Medicare in the 2021 Trump Budget [feedly]

Medicare in the 2021 Trump Budget
https://www.cbpp.org/blog/medicare-in-the-2021-trump-budget

President Trump's 2021 budget proposes about $500 billion in net Medicare spending reductions over ten years (see table), most of which would come from reducing payments to health care providers and not affect beneficiaries directly.

For the most part, the budget does not reflect the President's efforts to end the Affordable Care Act (ACA) or his executive order calling for various Medicare changes. These policies, which a budget would typically include, would weaken Medicare in several ways.

The budget would establish a new payment system for post-acute care, reduce Medicare coverage of bad debts (deductible and coinsurance amounts that are uncollectible from Medicare beneficiaries and that Medicare now pays to reimburse hospitals and other institutional providers), limit medical malpractice awards, extend through 2030 the 2 percent Medicare sequestration cut under the 2011 Budget Control Act, and pay for all doctor and other outpatient services at the same rate regardless of where they're provided. Most of these proposals also appeared in last year's budget.

In two cases — payments to hospitals for graduate medical education (GME) and for uncompensated care — the budget proposes to move spending from Medicare's trust funds to new, smaller grant programs funded by general revenues. While the budget would cut Medicare spending by $756 billion over ten years, the cuts amount to $501 billion after accounting for the general revenue payments for GME and uncompensated care.

In addition to its specific Medicare proposals, the budget assumes $135 billion in savings over ten years from unspecified comprehensive drug pricing reform. Most savings from such legislation would likely accrue to Medicare.

Several of the major budget proposals, such as site-neutral payments to equalize Medicare's payments to different kinds of facilities (as explained in the table below), are similar to recommendations from the Medicare Payment Advisory Commission to address overpayments to certain providers. These proposals would strengthen Medicare's finances. Medicare's trustees project that its Hospital Insurance (HI) trust fund will be depleted in 2026 under current law, though incoming payroll taxes and other revenue could still pay 89 percent of HI costs that year. Under the President's budget proposals, HI would remain solvent for at least 25 years, according to the Department of Health and Human Services.

Unfortunately, other Administration proposals would weaken Medicare's finances and harm beneficiaries.

President Trump's October executive order on Medicare could weaken the program in several ways. Although many of its proposed changes are vague, and most would require changes in law or regulation, the order would promote private Medicare Advantage plans over traditional Medicare and could raise costs for some or all beneficiaries by increasing payment rates to providers, moving toward transforming Medicare into a program that provides premium support for beneficiaries, removing limits on private contracts between patients and providers, and making it easier for seniors to opt out of Medicare. The budget includes the latter two proposals, but with no costs or savings attached.

Most significant, the Administration has joined 18 Republican attorneys general in asking the courts to strike down the entire ACA. The President has also pledged to pursue ACA repeal legislation in 2021 if Republicans control Congress. If these efforts succeed, Medicare beneficiaries, providers, and plans could face serious harm.

Striking down the ACA would reopen the Medicare drug "donut hole" (under which beneficiaries paid all of their drug costs until they reached the yearly catastrophic spending threshold), reintroduce cost sharing for preventive services, and create confusion and uncertainty around payments to plans and providers. It would also greatly weaken Medicare financing by repealing the ACA's Medicare payroll tax increase on high earners and undoing significant payment reforms.

Medicare Proposals in the 2021 Budget
Savings, 2021-2030 (In billions of dollars)
Proposal	Billions
Pay hospital outpatient departments and hospital-owned physician offices at physician office rates (move toward site neutrality)	-164
Reduce post-acute care payments	-101
Promote site neutrality in payments for long-term care hospitals	-9
Reduce Medicare coverage of bad debts	-34
Modify payments to hospitals for uncompensated care	-88
Reform graduate medical education payments	-47
Expand durable medical equipment competitive bidding	-8
Expand prior authorization in traditional Medicare	-14
Reform medical liability	-27
Extend mandatory sequestration	-12
Interactions between proposals and other	3
Net Medicare savings	-501
Less: General revenue payments for uncompensated care and graduate medical education	255
Gross Medicare savings	-756

Note: The general revenue payments for graduate medical education are allocated between Medicare and Medicaid in proportion to the gross savings in each program. The budget also assumes $135 billion in savings from unspecified drug pricing reform. Most of these savings would likely accrue to Medicare.

