It’s not all the economy, stupid, but…

Of course, “it’s the economy, stupid” was Bill Clinton’s famous winning strategy to beat GHWB in 1992.  And, the evidence is overwhelming that the economy is hugely influential in presidential elections– especially with an incumbent.  So Trump definitely has the wind at his back, in this regard.  Drum:

Here is the answer to this morning’s mystery chart:

  • Incumbent presidents lose reelection if economic growth dips below zero in either the election year or the year before.
  • Otherwise they win.
  • This rule has been 100 percent accurate for every incumbent since 1950.

Economic growth did not fall below zero last year and it is not going to fall below zero this year. This means that Donald Trump has a strong wind at his back and will be hard to beat in November. I sure hope liberals are all aware of this and are willing to work their guts out no matter how discouraged they may get from time to time. This includes being discouraged because your candidate didn’t win the primary; because your policies are not getting the priority you’d like; because things look dire in the Senate races; because the polls sometimes show spikes in favor of Trump; and becasue of general angst over how things are going.

If you ever think of giving up, just remember 2016. All the way until a couple of weeks before Election Day, Donald Trump looked like a sure loser. Two days before Election Day he looked like a nearly sure loser. But he never gave up. And he won. Stuff happens. If he can do it, so can we.

And, yes, that is a helluva post-1950 pattern.  That said, never since 1950 have we seen a president with approval so low with economic growth and unemployment figures like we currently have.  So, the simple truth is that this does not give Trump the overwhelming advantage that would have re-elected pretty much every other modern president.  As I’ve often emphasized, given the economy, Trump’s approval is pretty abysmal.  And presidential approval is definitely strongly related to re-election prospects.

Of course, given Trump’s manifest horribleness, he should be at 25% support, not hanging out in the 40’s.  Trump definitely has a very reasonable chance at re-election.  But, again, because he’s Trump, he also has a pretty damn good chance of being defeated.  So long as everybody from center to left actually turns out and votes against him.

The key to more affordable health care: more government

The evidence for this statement from health care systems around the world is simply overwhelming.  But, since Republicans are so wedded to the “government = bad” rhetoric (unless Trump tells them to think otherwise), it is especially politically difficult to create a system with the much greater government involvement needed to actually keep prices down.

Dylan Scott has been traveling the world for Vox to learn lessons from other country’s health care systems.   Here’s a couple of them related to this point:

3) Universal health coverage requires a lot of government spending and regulations

There is no way to avoid it: If you want universal coverage, the government is going to play a huge role. In Taiwan and Australia, that means the government runs a universal insurance program that covers everybody for most medical services.

But even in the Netherlands, which relies on private health insurers, the government oversees everything. It sets rules about what benefits have to be covered, what prices can be charged, and what cost sharing is required. It collects contributions from employers to pay the cost of covering everybody and spreads it among the insurers based on the health status of their customers.

Christina Animashaun/Vox

All told, about 75 percent of the funding for health insurance in the Netherlands is still running through the national government, even if the actual insurance benefits are being administered by private companies.

The US stands alone in how much of its health spending comes from private sources — and still doesn’t have universal coverage.

4) Other countries put much stricter controls on health care costs than the US

Under all of these insurance schemes, the governments use much more force to keep health care prices down compared to the US.

In Taiwan, that means global budgets — an annual amount set aside every year for various sectors of the health industry (hospitals, drugs, traditional Chinese medicine, etc.).

In Australia, most doctors do what’s called bulk billing for their Medicare program: The government sets a price, and doctors generally accept it. They can choose to charge more, but it’s relatively rare. They’ve also set up a respected system for evaluating the value of drugs and what their national health insurance plan will pay for them, incorporating input from medical experts, patients, and the drug industry.

In the Netherlands, even with private insurers, the government sets limits on how much health spending can accrue in a given year and has the authority to impose budget cuts if spending exceeds that limit. Prices are also set for particular services, like after-hours primary care. Insurers do have some limited flexibility in which providers they contract with, but the government sets their health care budget for them.

We have experimented with that kind of system in the US, as Tara Golshan covered in this series in her story on Maryland. She documented how the state has tried to use a model like this, global budgets, to improve care for patients by encouraging hospitals to focus on the health of their patients instead of whether they have enough people in their beds.

But Maryland remains an exception. And as the research shows, the US spends dramatically more for many common medical services compared to other developed countries:

As I like to say, free markets are great, where they work.  And they clearly don’t work very well in health care and every other advanced democracy has figured this out.  And, whether it’s Medicare for All, some, or none we undoubtedly need our government to play a dramatically larger role.

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