How much blame should Obama bear for the Democratic Party's decline?

The Something Awful Forums > Discussion > Debate & Discussion > How much blame should Obama bear for the Democratic Party's decline?

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Dmitri-9: Nov 30, 2004; There's something really sexy about Scrooge McDuck. I love Uncle Scrooge.

Keith Ellison weighs in:

http://thehill.com/homenews/campaign/329673-ellison-obama-deserves-blame-for-democratic-losses

quote:

Rep. Keith Ellison (D-Minn.) said former President Obama is partially to blame for the Democrats� poor showing at the polls in 2016.

Ellison, now the deputy chairman of the Democratic National Committee, blamed Obama for ignoring party politics while he was in office, which he said had put the president�s legacy at risk.

�Look I�m a great fan of President Obama. I totally voted for many of the things he supported � Dodd Frank, Affordable Care Act, Lilly Ledbetter Fair Pay Act � I could keep going,� Ellison said at an event Wednesday at the University of Minnesota.

�Wonderful achievements. But Barack Obama could have been a better party leader, and I think the fact that he wasn�t put his legacy in jeopardy,� he said.

Ellison added that Obama was �great at getting himself elected� but said he should have worked closer with party leaders to ensure the Democrats were in power to protect his accomplishments.
�Your legacy is not a building that he�s going to construct in Chicago housing his presidential papers,� Ellison continued. �His legacy is the work he�s done, which I believe is tremendous. But given we lost a lot of statehouse seats, governorships, secretary of states, his true legacy is in danger, and I think he can�t say that he wasn�t part of those losses. Who else, right?�

Ellison�s criticism comes as the DNC begins the process of rebuilding the national party under the leadership of new Chairman Tom Perez after a disastrous 2016 election cycle.

Democrats are still reeling from Hillary Clinton�s loss to President Trump. The party had also hoped to reclaim a majority in the Senate and make inroads into the GOP majority in the House.

Republicans have gained hundreds of seats at state legislatures nationwide since Obama was elected in 2008. Republicans control the governor�s mansions and both chambers of the legislature in 24 states.

�He should have been far more out there in 2010, which was a year when we were going to be doing redistricting. He should�ve been campaigning like he was on the ballot and should have been very visible,� Ellison said.

�He�s great at getting himself elected but should�ve worked much more closely with Congress, and I think in 2014 we had record low voter turnout ... and I think that too really was a time when he needed to be visible and present and very engaged ... he needed to raise money for state legislative races.�

Many liberals believe Obama allowed the DNC to fall into a state of disrepair under his chosen leader, Rep. Debbie Wasserman Schultz (D-Fla.). Wasserman Schultz stepped down during the Democratic National Convention after WikiLeaks published internal DNC emails that showed staffers favoring Clinton over progressive favorite Bernie Sanders, the independent senator from Vermont.
Ellison backed Sanders during the primary, and Sanders returned the favor when Ellison ran to be the next DNC chair.

Perez, a former Labor secretary under Obama who was backed by key figures from that administration, defeated Ellison to become the next chairman. In a show of unity, Perez made Ellison his deputy chairman.

Perez and Sanders are currently on a unity tour aimed at energizing liberals in opposition to Trump and to healing lingering party divisions from the primary.

# ? Apr 23, 2017 22:35

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# ? May 2, 2024 20:44

Condiv: May 7, 2008; Sorry to undo the effort of paying a domestic abuser $10 to own this poster, but I am going to lose my dang mind if I keep seeing multiple posters who appear to be Baloogan.

With love,
a mod

obama is terrible and i hope he fucks off too since it's obvious now he's just as poison to the dems as hillary

# ? Apr 24, 2017 11:18

Feldegast42: Oct 29, 2011; COMMENCE THE RITE OF SHITPOSTING

Dmitri-9 posted:

Keith Ellison weighs in:

http://thehill.com/homenews/campaign/329673-ellison-obama-deserves-blame-for-democratic-losses

Sounds about right. I like Obama a lot too but not focusing on down ballot races in the last 8 years really killed us.

# ? Apr 24, 2017 15:31

21 Muns: Dec 10, 2016; by FactsAreUseless

Condiv posted:

obama is terrible and i hope he fucks off too since it's obvious now he's just as poison to the dems as hillary

Yes, which is to say, not poisonous at all. Hillary would have won against someone who didn't inflame the GOP's racism like Trump. Even being a woman wasn't enough to bring her down. Hillary and Obama are tied for the best candidate the Democrats have put forward since... Kennedy? Roosevelt? And our best candidate lost against their worst candidate. Our country is so hosed.

# ? Apr 24, 2017 18:20

Ytlaya: Nov 13, 2005

21 Muns posted:

Yes, which is to say, not poisonous at all. Hillary would have won against someone who didn't inflame the GOP's racism like Trump. Even being a woman wasn't enough to bring her down. Hillary and Obama are tied for the best candidate the Democrats have put forward since... Kennedy? Roosevelt? And our best candidate lost against their worst candidate. Our country is so hosed.