Source: Office of Management and Budget

TOPICS: 

Federal Budget, Health, Medicare

 -- via my feedly newsfeed

Peter Temin: Land Tenure and Exploitation from the Roman Empire to Lord Peter Wimsey [feedly]

A fascinating excerpt from Temin's book via Brad DeLong: a class history of the transition from Roman to Feudal social organization tracing the gain or loss of 'land ownership

Weekend Reading: Peter Temin: Land Tenure and Exploitation from the Roman Empire to Lord Peter Wimsey
https://www.bradford-delong.com/2020/02/weekend-reading-peter-temin-land-tenure-and-exploitation-from-the-roman-empire-to-lord-peter-wimsey.html

Peter Temin: The Roman Market Economyhttps://delong.typepad.com/files/temin-roman.pdf: Land Ownership: 'For at least four centuries... the Roman Empire preserved peace around the Mediterranean basin and allowed the system of land ownership and taxation to continue. Starting in the fifth century, the ability of the western Empire to preserve peace began to erode. Rome was sacked early in the fifth century, a traumatic event that led Augustine to write the City of God distinguishing belief in the Catholic Church from the defense of any earthly city. More important if less visible to most people living through it was the capture of Africa by the Vandals in 439. This loss deprived the central government of an important component of its tax base and made it impossible for the government to mount effective counterattacks against the various invaders of the Roman Empire. This clearly set up a cumulative process that led in a few decades to the demise of the western Empire (Heather 2005; Wickham 2009). What was the effect of this cataclysmic change on Roman property own- ers? I suggest that many landowners were unaffected as the decline of central authority began. Most of their activities were local, and local authorities continued to guide local economies. Invasions were sporadic and affected only swaths through the vast empire. Landowners in the path of the invaders must have experienced problems with their land ownership, but landowners in other areas probably carried on as they and their fathers had done before. Imported goods to any area became more rare and expensive as travel became more dangerous. "Across the sixth and seventh centuries African goods are less and less visible in the northern Mediterranean; they vanish first from inland sites, and then from minor coastal centres" (Wickham 2009, 218). The process of Roman decline was not one of uniform decline that affected everyone alike. Instead it was a selective process that involved more and more people over time...

...The spread of violence was sporadic and uneven. As more and more areas were affected, land ownership under Roman rules became more and more localized. Land ownership in the form described earlier was confined to Roman islands in a barbaric sea (with apologies to Pirenne 1956). These islands shrank over time as the violence overspread the declining empire until most of them disappeared at some undetermined time (McCormick 2001).

We see remnants of the Roman land system in an account of taxes due from tenants to the Abbey of St. Martin de Tours around 700 listing four-teen hundred tenants and the modii of wheat, rye, barley, oats and spelt due (Gasnault 1975, 95ff). There is more detail in a list of tenants of the Abbey of St. Germain-des-Pres a century later. There is a list of more than fifteen hundred farms with "at least" ten thousand residents. Almost all of these farms were were "ingénuilles", but some were "lidiles" and "serviles." Most of islands of Roman land tenures must have clustered around abbeys, the most stable landholders in Merovingian and Carolingian times (Longon 1978, Tome I, 243).

