Chelsea Clinton for president?

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

Veteran newsmen Steve Barnes and Ernie Dumas have forgotten more about politics than I know. Sitting across the table from them after taping the AETN public affairs show “Arkansas Week” last Friday, I asked them this question, or a variation of it: Who are the young Democrats moving into national leadership who soon could run for president?

What followed was several seconds of silence, and then none of us could produce any names.

The topic came up because of the problems facing Hillary Clinton, who I argued recently in this space would probably be the next president of the United States. With her email problems not going away, that’s looking less certain.

The problem for Democrats is, who would be the alternative – not just among younger Democrats, but even young-ish ones? The closest current rival for Clinton, 67, is Sen. Bernie Sanders, a 73-year-old Vermont socialist. Even though it’s very late in the process, some Democrats have been flirting with Vice President Joe Biden, who is 72. There’s even talk of former Vice President Al Gore, 67, entering the race.

So far, the Democrats have four announced candidates, but three of them have no shot at the presidency. Meanwhile, the Republicans have a wide open race with 17 candidates – governors and ex-governors, senators, business leaders, a neurosurgeon – most of whom are plausibly presidential.

It’s not that the president should be a young person. It’s that political parties should develop their talent. Democrats don’t necessarily need a candidate like the Republicans’ Sen. Marco Rubio, who’s 44, or Wisconsin Gov. Scott Walker, who’s 47. They need viable candidates in their 50s and early 60s who could have run this year. And they don’t have them.

Why not? The most important reason probably is the hold the Clintons have had on the party since 1992. She has been the heir apparent since Gore lost in 2000, with her seemingly inevitable nomination in 2008 derailed only by then-Sen. Barack Obama’s emergence. The party hasn’t merely been ready for Hillary. It’s been holding the door open for her – and slamming it shut on others.

Other factors? in Congress the party has been led by Sen. Harry Reid and Speaker Nancy Pelosi, both 75, neither of whom ever seemed interested in running for president. Their iron rule has kept other Democrats in Congress from making names for themselves. Also, Democrats don’t have as strong a media apparatus keeping the party’s talent in front of their own voters. MSNBC is no Fox News, and Democrats don’t have a Rush Limbaugh at all.

Democrats also have fewer officeholders in the places where many presidential candidates are produced: governor’s mansions. There are only 18 Democratic governors, compared to 31 Republican ones.

There are many reasons for this disadvantage, including President Obama’s unpopularity. But another reason may be simple population distribution. Remember those electoral maps that show the country painted county by county with a wide swath of Republican red bordered by Democratic blue on the coasts? Democrats are concentrated in urban areas, while Republicans are spread through the middle of the country. If a Democratic governor is going to run for president, he or she probably will come from a blue state like California, which is currently led by Gov. Jerry Brown, 77.

This also gives the Republicans an advantage in controlling the U.S. Senate, by the way.

Americans tend to hand the White House keys from one party to the other every eight years or so, which favors Republicans in 2016. But otherwise, Democrats enter this cycle with many advantages. They have won the popular vote in five of the last six presidential elections and the election itself four of those times. Most of the country’s demographic trends favor them. They lead among women, who vote more frequently than men; among minorities, who become a greater percentage of the population every day; and among young people moving into the voting population.

But to take advantage of this situation, Democrats need young and young-ish candidates who can run for president. In fact, both parties should have numerous candidates ready to run in every election cycle, despite whose “turn” it is. Sure, there are advantages to anointing a candidate two years before the election. But what if that candidate runs into big problems?

So quick – name a young Democrat with a name, money, connections, and national stature.

Chelsea Clinton?

Hutchinson will wrestle less with execution role than previous governors

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

Sometime in the very near future, a night will come when Arkansas will execute its first inmate since 2005.

Eight inmates have exhausted their appeals, and a recent U.S. Supreme Court ruling seems to remove the biggest obstacle that has kept them alive – concerns over the effectiveness of the sedative that puts the condemned to sleep before the lethal drugs are administered. Still, there will be legal challenges, including one already filed over a state law passed this year that shields the identities of the drugs’ vendors.

The night of the first execution, assuming it occurs, Gov. Asa Hutchinson will be the one person in the world who could throw a life preserver to a drowning man – who, of course, will have been convicted beyond a reasonable doubt of drowning someone else. Hutchinson alone could stop the execution with a phone call.

