I fully support popularism. Which is why I am stumped, somewhat, by the actions of Sinema and Manchin. On the one hand it does help advance a theory I have: when policy details don’t matter, performing moderation is the only way to convince the median voter you’re worth their vote. If this is true I wish Sherod Brown, Tim Ryan, Mark Kelly, Jon Osoff and Jon Tester were jumping up and down with them. But I am not so sure this is true, which leads me to believe moderates are just scared, and that’s a pity.
I really want to know: what does Joe Manchin want? Is this a performance or is there a goal in mind? What does he hope to accomplish this term? Otherwise the whole endeavor seems fruitless. I hope this is more than a pointless exercise designed to save seats which might be lost anyway.
I agree that the prescription drug proposal is probably really popular. It's also horrible policy. Profits drive R&D. The R&D that made a breakthrough vaccine possible within a year.
As a biotech investor I can tell you that many investments go to zero. Same applies with big pharma. Most investments don't work out. So the ones that do have to pay for a LOT of failures.
Worse, we are subsidizing the rest of the world's R&D. It's not fair, but we need to keep doing the research
What you're missing is that the government subsidizes much of the basic research that creates these drugs- including mRNA vaccines- to begin with. I appreciate that you believe yourself to be a 'biotech investor', but in fact all Americans who pay taxes are biotech investors. There's nothing wrong with the US government- which currently takes in $3 trillion a year in taxes and spends over $6 trillion- tightening its belt a bit and getting a better deal on drugs whose research it *subsidized to begin with*.
After all, these aren't price controls- big pharma is free to sell to private insurers or any other private party, for as much as the market can bear. This is the US government setting a maximum on what the government itself will pay. If the biotech sector requires America to literally never negotiate at all- again, for drugs whose R&D they already subsidized- sounds like biotech is a crony capitalist industry too dependent on government subsidies!
Love to hear a deep dive into how a senator from Arizona can oppose lower drug prices. Same for West Virginia. Have to believe both the states have very high incidence of Medicare or Medicaid. And also what are party leaders doing to bring them into line. This is all so frustrating.
I can't give you that deep dive explanation. Hopefully MY or someone more informed with me will step and do it. But from what I gathered elsewhere in this comment section, they are opposed to the way it's being done (government price controls) and not to cheaper drugs themselves. Which sounds reasonable enough to me; price controls don't really have a great track record. But I don't really know what I'm talking about beyond what I gleaned below.
"I dimly recall the waning days of the Cold War, but the median voter heard Ronald Reagan tell Gorbachev to “tear down this wall” and then saw it happen. Ideas that strike 30 year-olds as painfully old-fashioned are mainstream."
I really want to echo this except that I am about to be 51, and so it is not a dim recollection. I came of age in the late 80's and early 90's and as a young person fancied myself a socialist, and spent the summer reading the Communist Manifesto. The wall came down while I was in college, and after working for the summer to save enough money to live for awhile, I moved to Poland to live in the newly free eastern Europe of 1992. And I definitely came away as a capitalist because it's clear that as long as there is a scarcity constraint you need financial incentives to get people to produce at something approaching efficiency. I understand that there is some Star Trek iteration in which scarcity has been overcome and competition is exclusively for status and not material well being, and I guess in that universe socialism could prevail, but I really have a hard time imagining that world (limits of my imagination and the effects of being old I suppose) and to the extent it would come about because of technological innovation, I imagine that we would need a lot more capitalism to get there. So as someone who always votes for democrats, and gives them money, and is to the left of the median voter by a bunch, the socialist talk makes me feel something approaching contempt for the politicians who are spouting it. They never really say what they mean and it's clearly alienating key constituencies so why the attachment? It may be unfair, but it makes people seem unserious -- and it doesn't help when you name your magazine after a French revolutionary faction that ended up super bloodthirsty.
It's also crazy to me that after 100 years of Marxism being put into practice: The PRC, North Korea, Lenin/Stalin, the Khmer Rouge and all the resulting genocide and tyranny, people still have the audacity to call themselves actual Marxists and Communists.