The eastern Empire did not collapse, although it lost control of Egypt in 698. The Byzantine state remained strong and land taxation continued to provide a fiscal base to the state. "Indeed, payment of the [land] tax was itself proof of ownership. Since the early eighth century, perhaps earlier, the tax was estimated on the value of the land" (Laiou and Morrisson 2007, 50). High-quality land was worth the most; second-quality land, less; and pasture, even less. The tax rate, which appears to have endured into the twelfth century, was about one quarter of cereal production.... Agricultural production was divided between what can be called estates and village. Estates were the successors to Roman latifundia, and villages were composed of independent proprietors. The latter paid taxes to the state as in Roman times, and their tax rate was only half the dues paid by tenant farmers. This major difference was due partly to the protection offered by the estate and partly to services and capital provided by the lord of the estate..... The Byzantine system of land tenure was taken over by the Ottoman Empire and continued into modern times. In fact, the land tax in modern Israel is known as the arnona, a Hebrew term that goes back to the Talmud, where it denoted a tax on livestock and grain. It is most likely derived from the Latin word, annona, the Roman land tax to finance food distribution in the city of Rome.

In contrast, invasions of Western Europe multiplied and violence spread after the western Empire collapsed, and the Roman organization of society broke down entirely. We know little about the terms of land tenure in the Carolingian period as the terms used disappeared in later centuries.... There was no land tenure in the period of chaos when you only had authority over a plot of land if you were physically present and could fight off other claimants. It was hard even to grow a crop in such a situation as there was no way to ensure you could reap the harvest from seeds you had sown. Population consequently was very small, declining sharply to the extent we know it after the western Roman Empire collapsed. Travel was so hazardous that it was easier to bring people to food than food to people. "The nobleman with his entourage moved round constantly from one of his estates to another; and not only in order to supervise them more effectively. It was necessary for him to consume the produce on the spot, for to transport it to a common center would have been both inconvenient and expensive" (Bloch 1961, 63). Land ownership was exceedingly tenuous.

This chaotic period when central authority disappeared was traumatic in European history. Shakespeare employed the memory of this period many centuries later to set the stage for the tragedy of King Lear.... The king says he will travel with a large armed escort from place to place to consume the local produce. The many knights were to protect him; the traveling was to take him to the food instead of vice versa.... There was no ownership of land in this situation, as control could not be exerted at a distance. There was instead possession by people on the land who could and would defend it. This kind of possession was called a fief.... A fief lasted only as long as the person possessing the land gave service; it was not inherited. It was far different and less stable than land ownership or possession in Rome.... The society changed from one based on taxes to one based on personal service. What does it mean to own land if taxes on the land no longer sustain a government?

Feudalism was the way out of this chaos. It is best seen as a way to organize defense in a violent world. There was not enough security for a central government to collect taxes and field a military force, and all action had to be local. Subject to this constraint, it was natural for families and then close acquaintances to band together for their mutual defense. Adam Smith told us that labor specialization is limited by the extent of the market. Markets in these conditions were local and small, and the labor differential was limited to two classes of people, those who fought and those who farmed—knights and farmers.

A fief allowed a knight to fight for the defense of the farmers in the fief, but isolated knights were not much use against concerted attack. Feudalism was a way for knights to come together through lord and vassal arrangements that constructed a hierarchy of vassals under a lord who could field a group of knights. Vassals then used the resources of their fiefs to support their military activities, which were used in the service of their lords. The farming that underlay all this was done by the lords' villeins and other serfs. The lords in return for the vassals' support used their military resources to preserve the vassals' fiefs. Fiefs were retained as long as vassals fulfilled their part of the bargain, giving rise to elaborate rituals to assure lords that vassals would come forth when needed. The feudal system succeeded in bringing more peaceful conditions to Western Europe, and problems changed from defending from invaders to defending against neighbors. There developed a small arms race in armaments for knights and their horses.... The nonhereditary fief eventually was supplanted by a hereditary model as lords needed a reliable source from which to obtain vassals. The most convenient way to obtain future vassals was by making new acts of homage with the children of current vassals. Once this practice started, the converse situation where children of vassals were denied the fiefs of their fathers made it harder to add more vassals. Fiefs consequently took on a hereditary character....