Why would you come to this conclusion about Hillary? I don't think Trump got many more votes than a "normal" GOP candidate. At best you could say Hillary was average (as a candidate, ignoring her bad campaign). Are you looking at the raw total of votes instead of votes as a percent of the population or something?

edit: To elaborate a bit, from what I understand the numbers do not support a "Trump won because he brought out all the racists" interpretation of the election. A lot of racists voted for Trump, but that's mostly just because Republicans are racist and Republicans voted for the Republican candidate.

# ? Apr 24, 2017 19:50

RaySmuckles: Oct 14, 2009; Grimey Drawer

jeepers creepers, how can anyone list hillary clinton as "one of the best democratic candidates in half a century"

her campaign was in turmoil the moment she announced. loving bernie sanders almost beat her

hillary, rightly or wrongly, has too much baggage and people around the country already have an extremely dichotomous view on her. she never, ever should have run

# ? Apr 24, 2017 20:13

Eggplant Squire: Aug 14, 2003

Yeah like regardless of how bullshit the scandals around her were, enough people believed in them that she was way too damaged even before the primary started. The whole FBI thing could have easily gone against her worse than it did and that alone should have given everyone pause about sending her against any Republican.

# ? Apr 24, 2017 20:17

A big flaming stink: Apr 26, 2010

"Clinton would have won!" is a new hot take i gotta admit. as great or as terrible of a president clinton would have been (depends on how much you believed her campaign policies) it is beyond a shadow of a doubt that hillary is a dogshit candidate.

# ? Apr 24, 2017 20:30

Main Paineframe: Oct 27, 2010

RaySmuckles posted:

jeepers creepers, how can anyone list hillary clinton as "one of the best democratic candidates in half a century"

her campaign was in turmoil the moment she announced. loving bernie sanders almost beat her

hillary, rightly or wrongly, has too much baggage and people around the country already have an extremely dichotomous view on her. she never, ever should have run

Considering how pathetic most of the last fifty years worth of Democratic presidential candidates have been, it's a fairly credible claim.

# ? Apr 24, 2017 20:31

A big flaming stink: Apr 26, 2010

Main Paineframe posted:

Considering how pathetic most of the last fifty years worth of Democratic presidential candidates have been, it's a fairly credible claim.

I mean, Bill for one.

# ? Apr 24, 2017 20:32

Typo: Aug 19, 2009; Chernigov Military Aviation Lyceum
The Fighting Slowpokes

Main Paineframe posted:

Considering how pathetic most of the last fifty years worth of Democratic presidential candidates have been, it's a fairly credible claim.

Bill and Obama were good candidates

I distinguish "candidate" from "president"

# ? Apr 24, 2017 20:55

Typo: Aug 19, 2009; Chernigov Military Aviation Lyceum
The Fighting Slowpokes

bill was a guy you would have a beer with and so was obama, that's the bar for a good candidate in america

# ? Apr 24, 2017 20:55

Shbobdb: Dec 16, 2010; by Reene

I wish someone would have had a beer with W during his campaign.

# ? Apr 24, 2017 21:09

Main Paineframe: Oct 27, 2010

Typo posted:

Bill and Obama were good candidates

I distinguish "candidate" from "president"

Yeah, but that's pretty much it. The rest of the last fifty years of Democratic presidential candidates are mostly losers like McGovern and Dukakis.

# ? Apr 24, 2017 21:11

Pedro De Heredia: May 30, 2006

21 Muns posted:

Yes, which is to say, not poisonous at all. Hillary would have won against someone who didn't inflame the GOP's racism like Trump. Even being a woman wasn't enough to bring her down. Hillary and Obama are tied for the best candidate the Democrats have put forward since... Kennedy? Roosevelt? And our best candidate lost against their worst candidate. Our country is so hosed.

Clinton was not a good candidate.

She's barely been able to win any elections in her entire political career.

# ? Apr 24, 2017 21:15

Typo: Aug 19, 2009; Chernigov Military Aviation Lyceum
The Fighting Slowpokes

someone with favorability hovering near 40 and unfavorability at 50+ is not a good candidate

# ? Apr 24, 2017 21:23

Mister Facetious: Apr 21, 2007; I think I died and woke up in L.A.,
I don't know how I wound up in this place...

Alienwarehouse posted:

Are you loving kidding me? Reread that post. Obama was elected in two landslides. It was realized in 2016 that the Democrats simply failed to do anything about neoliberalism, globalization, automation, and even the failing social safety net. People are suffering in record numbers, and that incredibly out-of-touch imbecile Hillary Clinton had to gall to say "America is already great!" for months. Are you one of those idiots that says Hillary lost due to sexism as well, despite evidence of her lovely neoliberal economic philosophy failing worldwide for the last fifteen years�which she STILL decided to campaign on?