All it took was 1 Hitler to completely destroy the reputation of fascism - so much so that it's a standard mud-slinging epitaph of both the left and right in the US.
But some people have no problem saying "I'm a communist...I'm a communist but I'm not like those guys who shot and starved millions of their own people and put millions more into gulags and concentration camps. I'm the good version of those guys... trust me, I'd never implement a reign of terror and execute my political opponents like those guys we named our magazine after. We're totally against that kind of stuff :)"
There’s a rational theory here that progressives moving the Overton window allows for liberal policies to then be acceptable. If progressives vote against infrastructure, progressive tax increases and refundable CTC, then that’s not the game they are playing. They are playing a game of fundraising from rich people, loudly advocating leftist ideas to a persuadable subset of liberals, so as to not pass those types of center left bills.
This is a great article, but the inclusion of Sinema at the end is weird. After all, using your own thesis we could look at the median Arizona voter and discover just about everything we need to know to explain why Sinema is acting the way she is.
When the average person thinks of "prescription drug pricing" they are thinking of out-of-pocket costs, not price-fixing an entire industry as a legislative pay-for. As far as I'm aware, the actual details haven't of the proposal haven't been polled.
"About a quarter of Americans surveyed say they've had trouble paying for their prescription drugs, and a majority welcome government action to help cut the cost of medications."
Yes, as I said, Americans want lower out-of-pocket costs which is what that poll is about. That is different than what is being proposed in the legislation which is to cap the Medicare price by fiat and then use the "savings" from that to fund other programs. It's not clear how this would affect the wholesale price of drugs or what people have to pay out of pocket.
Not much at all - cutting the price of a $20k drug treatment regimen in half still leaves patients with coinsurance stuck with a higher out of pocket bill than most can afford. Uncapped coinsurance isn't allowed for $20k hospital or physician bills and it doesn't make sense to treat drug therapy differently, especially since it often saves or substitutes for other treatments.
You should listen to the last episode of the Weeds that Matt did with Ezra Klein and Sarah Kliff. Democrats are describing it as the government negotiating drug prices, but Matt & co. admit that actual legislation proposed is price fixing.
If we polled the question - "Should the government set the price of prescription drugs?" how do you think that would poll?
I think this problem is taken to its extreme in local politics in progressive jurisdictions. In these places the left doesn't even seem to care to try to win elections at all. Portland is the city I'm most familiar with, it has an extremely milquetoast establishment mayor. Progressive groups tried to beat him but lost in 2020 (fine) but instead of reevaluating how to get above 50%, they simply turned around and started a recall. It is also commonplace for many on the left to basically blame voters for being insufficiently progressive.
The result is you end up with a mayor/city government that is way to the right of what people would tolerate if progressive forces were aligned and fielding solid candidates. The constant protests and vociferous objections from the left don't succeed in winning power but they do succeed in making the city government unpopular and make it so nobody who has higher ambitions runs for city office.
I feel like city politics in most progressive cities would be a lot healthier if you had some local progressive parties that fielded candidate slates to challenge the establishment... for all their flaws NY and SF progressives do manage to give the voters in those cities a real choice in every election.
I'm a 69-yr old white guy with a college degree, so two-out-of three. I don't live in the suburbs. The last Presidential candidates I admired were Gene McCarthy and George McGovern. Every time I hear 'OK Boomer' from a snot-nosed 20- or 30-year old, I reach for the Republican lever.
So, you deliberately vote to support policies that make your life more difficult and/or less enjoyable and secure — as well as render your country weaker and your world more dangerous— because of the insolence of youth?
Sounds short-sighted.
(If you're answer is: you don't believe such are the outcomes of voting GOP, then the issue isn't arrogant youngsters, rather, the issue is you lean right on policy).
Nope, vote consistently Dem. Haven't noticed my life becoming more enjoyable and secure and the world less dangerous. My comment though was about how the Democratic Party messaging is consistently off-putting to my cohort, which Matt's post was about. There's another aspect to this as well, which is personnel is policy, and given the messaging, you have to wonder about the policy from a Democratic administration. Haven't noticed any progress on closing the carried interest loophole. Wonder why.