Society thus was divided into two parts. Knights and clerics did not work and paid no taxes. Peasants worked and paid for the consumption of the upper class as well as their own, a division of society that lasted into the eighteenth century.... There were many restrictions on land and land transfers as the need for service and the desire for inherited land got in each other's way. There must have been an evolution of these restrictions, but many different approaches appear to have been in use at the same time. This appearance may reflect the scarcity of historical evidence, but it more probably reflects a combination of regional differences in customs and uneven evolution even in local areas. Travel was difficult and transport was expensive; regions were far more isolated than in Roman times. "Regional differences were sharp, even between neighboring regions" (Van Bavel 2008, 14)....

The burden of rents and feudal dues on peasants has been calculated as about 40 percent of their production, although it varied quite a bit between manors (Allen 2005, 36; Van der Beek, 2010a). This is higher than the commonly accepted levels of taxation in the early Roman Empire, which hover around 10 percent of production. If these estimates are even approximately accurate, then one of two things must have happened in the first millennium. Either farming must have become vastly more efficient, or the after-tax income of farmers must have shrunk dramatically.The latter choice appears more likely at our current state of knowledge.

Feudal warfare relied on direct hand-to-hand combat, which established the knight as the primary military unit. Over time, military armies employed greater use of archers, which provided key advantages over knights in battle, and the knight as a military unit decreased in importance and gradually disappeared. With the introduction of firepower, archers made way for musketeers who used muskets as a means of offense. Although early firearms were less accurate and efficient than the bow and arrow, continual technological improvements in guns eventually rendered archers obsolete. Considering that it usually took many years of training to make an archer, while only days were required to train and field a musketeer, it became more efficient to employ musketeers as a military unit. The lower costs and faster production associated with training and fielding musketeers allowed for significant increases in army sizes....

In the feudal age, when chaos was the issue, there were economies of scale for individual fighters, that is, knights. There were few economies of scale after this limited scope. As security increased and warfare changed, archers and musketeers provided economies of scale that extended to larger numbers of soldiers. Economies of scale near the origin were reduced as archers and then musketeers needed less equipment and training than knights, while economies of scale for groups of soldiers increased as the power of firing in volleys became apparent. The new economies of scale came more from military organization than individual training. The new system was clear enough to be described clearly around 1600. "Maurice of Nassau and Gustavus Adolphus developed a system of organization, tactics, and drill that harked back to the Roman legions" (Boot 2006, 103). The economics of warfare had come full circle.

Land tenures had been advancing as military technology improved, at least in the most urbanized parts of Europe in northern Italy and the Low Countries. Land sales by peasants are recorded as early as the eighth and ninth centuries when northern Europe was in chaos. The clarification of property rights and the introduction of civil courts stimulated land markets in the later twelfth century.The Low Countries caught up by the fourteenth century when voluntary registration of private land transfers by public courts became common. Although these two regions developed differently, the growth of private land ownership and transfer increased in both during the medieval period (Van Bavel 2011).... States achieved a monopoly of violence and carried out varied activities of organized violence: making war, creating states, protection, and extraction of resources through taxes. Independent lords... could not defend themselves from the new states and were subject to capture or submission. Lords stopped being vassals and turned into landowners. The land that they owned, however, had the restrictions that had been imposed when the land had been a fief, when fee tails had evolved into entails. These impediments to market activity were retained by the aristocracy to preserve the integrity of the family estate. Lord Peter Wimsey is a fictional character of the early twentieth century, but his role as the landless younger son of the mythical Duke of Denver was a staple of British aristocracy for many centuries.

 -- via my feedly newsfeed

Dan Little: The future of our democracy [feedly]

While I am quite sympathetic to the arguments below, and share profound unease at the horrors of fascism's advance on US soil, this essay can also be used in a critique of "pure tolerance", as Professor Marcuse once expounded. Meaning, when institutions fail to contain or rectify destabilizing social and economic forces -- an era of more or less revolution, more or less lawlessness -- emerges. Sometimes adjustments, structural ones, are made within constitutional frameworks (the English revolutions, the US Civil War, the Great Depression/WW2). Sometimes not (the Russian Tsars, and Last Chinese Dynasty, British and French, or Vietnamese, colonial rule). In either case certain factions, ruling social coalitions, and their ideologies, become intolerable  -- and thus the criticism of pure tolerance consumes all.