The Democratic Party itself is the one that's been supporting neoliberalism, globalization, automation, and killing the failing social safety net. See: Bill Clinton.

Though really, it started with McGovern targeting the white collar professionals in the seventies over the poor and unions.

# ? Apr 24, 2017 21:35

Alienwarehouse: Apr 1, 2017

mcmagic posted:

I agree with this but there is no one else in the GOP who could've done it in 2016 other than Trump.

I got laughed at by my friends throughout the entire primary and general election campaigns for saying that Donald Trump was the only republican candidate that could defeat Hillary, simply due to his anti-free trade and somewhat anti-war rhetoric. Hillary would have steamrolled Little Marco and Lyin' Ted like like a tank rolling through no man's land. In retrospect, how loving amusing is it that Hillary had her connections in the media give Trump more airtime than everyone else, because she believed otherwise?

Mister Facetious posted:

The Democratic Party itself is the one that's been supporting neoliberalism, globalization, automation, and killing the failing social safety net. See: Bill Clinton.

Though really, it started with McGovern targeting the white collar professionals in the seventies over the poor and unions.

I know, but it became painfully obvious even to the politically inactive masses by 2016.

# ? Apr 25, 2017 03:36

mastershakeman: Oct 28, 2008; by vyelkin

Pedro De Heredia posted:

Clinton was not a good candidate.

She's barely been able to win any elections in her entire political career.

she's never won an actual race and will go down in history as the worst candidate of all time. don't forget she's the first one in decades to blow a fundraising advantage

# ? Apr 25, 2017 03:56

Typo: Aug 19, 2009; Chernigov Military Aviation Lyceum
The Fighting Slowpokes

Alienwarehouse posted:

I got laughed at by my friends throughout the entire primary and general election campaigns for saying that Donald Trump was the only republican candidate that could defeat Hillary, simply due to his anti-free trade and somewhat anti-war rhetoric. Hillary would have steamrolled Little Marco and Lyin' Ted like like a tank rolling through no man's land. In retrospect, how loving amusing is it that Hillary had her connections in the media give Trump more airtime than everyone else, because she believed otherwise?

I know, but it became painfully obvious even to the politically inactive masses by 2016.

Rubio prob would have outright won the popular vote

Trump won with basically the same Republican coalition which voted in Romney, what killed the Democrats was lower voter turnout than Obama

# ? Apr 25, 2017 05:12

side_burned: Nov 3, 2004; My mother is a fish.

mastershakeman posted:

she's never won an actual race and will go down in history as the worst candidate of all time. don't forget she's the first one in decades to blow a fundraising advantage

I got remember that, I have a friend who still thinks she was a great candidate and things aren't that bad because democrats won the popular vote and the rust belt states that went Trump weren't lost by "that much." The lesson he is taking from this is that Democrat messaging is working. I have learned from him that I do not want to ever read Wonkette.

# ? Apr 25, 2017 05:58

Cerebral Bore: Apr 21, 2010; Fun Shoe

Hillary Clinton has won two Senate elections in goddamn New York, and she might not even have won the first one if Giuliani didn't happen to self-destruct in a spectacular fashion and had to be replaced on the ballot by some no-namer. Hence I never really understood the idea that she was some expert at winning elections.

# ? Apr 25, 2017 09:02

Main Paineframe: Oct 27, 2010

Alienwarehouse posted:

I got laughed at by my friends throughout the entire primary and general election campaigns for saying that Donald Trump was the only republican candidate that could defeat Hillary, simply due to his anti-free trade and somewhat anti-war rhetoric. Hillary would have steamrolled Little Marco and Lyin' Ted like like a tank rolling through no man's land. In retrospect, how loving amusing is it that Hillary had her connections in the media give Trump more airtime than everyone else, because she believed otherwise?

One of Hillary's bigger mistakes was to assume that Trump's racism would drive away moderate/independent voters and motivate minorities, so instead of pushing her own message or countering Trump's message, she could just point at the racism. This is especially apparent in outside group spending, where something like 98% of the ad time bought by outside groups that supported Hillary was negative advertising against Trump. This led to situations where Trump would state his economic message, and rather than responding with her own economic message, the Hillary campaign chose to draw even more attention to Trump's economic message by pointing out that it was racist. Unfortunately, offered the choice between a racist economic message and no economic message, voters didn't find Hillary's strategy particularly compelling.

# ? Apr 25, 2017 14:25

Cerebral Bore: Apr 21, 2010; Fun Shoe

To be fair it's hard to have strong messaging on economic issues when your own campaign can't even figure out why you're running in the first place.

# ? Apr 25, 2017 14:29

shrike82: Jun 11, 2005

lol

quote:

Former President Barack Obama has agreed to speak at a Wall Street conference for $400,000, according to a new report.

Obama will appear at Cantor Fitzgerald LP�s healthcare conference in September, Fox Business Network first reported Monday.