Asked in his office if he’d considered what that night will be like, the former director of the Drug Enforcement Administration, undersecretary of the Department of Homeland Security, and U.S. attorney, said, “I’ve been in law enforcement a long time, but I haven’t thought about that. … It’s a serious thing. My objectives in life in terms of these type of cases is that you’re sure that the system works; that innocence is protected; guilt is established; and the system works; and it is reviewed; and they have competent counsel; then it’s my responsibility to carry out the law. We’re not there yet, so … you just simply do your duty until you get to that moment and you address it then.”

Some previous governors have felt more personally responsible. Hutchinson’s predecessor, Gov. Mike Beebe, never had to preside over an execution and said he was glad he didn’t. Gov. Mike Huckabee did preside over executions, and it troubled him to his core.

In January 1997, Arkansas efficiently executed three men in one night. Three weeks before it happened, I asked the then-new governor in a press conference how he felt about his role in the process. It was not his first execution. He said it was much easier to talk about the death penalty before he was responsible for carrying one out. Tears appeared in his eyes as he described the burden he felt.

“”There’s never a night in a person’s life that’s more god-awful, gut-wrenching than the night you personally have the responsibility to stop a man’s death, or not,” he said. “Anybody who feels good about it is a very sick person.”

Despite his misgivings, Huckabee allowed those executions, and others, to proceed. One of his predecessors, Gov. Winthrop Rockefeller, did not. Deeply opposed to the death penalty, he ordered a stay of all executions. After his defeat in 1970, he announced that he was commuting the sentences of all 15 men on Death Row.

“What earthly mortal has the omnipotence to say who among us shall live and who shall die? I do not,” he said in an emotional news conference. “Moreover, in that the law grants me authority to set aside the death penalty, I cannot and will not turn my back on lifelong Christian teachings and beliefs merely to let history run out its course on a fallible and failing theory of punitive justice.”

On Dec. 31, 1970, two days after that announcement, Rockefeller visited what had been Death Row and personally spoke to each inmate there. His 22-year-old son, Win, was at his side as an observer. The man who defeated Rockefeller, Dale Bumpers, later said he appreciated his predecessor commuting those sentences because it meant he would not have to preside over any executions.

Will Hutchinson be as conflicted as Huckabee, Bumpers or Beebe? It seems unlikely.

For a man who has spent much of his life in law enforcement, the execution will be the last act in a process that has involved many steps and many people. It will be the judicial process that will be responsible – and of course, the condemned. A horrific crime was committed, a fair trial occurred, and guilt was determined beyond reasonable doubt. And so while theoretically on that night he could toss that life preserver, I don’t think he’ll see that as part of his role.

He’ll see his role as carrying out the law regarding executions, while some previous governors couldn’t help but feel like they were sort of the executioner itself.

For GOP, is it Reagan or Goldwater?

Ted Cruz, in blue shirt, in Little Rock Aug. 12.

Ted Cruz, in blue shirt, in Little Rock Aug. 12.

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

Campaigning for president in Little Rock Wednesday before several hundred onlookers braving the midday heat, Sen. Ted Cruz said Republicans must nominate a “real and genuine conservative. That’s the only way we win. If we nominate Democrat-lite, we will lose once again.”

Many conservatives believe that’s true. Is it?

President Reagan won by campaigning as a conservative, which he undoubtedly was, and then President George H.W. Bush, who really wasn’t a true believer, only served one term. Sen. Bob Dole, more of a pragmatist, lost, and then President George W. Bush won running as a conservative and then expanded government in almost every direction. Republicans then lost with Sen. John McCain, whom conservatives distrust, and lost with Mitt Romney, who had to pretend to be more conservative than he was.

On the other hand, there’s Sen. Barry Goldwater.

Twice in the television age, Republicans have nominated candidates seeking to move the country rightward. One was Reagan, who won 44 states in 1980 and 49 states in 1984. The other was Goldwater, who won only 38.5 percent of the vote in 1964.

The problem with trying to determine anything about presidential elections is that there are so few of them. Scientific experiments require many subjects. In the last 80 years, we’ve had only 20 elections, and there have been only eight elections since World War II when an incumbent wasn’t running. The taller candidate usually wins, too, but no one is suggesting that Republicans stand back to back at the next debate.

That said, here is another generalization: The optimistic candidate who inspires and unifies the most people usually wins. Reagan wasn’t elected simply because he offered a conservative message. He also offered a hopeful, empowering one. Goldwater, on the other hand, came across as divisive and scary. Scoff if you will at President Obama’s hope and change, but it got him elected. George W. Bush offered a positive message, and he won, too, assuming the numbers were right in Florida in 2000. President Clinton talked about hope, too, while President Carter offered a fresh face in 1976 and President Kennedy spoke of a “New Frontier” in 1960.