The future of our democracy
http://understandingsociety.blogspot.com/2020/02/the-future-of-our-democracy.html

How can the United States recover its culture of civility and mutual respect among citizens after the bitter, unlimited toxicity of the first three years of Donald Trump's presidency? Trump's political movement, and the President himself, have gone in for an unbridled rhetoric of hatred, suspicion, racism, and white supremacist ideology that seems to have created a durable constituency for these hateful ideas. Even more troublingly, the President has cast doubt on the democratic process itself and the legitimacy of our electoral and judicial institutions.

Deeply troubling is the fact that the President consistently attempts to mobilize support purely on the basis of division, hatred, and contempt for his opponents. He has provided virtually no sustained exposition or defense of the policy positions he advocates -- anti-immigrant, anti-trade, anti-NATO, anti-Federal Reserve, anti-government. Instead, his appeals amount ultimately to no more than a call to hatred and rejection of his opponents. His current shameful threats against those who supported his impeachment (including Lt. Col. Alexander Vindman, pictured above) are simply the latest version of his politics of threat, hatred, and intimidation. This president has never understood his responsibility to serve all the people of our country -- not merely his supporters -- and to support its constitution and governing institutions faithfully and in support of the public good.

And almost all Republican leaders (with the admirable exception of Mitt Romney) have swallowed their own principles and have accepted these political appeals -- even as some observers have noted how much the current rhetoric resembles that of Benito Mussolini (link). If even a fraction of the voters who currently support the Trump movement do so with a positive endorsement of the racism and white-supremacy that the President and his supporters project, then there are tens of millions of hate-based partisans in our polity.

It is an urgent and pressing problem to find strategies for beginning to bring these citizens back from the brink of right wing extremism and hate.

One possible view is that the goal is unattainable. We might judge that it is very uncommon for hate-based partisans to change their attitudes and actions. So the best we can do is to minimize the likelihood that these individuals will do harm to others, and to maximize the impact and public visibility of more liberal people and movements. (The term "liberal" here isn't grounded in left-right orientation but rather the values of open-mindedness, tolerance, mutual respect, belief in democracy, and civility. Conservatives can be liberal in this sense.)

Another possibility is that the extremism currently visible among Trump supporters is just a short term eruption, which will subside following the 2020 election. This doesn't seem very likely, given the virulence of animosity, suspicion, and hatred currently on display among many of Trump's supporters. It seems to be easier to incite hatred than to quench it, and it seems unlikely that these activists will quietly morph into tolerant and civil citizens.

A third possibility is that we will have to acknowledge the presence of hate-based extremists and organizations among us and work aggressively to build up a younger constituency for progressive and tolerant values to present a stronger voice in support of inclusion and democracy. This is not so different from the current situation in some Western European democracies today, where virulent extremist political organizations compete with more inclusive and democratic organizations.

The difference of our current circumstances in the winter of 2020 and those of November 2016 is the steady degradation of our institutions that the Trump administration has successfully undertaken. Packing the Federal courts with right-wing ideologues (often rated unqualified by the American Bar Association), treating the Congress and its elected members with contempt, derision, and threat, flouting the laws and ethics surrounding the status of whistle-blowers, appointing unqualified ideologues to direct Federal agencies like the EPA, Homeland Security, and Commerce, and subverting the ethics and political neutrality of the Department of Justice -- these are harms that may never be fully repaired. The moral corruption of the leaders of the GOP -- their fundamental and all but universal unwillingness to publicly reject the outrageous and anti-democratic behavior of this President -- will never be forgotten.

What is the future of our democracy? Can we regain the fundaments of a tolerant, institutionally stable polity in which government is regulated by institutions and politicians are motivated to work to enhancing the preconditions of civility and democratic equality? Or are we headed to an even more personalized form of presidential rule -- a twenty-first century version of nationalist authoritarianism, or fascism?

Madeline Albright expressed just such worries almost two years ago about the future of our democracy in Fascism: A Warning, and her words are deeply worrisome, perhaps prophetic.