Yes, your suggestion of a such a memento is likely a good idea as long as it doesn’t just cause head-banging frustration and resentment. Which I’m afraid it might do—at least for me. Like a lot of suggestions for what Democrats ought to do, this post doesn’t get down to specifics. I’m not saying you couldn’t provide specifics—and maybe you have elsewhere—but you don’t here. And specifics would be really helpful right now. Time is short. Stakes are high. What mistakes will the staffers with your Post-It stuck to computer screens avoid? What will they remember to include? How will their articulation of an issue change? What should Democrats say—or not say—to make a few more of these 50-something white people who didn’t go to college and live in unfashionable suburbs more likely to vote for Democrats or less likely to vote for Republicans?
Absolutely 100% on everything until the last paragraph.
On the prescription drug plan, this is a very specific proposal that may well have some serious problems. Where did this proposal come from? Has it been discussed or studied? There are legitimate concerns about incentives for drug development.
Yet,.. when a member says "wait, is this really a good idea?" they are smeared. But it's a good question. I want drug prices to come down too...very much so. But it's tricky. I don't have confidence that this is the way to do it, and there could be real harm done over time. But we are in "Pharma bad" mode, instead of figuring out how to make pharma work for us, rather than the reverse. I want cheaper meds but lots of innovation as well.
I hope Kamala Harris reads this article.
Voter turnout is a disgrace.
I fully support popularism. Which is why I am stumped, somewhat, by the actions of Sinema and Manchin. On the one hand it does help advance a theory I have: when policy details don’t matter, performing moderation is the only way to convince the median voter you’re worth their vote. If this is true I wish Sherod Brown, Tim Ryan, Mark Kelly, Jon Osoff and Jon Tester were jumping up and down with them. But I am not so sure this is true, which leads me to believe moderates are just scared, and that’s a pity.
I really want to know: what does Joe Manchin want? Is this a performance or is there a goal in mind? What does he hope to accomplish this term? Otherwise the whole endeavor seems fruitless. I hope this is more than a pointless exercise designed to save seats which might be lost anyway.
I agree that the prescription drug proposal is probably really popular. It's also horrible policy. Profits drive R&D. The R&D that made a breakthrough vaccine possible within a year.
As a biotech investor I can tell you that many investments go to zero. Same applies with big pharma. Most investments don't work out. So the ones that do have to pay for a LOT of failures.
Worse, we are subsidizing the rest of the world's R&D. It's not fair, but we need to keep doing the research
What you're missing is that the government subsidizes much of the basic research that creates these drugs- including mRNA vaccines- to begin with. I appreciate that you believe yourself to be a 'biotech investor', but in fact all Americans who pay taxes are biotech investors. There's nothing wrong with the US government- which currently takes in $3 trillion a year in taxes and spends over $6 trillion- tightening its belt a bit and getting a better deal on drugs whose research it *subsidized to begin with*.
After all, these aren't price controls- big pharma is free to sell to private insurers or any other private party, for as much as the market can bear. This is the US government setting a maximum on what the government itself will pay. If the biotech sector requires America to literally never negotiate at all- again, for drugs whose R&D they already subsidized- sounds like biotech is a crony capitalist industry too dependent on government subsidies!
Who doesn't love Rochester, NY!? Matt, what are your thoughts on garbage plates?
Love to hear a deep dive into how a senator from Arizona can oppose lower drug prices. Same for West Virginia. Have to believe both the states have very high incidence of Medicare or Medicaid. And also what are party leaders doing to bring them into line. This is all so frustrating.
I can't give you that deep dive explanation. Hopefully MY or someone more informed with me will step and do it. But from what I gathered elsewhere in this comment section, they are opposed to the way it's being done (government price controls) and not to cheaper drugs themselves. Which sounds reasonable enough to me; price controls don't really have a great track record. But I don't really know what I'm talking about beyond what I gleaned below.