Of course, candidates try to slice and dice the electorate in order to cobble together 270 Electoral College votes, but pitting us against each other isn’t a good message. We’ll never know if Romney would have won if he hadn’t been caught saying that 47 percent of Americans are freeloaders, but it certainly didn’t help that he said it, and it was worse that he believed it.

I’ve never seen the country so divided, but then again, I’m “only” 46. So maybe what I’ve just written no longer applies. It’s possible that the next president will have no choice but to be divisive if he or she wants to be elected and wants to get anything done in office. Obama campaigned as a unifier and initially tried to work with Republicans. That didn’t work, and now he’s not even trying to connect with Americans not inclined to agree with him.

Cruz is not concerned with appealing to the other side and doesn’t mind making enemies. Speaking in Little Rock, he said the Obama administration is the world’s leading state sponsor of terrorism because of the Iran deal. On the Senate floor, he said his own majority leader, Sen. Mitch McConnell, had lied. He really hasn’t passed anything of significance in the Senate. Then again, almost no senator has lately.

So maybe it’s the perfect time for an openly divisive candidate like him. Unlike McCain and Romney, he won’t be forced to move to the right during the primaries, say things he doesn’t believe, and then move back to the center for the general election. Cruz can stay where he is for the next year and then move slightly toward the middle to try to pick off states like Ohio and Pennsylvania.

The best possible scenario is for the country to elect a problem-solving leader with a unifying message, regardless of party label. That would be somebody like Reagan, actually, who held sincere beliefs but didn’t hate anybody and often compromised with Democrats while in office. The worst possible scenario – for Republicans and probably for the country – is for the party to nominate a candidate that conservatives don’t like who then loses. If that keeps happening, the GOP eventually will nominate another Goldwater, if it doesn’t happen this year.

Health care reforms: These would be easy

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

Health care reform is difficult, in large part because it’s so hard to achieve consensus on many issues related to it. Repeal Obamacare, or amend it? Keep the private option, or replace it?

So maybe more attention should be paid to reforms where agreement is possible. For starters, here are two.

One would be for hospitals to make fewer people sick. According to the federal Centers for Disease Control and Prevention, 648,000 Americans contracted infections while in an acute care hospital in 2011, and 75,000 of them died while a patient, though not necessarily from the infection. One in 25 hospital patients is infected during their stay.

Not all of those infections were the hospitals’ fault, of course. Many patients have weakened immune systems. But many infections are preventable if hospitals follow simple procedures. Sometimes it’s as simple as making sure physicians and nurses wash their hands.

That’s one of the practices at Unity Health in Searcy, one of nine hospitals in the country and the only one in Arkansas given a top rating for infection control by Consumer Reports.

The magazine recently rated 3,000 hospitals based on five infections: clostridium difficile, or C. diff, which develops in 290,000 patients each year and contributes to the death of at least 27,000; methicillin-resistant staphylococcus aureus, or MRSA, which contributes to more than 8,000 deaths annually; catheter-associated urinary tract infections; central-line associated bloodstream infections; and surgical-site infections.

Unity Health staff members told me there’s no magic bullet. Instead, they just follow nationally recognized guidelines, such as using a bleach-based cleaning procedure to combat C. diff infections. They avoid unnecessary catheterization. The housecleaning staff keeps the rooms clean.

How can more hospitals be encouraged to follow Unity Health’s lead? One way is to continue changing the perverse incentives surrounding health care. Medical providers traditionally have been paid by insurance companies and government payers under a “fee for service” model. They bill for each service they provide, so if a patient is infected while in the hospital, the hospital gets paid for treating that infection. That doesn’t mean hospitals are purposely careless, but it does give them less reason to be extremely careful.

Arkansas is a national leader in creating an “episodes of care” payment model based on appropriate costs for select procedures, such as knee and hip replacements, from the beginning to the end of treatment. If average costs for all such patients fall below a certain threshold, medical providers are paid a bonus, and they face a penalty if costs are too high. So if enough patients contract an infection, the hospital’s bottom line will suffer.

The model was created with input from government agencies, insurance companies and medical providers. In other words, consensus was created. The state started with five episodes and has been increasing the number. The federal Medicare program is experimenting with the model as well.

Makes sense, doesn’t it? If health care is to remain a free market entity, then providers should face the same expectations as other businesses: If I hire you to fix something, you don’t get paid more if you break something else.

Another health care reform where consensus should be possible is increasing the number of medical professionals.