Fascist attitudes take hold when there are no social anchors and when the perception grows that everybody lies, steals, and cares only about him-or herself. That is when the yearning is felt for a strong hand to protect against the evil "other"—whether Jew, Muslim, black, so-called redneck, or so-called elite. Flawed though our institutions may be, they are the best that four thousand years of civilization have produced and cannot be cast aside without opening the door to something far worse. The wise response to intolerance is not more intolerance or self-righteousness; it is a coming together across the ideological spectrum of people who want to make democracies more effective. We should remember that the heroes we cherish—Lincoln, King, Gandhi, Mandela—spoke to the best within us. The crops we'll harvest depend on the seeds we sow. (kl 94)

Fascism, most of the students agreed, is an extreme form of authoritarian rule. Citizens are required to do exactly what leaders say they must do, nothing more, nothing less. The doctrine is linked to rabid nationalism. It also turns the traditional social contract upside down. Instead of citizens giving power to the state in exchange for the protection of their rights, power begins with the leader, and the people have no rights. Under Fascism, the mission of citizens is to serve; the government's job is to rule. (kl 261)

Or consider how Steven Levitsky and Daniel Ziblatt pose their fears in How Democracies Die:

But now we find ourselves turning to our own country. Over the past two years, we have watched politicians say and do things that are unprecedented in the United States—but that we recognize as having been the precursors of democratic crisis in other places. We feel dread, as do so many other Americans, even as we try to reassure ourselves that things can't really be that bad here. After all, even though we know democracies are always fragile, the one in which we live has somehow managed to defy gravity. Our Constitution, our national creed of freedom and equality, our historically robust middle class, our high levels of wealth and education, and our large, diversified private sector—all these should inoculate us from the kind of democratic breakdown that has occurred elsewhere.

Yet, we worry. American politicians now treat their rivals as enemies, intimidate the free press, and threaten to reject the results of elections. They try to weaken the institutional buffers of our democracy, including the courts, intelligence services, and ethics offices. American states, which were once praised by the great jurist Louis Brandeis as "laboratories of democracy," are in danger of becoming laboratories of authoritarianism as those in power rewrite electoral rules, redraw constituencies, and even rescind voting rights to ensure that they do not lose. And in 2016, for the first time in U.S. history, a man with no experience in public office, little observable commitment to constitutional rights, and clear authoritarian tendencies was elected president. (1)

Albright, Levitsky, and Ziblatt are not alarmists; they are experienced, knowledgeable, and wise observers of and participants in democratic politics. Their concerns should worry us all.

 -- via my feedly newsfeed

President’s “Health Reform Vision”: $1 Trillion in Cuts, No Plan to Protect People With Pre-Existing Conditions [feedly]

President's "Health Reform Vision": $1 Trillion in Cuts, No Plan to Protect People With Pre-Existing Conditions
https://www.cbpp.org/blog/presidents-health-reform-vision-1-trillion-in-cuts-no-plan-to-protect-people-with-pre-existing

 -- via my feedly newsfeed

Depletion of IRS Enforcement Is Undermining the Tax Code [feedly]

Depletion of IRS Enforcement Is Undermining the Tax Code
https://www.cbpp.org/federal-tax/depletion-of-irs-enforcement-is-undermining-the-tax-code

Testimony of Chye-Ching Huang, Senior Director for Economic Policy, CBPP, before the House Ways and Means Committee

 -- via my feedly newsfeed

Tom Friedman: Calling Michael Bloomberg

Tom Friedman goes nuts over Sanders victories: Just take a drink, Tom, lighten up, you act like a boss told he will have to bargain with a union :)   

https://www.nytimes.com/2020/02/11/opinion/bloomberg-president-2020.html  

text only:

My fellow Americans, we face a national emergency. Never before have we had a president so utterly lacking in personal integrity, so able to lie and abuse his powers with such impunity and so blindly backed by an amoral party, an unscrupulous attorney general and a media-fund-raising juggernaut. It is an engine of raw power that will cram anything the president says or does right down your throat.