"I dimly recall the waning days of the Cold War, but the median voter heard Ronald Reagan tell Gorbachev to “tear down this wall” and then saw it happen. Ideas that strike 30 year-olds as painfully old-fashioned are mainstream."
I really want to echo this except that I am about to be 51, and so it is not a dim recollection. I came of age in the late 80's and early 90's and as a young person fancied myself a socialist, and spent the summer reading the Communist Manifesto. The wall came down while I was in college, and after working for the summer to save enough money to live for awhile, I moved to Poland to live in the newly free eastern Europe of 1992. And I definitely came away as a capitalist because it's clear that as long as there is a scarcity constraint you need financial incentives to get people to produce at something approaching efficiency. I understand that there is some Star Trek iteration in which scarcity has been overcome and competition is exclusively for status and not material well being, and I guess in that universe socialism could prevail, but I really have a hard time imagining that world (limits of my imagination and the effects of being old I suppose) and to the extent it would come about because of technological innovation, I imagine that we would need a lot more capitalism to get there. So as someone who always votes for democrats, and gives them money, and is to the left of the median voter by a bunch, the socialist talk makes me feel something approaching contempt for the politicians who are spouting it. They never really say what they mean and it's clearly alienating key constituencies so why the attachment? It may be unfair, but it makes people seem unserious -- and it doesn't help when you name your magazine after a French revolutionary faction that ended up super bloodthirsty.
It's also crazy to me that after 100 years of Marxism being put into practice: The PRC, North Korea, Lenin/Stalin, the Khmer Rouge and all the resulting genocide and tyranny, people still have the audacity to call themselves actual Marxists and Communists.
All it took was 1 Hitler to completely destroy the reputation of fascism - so much so that it's a standard mud-slinging epitaph of both the left and right in the US.
But some people have no problem saying "I'm a communist...I'm a communist but I'm not like those guys who shot and starved millions of their own people and put millions more into gulags and concentration camps. I'm the good version of those guys... trust me, I'd never implement a reign of terror and execute my political opponents like those guys we named our magazine after. We're totally against that kind of stuff :)"
What *kind* of anger management problem?
We all subscribe here, so I'm assuming most of us read till that very last paragraph.
Still, it would be amusing to count the comments that evidence otherwise. This piece has good advice, *especially* for moderate Dems.
There’s a rational theory here that progressives moving the Overton window allows for liberal policies to then be acceptable. If progressives vote against infrastructure, progressive tax increases and refundable CTC, then that’s not the game they are playing. They are playing a game of fundraising from rich people, loudly advocating leftist ideas to a persuadable subset of liberals, so as to not pass those types of center left bills.
I don't think many activists really care about actual outcomes.
This is a great article, but the inclusion of Sinema at the end is weird. After all, using your own thesis we could look at the median Arizona voter and discover just about everything we need to know to explain why Sinema is acting the way she is.
I thought the same, but someone pointed out her fellow AZ senator is Mark Kelly.
I think we could afford to primary her with someone moderately to her left.
Sure, you could try that, but she doesn't run until 2024 and you've still got to win the general.
I think the point Matt is making is that you can make mistakes about what the median voter wants whether your progressive or centrist or conservative.
Good point. I'm not as confident that Sinema is making is a mistake though.
But Sinema is against Medicare prescription drug pricing, which is supported by the median AZ (and American) voter
When the average person thinks of "prescription drug pricing" they are thinking of out-of-pocket costs, not price-fixing an entire industry as a legislative pay-for. As far as I'm aware, the actual details haven't of the proposal haven't been polled.
Polls show wide approval for government intervention specifically, to control prescription drug pricing
https://www.npr.org/sections/health-shots/2019/03/01/699086303/poll-americans-support-government-action-to-curb-prescription-drug-prices
"About a quarter of Americans surveyed say they've had trouble paying for their prescription drugs, and a majority welcome government action to help cut the cost of medications."
Yes, as I said, Americans want lower out-of-pocket costs which is what that poll is about. That is different than what is being proposed in the legislation which is to cap the Medicare price by fiat and then use the "savings" from that to fund other programs. It's not clear how this would affect the wholesale price of drugs or what people have to pay out of pocket.