Fox Business said it confirmed Obama�s appearance with senior people at Cantor, a financial services firm.

# ? Apr 25, 2017 14:33

mcmagic: Jul 1, 2004; If you see this avatar while scrolling the succ zone, you have been visited by the mcmagic of shitty lib takes! Good luck and prosperity will come to you, but only if you reply "shut the fuck up mcmagic" to this post!

The Wall St speeches are just icky. Not that I would turn down 400k...

# ? Apr 25, 2017 14:35

Eggplant Squire: Aug 14, 2003

I am curious what it will be about.

# ? Apr 25, 2017 14:37

Typo: Aug 19, 2009; Chernigov Military Aviation Lyceum
The Fighting Slowpokes

Main Paineframe posted:

One of Hillary's bigger mistakes was to assume that Trump's racism would drive away moderate/independent voters and motivate minorities, so instead of pushing her own message or countering Trump's message, she could just point at the racism. This is especially apparent in outside group spending, where something like 98% of the ad time bought by outside groups that supported Hillary was negative advertising against Trump. This led to situations where Trump would state his economic message, and rather than responding with her own economic message, the Hillary campaign chose to draw even more attention to Trump's economic message by pointing out that it was racist. Unfortunately, offered the choice between a racist economic message and no economic message, voters didn't find Hillary's strategy particularly compelling.

apparently the reason why she didn't was because she thought the email scandal was destroying every attempt at her trying to bring up a positive message, so she thought she was stuck with mudslinging and hope her mudslinging is outweigh the emails

# ? Apr 25, 2017 15:40

TyroneGoldstein: Mar 30, 2005

Typo posted:

apparently the reason why she didn't was because she thought the email scandal was destroying every attempt at her trying to bring up a positive message, so she thought she was stuck with mudslinging and hope her mudslinging is outweigh the emails

Ugh, in a way this is even more damning. I don't know if I'm just too low level or too insignificant, but my first impulse in this case would be to say 'gently caress it, I'm still going with why I should be President. gently caress this guy. I'm talking about what I"m good at. What I can bring to the table."

I know it's simplistic...but drat.

# ? Apr 25, 2017 16:14

Pedro De Heredia: May 30, 2006

shrike82 posted:

lol

jesus

# ? Apr 25, 2017 17:01

Cerebral Bore: Apr 21, 2010; Fun Shoe

TyroneGoldstein posted:

Ugh, in a way this is even more damning. I don't know if I'm just too low level or too insignificant, but my first impulse in this case would be to say 'gently caress it, I'm still going with why I should be President. gently caress this guy. I'm talking about what I"m good at. What I can bring to the table."

I know it's simplistic...but drat.

Turns out that the only thing Hillary could bring to the table was going negative.

It's kinda unsurprising in hindsight. She tried to go negative on Obama in 2008 but it wouldn't stick, and she did the same thing with Bernie in 2016 except that she was successful that time.

# ? Apr 25, 2017 17:05

Typo: Aug 19, 2009; Chernigov Military Aviation Lyceum
The Fighting Slowpokes

Cerebral Bore posted:

and she did the same thing with Bernie in 2016 except that she was successful that time.

she actually didn't really: the reason why she didn't though was because her team was very very sure it was going to backfire

So Bernie went negative on her first tbf

# ? Apr 25, 2017 17:06

mcmagic: Jul 1, 2004; If you see this avatar while scrolling the succ zone, you have been visited by the mcmagic of shitty lib takes! Good luck and prosperity will come to you, but only if you reply "shut the fuck up mcmagic" to this post!

Typo posted:

she actually didn't really: the reason why she didn't though was because her team was very very sure it was going to backfire

So Bernie went negative on her first tbf

GOD FORBID Bernie run an actual campaign. What a dick.

# ? Apr 25, 2017 17:08

Main Paineframe: Oct 27, 2010

Typo posted:

apparently the reason why she didn't was because she thought the email scandal was destroying every attempt at her trying to bring up a positive message, so she thought she was stuck with mudslinging and hope her mudslinging is outweigh the emails

Not just the emails, but anything that looked bad. Every time something negative about her came up, her campaign dropped all attempts at marketing her positively and bought a bunch of ads to highlight Trump's negatives. It happened after she collapsed at the 9/11 memorial, for instance.

# ? Apr 25, 2017 17:09

Cerebral Bore: Apr 21, 2010; Fun Shoe

Typo posted:

she actually didn't really: the reason why she didn't though was because her team was very very sure it was going to backfire

So Bernie went negative on her first tbf

Did you miss the legion of Hillfolk in the media trying their damndnest to portray Bernie and everybody who supported him as super racist and/or sexist and Hillary happily going along with it? It's not as if negative campaigning has to stop at the doors of your office, in fact it's usually more effective if some outside party is doing it for you.

