Politics. As social media induced insanity of the last decade recedes, the public has awakened to the reality that things like electing District Attorneys that don’t prosecute is a nutty idea.
Fortunately for San Franciscans, they got a do-over.
Chesa Boudin was recalled by his constituents last week for simply not doing the job of prosecutor – well or at all.
Recall is humiliating. From this point forward no one will write Mr. Boudin’s name without a comma followed by something on the order of “recalled 60-40 by his constituents in 2022.”
Not that we are likely to see Mr. Boudin’s name in print much. Recalls, especially ones with such massive margins of victory, are career ending. The people of San Francisco, always at the vanguard of progressivism, hated Mr. Boudin so much they could not stand five more minutes of his version of uber-progressivism.
If San Francisco has had it, who else has?
More important for our purposes, how viable are other uber-progressive ideas like Medicare for All; drug price controls; the contents of the Build Back Better Act; and federal quasi- or complete legalization of marijuana? Faculty lounge talk, as James Carville put it so hilariously.
We will know in November, but things are not looking up.
Policy. It probably does not help that most of the health care priorities of the White House, House of Representatives and a minority of the Senate amount to pretty dog-eared stuff. The same, incidentally, could be said for the Republican obsession with using the tax code to promote consumerism. If these were good ideas, they would have passed a long time ago.
One of the few original thoughts to cross the minds of federal health policy wonks, price transparency, has been woefully under-enforced until very recently. The Trump-era law, which was an iteration on a provision of the Affordable Care Act, requires hospitals to post their prices in machine readable form.
Only a fraction complies despite efforts by the Biden administration to increase penalties. Enter Jared Polis, the Democratic Governor of Colorado. He signed a bill last week that prohibits those Colorado hospitals that are not in compliance with federal price transparency law from sending patient bills to collection.
It is a pretty elegant solution. In the near term, hospitals will continue to obfuscate figuring the loss of collections would be worth the negative impact of price discovery. In time though, losses on collections will rise as patients come to understand they do not need to pay their share as long as the hospitals are out of compliance. At that point, price discovery should begin to look pretty attractive.
Although the goal of price transparency is to enhance consumer choice, the big winners will be employers. Health care costs have been a drag on wages for over a decade. Employers saw what happened to EBITDA when the SG&A line dropped during pandemic as workers shunned hospitals and physicians’ offices.
With a need to keep up with inflation, employers have more incentive than ever to control their benefit spend. Knowing that the price range for a normal baby delivery can be anywhere between 12k to 46k in their market will only help.
Plus, it is a refreshingly original idea.
Power. The era of the sore loser began with Stacey Abrams, reached its pinnacle with Donald Trump’s defeat and appears to have ended when David McCormick last week conceded to Mehmet Oz with just 1,000 votes between them.
The wisdom of this concession may be known come November. In both primaries, Democrats and Republicans were able to turn out about 1.2M people. The November election will be a nail-biter.
McCormick’s concession and Dr. Oz’s refusal to take Donald Trump’s advice and declare victory before the count was complete makes them both look like gentlemen. Dr. Oz is also now freed somewhat by Trump's taint that may make him interesting to swing voters.
The second wisdom of McCormick’s concession is that, in the absence of a nasty contest, it will be far easier to point his supporters to Oz, improving Republican’s chances against Democrat John Fetterman.
Will it work? It could.
What happens next will, in part, determine the course of the lame duck session. If Democrats can maintain control, some of the urgency building to pass tax increases to fund a domestic policy agenda of the scope and size not seen since the 1970s, will probably abate. That agenda includes the drug price negotiation, linking increases to inflation – which seems kind of funny now - expansion of ACA tax subsidies and filling the Medicaid gap.
If Democrats lose control of the Senate, the urgency builds. We often feel cruel pointing out the age of Democratic leadership, but American politics suffers from a few too many leaders at the end game.
Have a great rest of your weekend.
Emily Evans