James Carville had it exactly right when he noted on "Morning Joe" the other day that the only thing standing in the way of lasting damage by this machine to all that makes America unique and great is the Democrats' nominating the right person to defeat Donald Trump.

We have to get this right. This is no ordinary time, no ordinary Republican Party, no ordinary incumbent, and it will require an extraordinary Democratic machine to triumph.

Because, without doubt, Russia and China also will be "voting" Trump 2020 — for three reasons: (1) Trump keeps America in turmoil and unable to focus on building the infrastructure we need to dominate the 21st century the way we did the 20th. (2) Both Beijing and Moscow know that Trump is so disliked by America's key allies that he can never galvanize a global coalition against China or Russia. And (3) both Russia and China know that Trump is utterly transactional and will never challenge them on human rights abuses. Trump is their chump, and they will not let him go easily.

ADVERTISEMENT

Continue reading the main story

So who is the right Democratic candidate? Well, for starters I will tell you who it is not. It is not Bernie Sanders. On which planet in the Milky Way galaxy is an avowed "socialist" — who wants to take away the private health care coverage of some 150 million Americans and replace it with a gigantic, untested Medicare-for-All program, which he'd also extend to illegal immigrants — going to defeat the Trump machine this year? It will cast Sanders as Che Guevara — and it won't even be that hard.

Yes, the failures of American capitalism to deliver inclusive growth, which have propelled the Sanders campaign and animated his followers, require urgent attention by our next president. But Sanders, in key cases, has the wrong solutions to the right problems. He's the wrong candidate to take down Trump.

Please, Democrats, don't tell me you need Sanders's big, ill-thought-through, revolutionary grand schemes to get inspired and mobilized for this election. You want a revolution? I'll give you a revolution: four more years of Donald Trump, unencumbered by the need to get re-elected. That will be a revolution! And it will do permanent damage to the institutions and norms that have sustained this country since its founding, not to mention our environment, which Trump has been selling off to oil, gas and mining companies at an alarming pace.

So, who is the right candidate and what is the right strategy?

On strategy, we know the formula that works, because it already has: Appeal to independents, moderate Republicans and suburban women. These are the constituencies that did not like Hillary Clinton and were ready to give Trump a chance in 2016 — but abandoned him in 2018 and delivered the House of Representatives to the Democrats, and then also two governorships in red states.

If Democrats can choose a candidate who can hold the core Democratic base and also appeal to these same independents, moderate Republicans and suburban women in the key swing states, they can absolutely defeat Trump.

Editors' Picks

MAGA War on Architectural Diversity Weaponizes Greek Columns

The Unhealthy Math of Skinny + Pretty = Good

Westminster Dog Show Photos: Ready for Prime Time

Continue reading the main story

ADVERTISEMENT

Continue reading the main story

How do you do that as a candidate?

For starters, by stressing national unity, personal integrity and a willingness to pursue bipartisanship whenever the other side is ready. A lot of Americans are worried sick that Trump is tearing the country in half.

As Larry Diamond, editor of The Journal of Democracy, pointed out to me, several studies he's been publishing show that the best way to defeat illiberal populism is not by trying to out-polarize the polarizer in chief but rather through broad, inclusive electoral strategies that pragmatically address the economic and social concerns of voters, including those who had previously voted for the populist.

That was the approach that enabled the secular opposition to defeat the party of Turkey's autocratic president, Recep Tayyip Erdogan, in municipal elections last year in Istanbul and other cities. A similar depolarizing approach powered the victory of Greece's liberal-centrist New Democracy party over the ruling left-wing populist Syriza in national elections last year.

You also do it by repeating every hour every day — with evidence — that Trump is out to destroy Obamacare through the courts, which means eliminating its coverage for pre-existing conditions, and only the Democrats will save it and improve it.