EDIT: I mean, hell, the same people literally tried to do the same to Obama in 2008. At some point basic pattern recognition ought to kick in.

# ? Apr 25, 2017 17:11

21 Muns: Dec 10, 2016; by FactsAreUseless

Main Paineframe posted:

Not just the emails, but anything that looked bad. Every time something negative about her came up, her campaign dropped all attempts at marketing her positively and bought a bunch of ads to highlight Trump's negatives. It happened after she collapsed at the 9/11 memorial, for instance.

Are we repeating InfoWars talking points as if they were real, now? :psyboom:

There are few stories I've ever seen more obviously faked than that "collapse". She was just getting in the car in a hurry and it's loving embarrassing that we're still arguing about this six months after the election.

# ? Apr 25, 2017 17:18

Crowsbeak: Oct 9, 2012; by Azathoth; Lipstick Apathy

Need a one week ban. Oh and I leave you with noted wonderful liberal Ezra Klein speaking the wonders of the authoritarian city state of Singapore medical system. Note how I said it is an authoritarian city state. Never once does Ezra mention this in the article. (Frankly I would argue this is because Singapore is ezra kleins fever dream of the his ideal place to live. )

Love these WONDERFUL liberals.

http://www.vox.com/policy-and-politics/2017/4/25/15356118/singapore-health-care-system-explained

A idiot gave Paul Ryan blow jobs posted:

Is Singapore�s �miracle� health care system the answer for America?
The Singapore model shows how liberal and conservative ideas can fuse.
Updated by Ezra Klein@ezraklein Apr 25, 2017, 9:20am EDT

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ROSLAN RAHMAN/AFP/Getty Images Singapore�s health care system is a marvel, but the reasons it works in Singapore are the reasons it wouldn�t work in America.

When liberals talk about their health care utopia, they have scores of examples to choose from. Some name France�s high-performing multi-payer system (No. 1 on the World Health Organization�s rankings, in case you haven�t heard). Others point to Canada�s single-payer simplicity. The Scandinavian countries all do health care well, and there�s much to recommend Germany�s hybrid approach.

Conservatives really only have one example of a free market health care paradise to point to: Singapore. But oh, what an example it is! In a New York Times column called �Make America Singapore,� Ross Douthat called it �the marvel of the wealthy world.� After the election, Fox News published an op-ed headlined, "Want to ditch ObamaCare? Let's copy Singapore's health care miracle.�

Why are conservatives so taken with Singapore? The American Enterprise Institute�s glowing write-up explains it well:

What�s the reason for Singapore�s success? It�s not government spending. The state, using taxes, funds only about one-fourth of Singapore�s total health costs. Individuals and their employers pay for the rest. In fact, the latest figures show that Singapore�s government spends only $381 (all dollars in this article are U.S.) per capita on health�or one-seventh what the U.S. government spends.

Singapore�s system requires individuals to take responsibility for their own health, and for much of their own spending on medical care.

Here�s what Singapore�s conservative admirers get right: Singapore really is the only truly universal health insurance system in the world based on the idea that patients, not insurers, should bear the costs of routine care.

But Singapore isn�t a free market utopia. Quite the opposite, really. It�s a largely state-run health care system where the government designed the insurance products with a healthy appreciation for free market principles � the kind of policy Milton Friedman might have crafted if he�d been a socialist.

Unlike in America, where the government�s main role is in managing insurance programs, Singapore�s government controls and pays for much of the medical system itself � hospitals are overwhelmingly public, a large portion of doctors work directly for the state, patients can only use their Medisave accounts to purchase preapproved drugs, and the government subsidizes many medical bills directly.

What Singapore shows is that unusual fusions of conservative and liberal ideas in health care really are possible. Singapore is a place where the government acts to keep costs low and then uses those low costs to make a market-driven insurance system possible. One thing you quickly realize when studying their system is it would be a disaster if you tried to impose it in a country with America�s out-of-control medical prices.

That speaks to the more depressing lesson of Singapore. As soon as you begin seriously comparing where they are, and how their system works, to where the US is, and how our system works, it becomes painfully clear how far America is from having the institutions or preconditions for truly radical health care reform.
How Singapore�s health insurance system works

Books could be written on the structure of Singapore�s health care system, and indeed, they have been. Jeremy Lim�s Myth or Magic: The Singapore Healthcare System is particularly excellent, though William Haseltine�s Affordable Excellence: The Singapore Healthcare Story has the advantage of being free. A deep dive here is rewarding, and my summary will necessarily oversimplify.

But the basic structure of Singapore�s insurance system is built around the �three M�s�: Medisave, Medishield, and Medifund. Let�s take them in turn.

Medisave: When conservatives praise Singapore�s health system, they are typically praising the Medisave system. Medisave is a forced savings plan that consumes between 7 and 9.5 percent of a working Singaporean�s wages � think of it like the Social Security payroll tax, if said tax funded a health savings account. Singaporeans then pay for some routine care out of their Medisave accounts.