Not much at all - cutting the price of a $20k drug treatment regimen in half still leaves patients with coinsurance stuck with a higher out of pocket bill than most can afford. Uncapped coinsurance isn't allowed for $20k hospital or physician bills and it doesn't make sense to treat drug therapy differently, especially since it often saves or substitutes for other treatments.
You should listen to the last episode of the Weeds that Matt did with Ezra Klein and Sarah Kliff. Democrats are describing it as the government negotiating drug prices, but Matt & co. admit that actual legislation proposed is price fixing.
If we polled the question - "Should the government set the price of prescription drugs?" how do you think that would poll?
I think this problem is taken to its extreme in local politics in progressive jurisdictions. In these places the left doesn't even seem to care to try to win elections at all. Portland is the city I'm most familiar with, it has an extremely milquetoast establishment mayor. Progressive groups tried to beat him but lost in 2020 (fine) but instead of reevaluating how to get above 50%, they simply turned around and started a recall. It is also commonplace for many on the left to basically blame voters for being insufficiently progressive.
https://twitter.com/ZakirSpeaks/status/1439667941159604225
The result is you end up with a mayor/city government that is way to the right of what people would tolerate if progressive forces were aligned and fielding solid candidates. The constant protests and vociferous objections from the left don't succeed in winning power but they do succeed in making the city government unpopular and make it so nobody who has higher ambitions runs for city office.
I feel like city politics in most progressive cities would be a lot healthier if you had some local progressive parties that fielded candidate slates to challenge the establishment... for all their flaws NY and SF progressives do manage to give the voters in those cities a real choice in every election.
I'm a 69-yr old white guy with a college degree, so two-out-of three. I don't live in the suburbs. The last Presidential candidates I admired were Gene McCarthy and George McGovern. Every time I hear 'OK Boomer' from a snot-nosed 20- or 30-year old, I reach for the Republican lever.
So, you deliberately vote to support policies that make your life more difficult and/or less enjoyable and secure — as well as render your country weaker and your world more dangerous— because of the insolence of youth?
Sounds short-sighted.
(If you're answer is: you don't believe such are the outcomes of voting GOP, then the issue isn't arrogant youngsters, rather, the issue is you lean right on policy).
Nope, vote consistently Dem. Haven't noticed my life becoming more enjoyable and secure and the world less dangerous. My comment though was about how the Democratic Party messaging is consistently off-putting to my cohort, which Matt's post was about. There's another aspect to this as well, which is personnel is policy, and given the messaging, you have to wonder about the policy from a Democratic administration. Haven't noticed any progress on closing the carried interest loophole. Wonder why.
Yes, your suggestion of a such a memento is likely a good idea as long as it doesn’t just cause head-banging frustration and resentment. Which I’m afraid it might do—at least for me. Like a lot of suggestions for what Democrats ought to do, this post doesn’t get down to specifics. I’m not saying you couldn’t provide specifics—and maybe you have elsewhere—but you don’t here. And specifics would be really helpful right now. Time is short. Stakes are high. What mistakes will the staffers with your Post-It stuck to computer screens avoid? What will they remember to include? How will their articulation of an issue change? What should Democrats say—or not say—to make a few more of these 50-something white people who didn’t go to college and live in unfashionable suburbs more likely to vote for Democrats or less likely to vote for Republicans?
Absolutely 100% on everything until the last paragraph.
On the prescription drug plan, this is a very specific proposal that may well have some serious problems. Where did this proposal come from? Has it been discussed or studied? There are legitimate concerns about incentives for drug development.
Yet,.. when a member says "wait, is this really a good idea?" they are smeared. But it's a good question. I want drug prices to come down too...very much so. But it's tricky. I don't have confidence that this is the way to do it, and there could be real harm done over time. But we are in "Pharma bad" mode, instead of figuring out how to make pharma work for us, rather than the reverse. I want cheaper meds but lots of innovation as well.