Recently, 214 physicians completed their residency training at UAMS and are ready to practice medicine. Unfortunately, that’s only a drop in a bucket with a hole in it. According to a 2015 study sponsored by the Association of American Medical Colleges (AAMC), the United States faces a shortage of between 46,000 and 90,000 physicians by 2025.

A medical education is costly. According to the AAMC, 84 percent of 2014 medical school graduates had education debt, with a median debt of $180,000 – and that comes after many years of school, long after law school graduates are making money suing doctors.

Gov. Asa Hutchinson has made increasing the number of high school students with computer coding skills a top priority. How about an effort to produce future doctors? Could we agree on that? If Arkansas can award more than 168,000 lottery scholarships, many to students who aren’t particularly focused or directed, can it reallocate resources to qualified medical school students?

More doctors are needed, and hospitals shouldn’t make people sick. Solving those problems won’t be easy, but coming to a consensus will be easier than it’s been with Obamacare and the private option. So can we talk about the easy stuff more often, and fight about the hard stuff a little less?

Private option: It’s all about the paperwork now

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

As of the beginning of this month, 31,501 Arkansans no longer have insurance through the private option, mostly because there’s a problem with their paperwork.

The state is redetermining eligibility for 600,000 Arkansans who receive health insurance through the private option or traditional Medicaid. Medicaid serves the poor, the disabled and others. The private option uses federal dollars to buy private insurance for lower-income Arkansans who previously wouldn’t have qualified for Medicaid.

The redetermination process, required by the federal government, has been a mess, beset by costly computer glitches. Now the state is trying to make up for lost time. Recipients whose incomes appear to have changed 10 percent are sent a Department of Human Services letter warning that they must verify their income within 10 days or they’ll lose their benefits.

If you count both the Medicaid and private option recipients, and both July and the upcoming August terminations, about 48,000 Arkansans will be off the rolls – 97 percent of them because they didn’t meet the deadline.

Some of that is because the state is overwhelmed. Some recipients have claimed to have submitted their incomes and then been told they’ve lost their benefits anyway. On Tuesday, Hutchinson announced a two-week pause in sending out the warning letters while DHS scrambles to find staff to process all the paperwork.

Why aren’t the others responding? Maybe they never realized they were on the private option, or they moved and never received the letter, or they read the letter and tossed it because they’re not sick right now. Some mistakenly sent verification to their local DHS office instead of the address required by the letter.

And some may have misunderstood the letter’s meaning or importance. Using bureaucratic language, it tells the recipient to verify their income or “your case will be closed and you will have to reapply” – not “or you will lose your insurance.” The envelope isn’t marked with anything that would communicate that it’s more important than all the other mass-produced envelopes in the recipient’s mailbox. Here’s the verification letter.

Asked if he might throw away an impersonal mass mailing, Gov. Asa Hutchinson, who personally selected that 10-day timeline, said, “If I were a recipient of Medicaid from DHS, and I get a letter from DHS, I would presume it’d be a responsibility to open that letter.”

He’s right that recipients of a very generous government health benefit have at least that responsibility. But the private option serves many lower-income people who, for whatever reason, haven’t previously qualified for Medicaid and often haven’t had health insurance, government or private. Many have jobs but just don’t have experience working the system.

Hutchinson also pointed out that recipients actually have much more than 10 days. Counting a grace period and then a 90-day appeal process where medical bills will be paid retroactively, recipients actually have three or four months before they are completely off the rolls. Before losing their benefits, they are told through another bureaucratic-sounding termination letter that their ”case will be closed.” Also, the insurance companies who provide private option recipients their coverage were alerted that they were about to lose their government-funded ratepayers, so they had a big incentive to try to contact them as well.

Seems like there should be a better way to verify who should receive a government benefit, and who shouldn’t. The state will pay to kick people off the private option, and then pay to put them right back on it when their pharmacist can’t fill their prescription.

The backstory behind this process is the controversy over the private option itself. Created as an outgrowth of the Affordable Care Act (Obamacare) it barely passed in 2013 and barely was reauthorized in 2014. The Legislature cut the private option’s marketing budget in 2014, which might could have paid for the ink to print on those envelopes, “Urgent: Respond within 10 days or you’ll lose your insurance.” The private option survived 2015 only because Hutchinson convinced legislators to give him a couple of years while he and a legislative task force create something better by the end of 2016. One by one, private option supporters are losing elections or drawing primary opponents.

So part of what’s happening is that we’re all trying to prove that we can get tough on the private option, right before we close the case on it and reapply with something else.