Conservatives like Medisave because it is built on a deep appreciation for the idea that routine medical care can be treated like any other good, and patients can be pushed to act like consumers when buying it. Which is all true. Medisave distinguishes Singapore�s system from that of the US or Western Europe, where insurers typically cover most of the cost of routine care.

But again, the way Medisave actually works is the government forces you to divert 7 to 9.5 percent of your wages into this account, and then it decides what you can do with those savings � one way Singapore keeps drug prices low, for instance, is it only allows Medisave funds to be used for drugs that the government judges cost-effective (more on this later).

So while Medisave may look like a health savings account, it�s a mandatory health savings account funded by a payroll tax and only usable in certain conditions.

Medishield: Not all medical care is routine care. For the big expenses, Singapore runs Medishield, a nationwide catastrophic insurance program. The premiums are set by your age, and the deductibles are reasonably high � roughly $1,400 in US dollars. Enrollment is automatic, though you can opt out if you choose.

Together, Medishield and Medisave form the core of Singapore�s more market-oriented health insurance system � the idea is you pay routine expenses out of your Medisave account, and if things get bad enough that you hit your deductible, you begin using your Medishield account. This accords with the broader conservative view on health care: Insurance should cover unexpected costs, and for everything else, people should shop around as they do for most other products, and unleash the powers of the market.

But to make that structure work, Singapore relies on a massive amount of government coercion across the entire system. Fully funding your Medisave account is compulsory, not optional. You�re automatically enrolled in Medishield. The government limits the services both programs can purchase and, as we�ll see, often produces or reprices the services both programs purchase.

Medifund: Some Singaporeans fall through the cracks of Medisave and Medishield. For them, there�s Medifund � Singapore�s payer-of-last-resort.

Medifund�s structure is unusual in two ways. First, it�s based on a $3 billion endowment, with the government only able to spend the previous year�s investment income to pay for the needy�s medical bills; dipping into the endowment itself is forbidden. Second, it�s administered with a lot of discretion at the hospital level � so rather than qualifying for Medifund based on income, the way Americans do for Medicaid, hospital boards administer Medifund to the patients they judge needy enough to qualify. This is less restrictive than it might sound � the government says that more than 99 percent of applications are approved.

The big vulnerability of Medifund is that a bad investment year could wipe out the government�s ability to pay � and do so at the moment it was most needed. It�s a testament to Singapore�s economy, and to the government�s fiscal skill, that they�ve not faced this problem yet.
How Singapore�s health care system works

It�s easy, looking at Singapore�s insurance scheme, to see what conservatives find so attractive in the system. While there�s significant coercion, there�s also a real focus on pushing patients to act like consumers, and reserving insurance for unexpected, unusual costs. In addition, Singapore�s safety net � Medifund � is limited in its commitments and administered at the local level.

But all that happens within the context of a government-controlled � and often government-run � medical system.

This is a key difference between Singapore and America. The bulk of the American government�s intervention into the health care system is done through health insurance, and so American analysts often look at Singapore�s insurance system and stop there. But the bulk of the Singapore government�s intervention into the health care system is through the health care system itself.

Take the way the two countries subsidize medical care. In America, insurance is often subsidized � by paying the bills of Medicare or Medicaid enrollees, by giving tax credits to Obamacare enrollees and employer-sponsored health plans. In Singapore, medical treatment itself is subsidized.

More than 80 percent of the hospital beds in Singapore are in public hospitals, and those hospitals are cut into different �wards� with different levels of amenities: A-class wards provide unsubsidized care but have single rooms and air conditioning, while C-class wards are overwhelmingly subsidized but are set up like shared dormitories with common toilets. There are a number of ward levels in between, too, all with a sliding scale of comfort and subsidization. So both A-ward patients and C-ward patients are paying for their own care, but the prices they�re paying are very, very different, because the government is absorbing the direct cost of care in the C-wards.

These subsidies remain a huge part of the country�s overall health spending. In 2009, the 3 M�s only financed 23 percent of total inpatient care; by contrast, government subsidies accounted for 51 percent. (It�s worth noting that government subsidies are a lot less prominent in primary care.)

The government�s subsidies are designed to do more than simply make care affordable � they�re also designed to shape patient and provider decisions and influence pricing. �The policies around what services to subsidize, how much to subsidize, who to subsidize and what providers and patients need to do in exchange for subsidy eligibility, make subsidies one of the most impactful tools in the Ministry of Health�s policy armamentarium,� Lim writes.

Take pharmaceuticals. In 2009, Americans spent $947 per person on drugs. Singaporeans spent merely $389. A major way the Singaporean government holds down drug prices is deciding which drugs are eligible for subsidies and Medisave spending.

The Singaporean Ministry of Health publishes a �standard drug list.� These are drugs the government believes to be �cost-effective and essential.� Drugs on that list are provided at subsidized rates to patients. The government also decides which drugs can be bought with Medisave funds. Drugs that don�t appear on either list may still be available in hospitals, but at prohibitive prices.