You do it by not only talking about how to redivide the pie — which we need to do — but by also talking about how to grow the pie, how to create more taxpayers and how to inspire more innovators. Ours is a capitalist country. Americans admire successful entrepreneurs. Let's praise job creators and risk-takers — as long as they and their companies pay their taxes. You want more and better jobs, you need more Steve Jobs.

You do it by celebrating the growing economy that Barack Obama reignited and Trump continued, while making clear that it still needs work. Too much of the Trump tax cuts have gone to companies and the most wealthy, with virtually nothing invested in infrastructure — roads, ports, schools, bandwidth, scientific research — or affordable housing, which we must have for inclusive prosperity.

You do it by hitting Trump hard on the environment, but not focusing just on "climate change," which is an abstraction for most people. Trump is unfit to serve four more years because of how he has removed so many protections for the water and air America's kids drink and breathe every day.

ADVERTISEMENT

Continue reading the main story

And you do it by supporting a balanced approach to immigration reform — a high wall, with a big gate.

I was glad to see candidates with this kind of message, like Amy Klobuchar and Pete Buttigieg, trending better in Iowa and New Hampshire. It showed that lots of Democrats are searching in this direction.

But there is one candidate on the Democratic side who not only has a track record of supporting all those issues but also has the resources to build a machine big enough to take on the Trump machine.

This candidate also has the toughness to take on Trump, because while Trump was pretending to be a C.E.O. on the show "The Apprentice," this candidate was actually building one of the most admired global companies as a real C.E.O.

This candidate is not cuddly, he is not always politically correct and he will not always tell you what you want to hear — or try to outbid you on how many free services he'll give away. He's made mistakes, especially around stop-and-frisk policing in New York City, which disproportionately targeted black and brown men and for which he recently apologized.

His mistakes, though, have to be weighed against a record of courageously speaking out and devoting enormous personal resources to virtually every progressive cause — gun control, abortion rights, climate change, Planned Parenthood, education reform for predominantly minority schools, affordable housing, income inequality and tax reform. And he has vowed as president to focus on building black wealth, not just ending poverty.

And this candidate knows how to get stuff done — he can fight this fire at the scale of the fire. His team has for years used social networks to promote progressive issues to centrist and conservative audiences. He won't cede the internet/Facebook/Twitter battlefield to Trump's team, who are killers in that space.

ADVERTISEMENT

Continue reading the main story

And this candidate is now rising steadily in the polls. This candidate is Michael Bloomberg. This candidate has Trump very worried.

Yes, Sanders is also polling well against Trump, but the Trump machine has not begun to focus on him yet — it hasn't begun bombing Facebook with ads about how Sanders honeymooned in the Soviet Union.

Sitting here today, Bloomberg — paired with a progressive vice-presidential candidate who can appeal to Sanders's voters — has the best chance to carry the day.

In an age when political extremists go all the way, and moderates tend to just go away, Bloomberg has the right stuff — a moderate progressive with a heart of gold but the toughness of a rattlesnake — for what is going to be an incredibly big, brutal task: making Donald Trump a one-term president.

(Disclosure: Bloomberg Philanthropies has donated to Planet Word, the museum my wife is building in Washington, to promote reading and literacy.)

The Times is committed to publishing a diversity of letters to the editor. We'd like to hear what you think about this or any of our articles. Here are some tips. And here's our email: letters@nytimes.com.

Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram.

Thomas L. Friedman is the foreign affairs Op-Ed columnist. He joined the paper in 1981, and has won three Pulitzer Prizes. He is the author of seven books, including "From Beirut to Jerusalem," which won the National Book Award.

--

John Case
Harpers Ferry, WV

Enlighten Radio

Socialist Economics

Facebook

President’s “Health Reform Vision”: $1 Trillion in Cuts, No Plan to Protect People With Pre-Existing Conditions [feedly]

President's "Health Reform Vision": $1 Trillion in Cuts, No Plan to Protect People With Pre-Existing Conditions
https://www.cbpp.org/blog/presidents-health-reform-vision-1-trillion-in-cuts-no-plan-to-protect-people-with-pre-existing

 -- via my feedly newsfeed