius need to drive past the proposed development to go two additional miles to get those services. Still, the citizens were aroused and they were in the faces of the Council members. Not in their back yards.

Across the street. They might find a store handy.

The former hearings at which the land at the corner of McAndrews and Springbrook was zoned commercial were also the "voice of the people." The City Council, carefully and in consideration of the overall public good, made clear to everyone the future potential use of that land. People who didn't want to live near a grocery store or gas station had every opportunity to move or to sell their land to people who wanted the convenience of nearby services.  Everyone had the same heads up. 

Years ago, when the Council zoned the land, they made a reasonable decision through a public process. They made a reasonable decision that people in neighborhoods need commercial services, and that it is better for everyone if those services are nearby, and the correct place to put them is at intersections where people are going anyway, and where the infrastructure is ready to accommodate them.  Places like the corner of McAndrews and Springbrook.

What will they sell there? Presumably the store will stock what people will buy. That is what smart store owners do. If people want thirty brands of olive oil, that is what they will stock. If they want fancy beers, that is what they will stock. 

People in the neighborhood buy gasoline. If they don't buy it there they will drive past the station to buy it elsewhere. If people persist in not wanting to buy gasoline there, then the station will close. Same with the car wash. The development is running a business and they will service the needs of the neighborhood, or some other business--a pharmacy or hair salon or something else--will replace the businesses that fail to serve the neighborhood's needs.

What better place for a neighborhood grocery and gas station than right there, at a place set up to accommodate it?

Either zoning means something or it doesn't. If the Council caves, it means no one can count on anything. It means that whoever can fill an auditorium gets what they want. That can turn around and bite.