Singapore is unusually secretive about how its pharmaceutical decisions are made � Britain�s much-criticized National Institute for Health and Care Excellence, which makes decisions about which drugs will qualify for public funds, is far more transparent. A previous health minister of Singapore says the opacity is to prevent �intense lobbying by pharmaceutical companies� � what they want are pharmaceutical companies selling all drugs at low prices in the hopes of getting onto the standard list. That�s how Singapore uses their subsidies to lower prices not just for the subsidized but for everyone.

Compare all this with America, where Medicare is prohibited, by law, from negotiating down the price of pharmaceuticals, even for its own enrollees!
One lesson of Singapore: everything is easier when costs are lower

According to the World Bank, in 2014 Singapore spent $2,752 per person on health care. America spent $9,403. Given this, it�s worth asking a few questions about what Singapore�s model really has to teach the US.

Are Singaporeans really more exposed to health costs than Americans? The basic argument for the Singaporean system is that Singaporeans, through Medisave and the deductibles in Medishield, pay more of the cost of their care, and so hold costs down. Americans, by contrast, have their care paid for by insurers and employers and the government, and so they have little incentive to act like shoppers and push back on prices. But is that actually true?

I doubt it. The chasm in total spending is the first problem. Health care prices are so much lower in Singapore that Singaporeans would have to pay for three times more of their care to feel as much total expense as Americans do. Given the growing size of deductibles and copays in the US, I doubt that�s true now, if it ever was. (It�s worth noting that, on average, Singaporeans are richer than Americans, so the issue here is not that we have more money to blow on health care.)

According to Singapore�s data, in 2008 cash and Medisave financed a bit less than half of the system�s total costs. Let�s say, generously, that�s $1,200 in annual spending. According to the Kaiser Family Foundation, the average deductible in employer health plans is now $1,478 � and that�s to say nothing of premiums, copays, etc. And of course, average deductibles outside the employer market are much, much higher.

Singapore�s system is probably better designed in terms of how consumers spend their own money. But the lower overall prices make them much less exposed to health costs than both patients and employers inside the American system � which suggests to me that Americans have at least as much incentive as Singaporeans to try to use their power as consumers to cut costs.

The fact that that hasn�t worked is, I think, a reason to believe we�ve gotten the lesson of Singapore�s health system backward. Singapore heavily regulates both the pricing and provision of medical care to keep costs low (as do all other developed countries) and then, working off that baseline of low costs, has Singaporeans pay out of pocket in order to keep them mindful of how much they�re spending.

In America, conservatives want to apply that strategy in reverse: working off a baseline of extremely high prices, they want to force people to pay out of pocket as a strategy to bring those prices down. That hasn�t worked so far, and my guess is efforts to double down on it � of which the Republican Obamacare alternative is one � will continue to fail.

What would happen if you brought Singapore�s system to the US? Spend a moment imagining a transition to a Singapore-like system in the US, given our prices. With per capita health spending over $9,000, we would need to force people to save far more than Singapore�s paltry 7 to 9.5 percent of monthly wages to build reasonable health savings accounts (remember, children and the elderly don�t earn much, and so need their expenses covered by their family�s savings).

A policy like this would make Obamacare�s individual mandate look gentle. Remember, the mandate doesn�t even apply if you can�t find a comprehensive health insurance plan that costs less than 8 percent of your household income. Here, you�d be forced to save more than 8 percent of household income, and that�s just for the part of the system managing out-of-pocket costs for routine care.

Which is all to say that there are a lot of program designs that are possible when health care is cheap, and very few that are possible when health care is as expensive as it is in the United States. Admirers of Singapore�s system often reverse the causality of their experiment: The Singaporean system is possible because the government keeps costs so low. If prices rose to US levels, their system wouldn�t be possible, as the out-of-pocket costs would lead to revolt.
Oh, and everything else in Singapore is different too

One difficulty with comparing anything in Singapore to anything anywhere else is Singapore is very, very weird.

It�s a city-state of 6 million people that�s only been governing itself since about 1960. Though elections are now considered broadly free in Singapore, power has only ever been held by one party � in part because that party has proven itself perhaps the most successful group of technocrats in human history. Singapore has gone from a poor country in the 1950s to holding the third highest per capita income today.

In part for that reason, trust in the government is extraordinarily high, and the government wields that power aggressively. Singapore�s health outcomes are excellent, but that�s not only because its health system is well-designed. Singapore manages a nanny state beyond anything Americans can imagine, or would permit.

Despite the country�s wealth, only 15 percent of Singaporeans have cars, because the government makes car ownership prohibitively expensive. There�s virtually no illegal drugs or gun crime in Singapore, in part because drug dealers are executed and guns are outlawed. Cigarette and alcohol taxes are enormous by American standards. As Matt Yglesias said in our episode of The Weeds discussing Singapore, �If you imagine America with no guns, less booze, much less drugs, and radically less driving, our public health outcomes would soar.�

There�s much America could learn from Singapore. But the lessons need to be taken in whole. The Singaporean system is unusually good at applying market forces to routine health expenses. But that happens within a context where the government is aggressively managing the supply of health services, the price of treatments, and the broader behavioral environment in which the system operates. Singapore�s health care system relies much more on the government, and much less on the market, than America�s does.

Which is not to say liberals should be confident about adopting Singapore�s model either. America is far from having the kinds of low costs or faith in public institutions needed to replicate Singapore�s �miracle.�

A point that both Lim and Haseltine make in their books is that the Singaporean government has sought to keep control of the health system because leaders� study of other countries persuaded them that once costs and medical interest groups grew out of control, the government could no longer effectively regulate the system. Quoting a former Singaporean health minister, Haseltine writes, �[I]f the public healthcare system is too small, it becomes the �tail that tries to wag the dog.� Once a private healthcare system becomes the dominant entrenched player, it is very difficult to unwind it � there are many vested interests and many pockets will be hurt.�

In America, the private health care system is the dominant entrenched player. And that makes radical reform, either toward a Singapore-like system or toward any other public-driven system, very, very difficult. There�s much you can imagine designing if we were starting from scratch, but it�s very challenging to design high-performing, clean systems that we could smoothly transition to from here, given how many hospitals and doctors and employers and even patients are dependent on the money flowing through system we have, and would viciously fight efforts to upend it.

Also lol at his truth is in the middle horseshit.

Crowsbeak fucked around with this message at 17:45 on Apr 25, 2017

# ? Apr 25, 2017 17:42

Condiv: May 7, 2008; Sorry to undo the effort of paying a domestic abuser $10 to own this poster, but I am going to lose my dang mind if I keep seeing multiple posters who appear to be Baloogan.

With love,
a mod

21 Muns posted:

Are we repeating InfoWars talking points as if they were real, now? There are few stories I've ever seen more obviously faked than that "collapse". She was just getting in the car in a hurry and it's loving embarrassing that we're still arguing about this six months after the election.

yes i'm sure the guy who got this as redtext "I'm a big baby who can't accept the fact that maybe if I hadn't shamed all the Bernie supporters during the primary they would've help mi abuela win." is a fan of attacking hillary with infowars talking points

# ? Apr 25, 2017 17:50

mcmagic: Jul 1, 2004; If you see this avatar while scrolling the succ zone, you have been visited by the mcmagic of shitty lib takes! Good luck and prosperity will come to you, but only if you reply "shut the fuck up mcmagic" to this post!

Crowsbeak posted:

Need a one week ban. Oh and I leave you with noted wonderful liberal Ezra Klein speaking the wonders of the authoritarian city state of Singapore medical system. Note how I said it is an authoritarian city state. Never once does Ezra mention this in the article. (Frankly I would argue this is because Singapore is ezra kleins fever dream of the his ideal place to live. )

Love these WONDERFUL liberals.

http://www.vox.com/policy-and-politics/2017/4/25/15356118/singapore-health-care-system-explained

Also lol at his truth is in the middle horseshit.

Huh? In Singapore THE GOVERNMENT CONTROLS HEALTH CARE PRICES AND THE MEANS OF HEALTH CARE FOR THE MAJORITY OF PEOPLE!!!! You can't talk about their system without that fact in context and as usual, american conservatives are craven morons when they do so. LOL @ them talking about "market forces" in that article. Morons.

# ? Apr 25, 2017 17:54

Adbot: ADBOT LOVES YOU

# ? May 2, 2024 20:44

Craptacular!: Jul 9, 2001; Fuck the DH

Hillary Clinton ran on this and also this.

All this bullshit, the latter as especially, made me want to vote for Trump out of spite. They clicked into something that very much resembles the tobacco industry's government mandated "stop smoking" campaigns that subversively make you want to smoke to rebel against the campaign.

The idea that the behavior of children is going to be altered by the President being foul mouthed or being on the record as liking big tits. Good grief. If you thought Trump saying "bomb the poo poo out of them" was going to make your child a degenerate, I'd hate for your kids to grow up during the Nixon tapes.

mcmagic posted:

GOD FORBID Bernie run an actual campaign. What a dick.

Bernie said "excuse me!" and interrupted her. What a chauvinist who can't stop mansplaining. Bernie is truly the worst and I'm going to ignore that DONALD FRIGGIN TRUMP would do all that and more. Shame on Bernie for not treating a woman with kids gloves. She's only been debating men most of her life.

Craptacular! fucked around with this message at 20:43 on Apr 25, 2017

# ? Apr 25, 2017 20:31

The Something Awful Forums > Discussion > Debate & Discussion > How much blame should Obama bear for the Democratic Party's decline?

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