It's Time for Democrats to Get Their Facts Right on Medicare-for-All

By Pramila Jayapal, The Washington Post

02 August 19

n the wake of the second Democratic presidential debate, it is clear that Medicare-for-all has become a defining issue of the 2020 election. Earlier this year, when I introduced our comprehensive, 120-page “Medicare for All Act of 2019,” I expected attacks from big pharma and for-profit insurance companies. But I did not expect misrepresentations from Democratic presidential candidates about what the bill is and is not.

Let’s be clear about the scale of this crisis. The United States currently spends an astronomical $3.6 trillion per year on health care — almost double what peer countries spend — and it is set to increase within 10 years to $6 trillion annually. Pharmaceuticals such as basic insulin cost up to 10 times less in Canada for the exact same drugs. Approximately 500,000 Americans turn to bankruptcy each year because they cannot afford medical costs — and that includes people with insurance.

With so much at stake, facts matter. So let’s get them right.

First, it is a myth that Americans love private insurance. The vast majority of Americans are deeply frustrated with the health-care system — even if they have private insurance. Opponents and pundits often quote polling that suggests support for Medicare-for-all drops when you tell people that their private insurance plan would go away. But when polls accurately describe Medicare-for-all, and explain that you can keep your doctor or hospital, the majority support increases. People are happy to get rid of private insurance; they just want to know they can keep their doctors and hospitals, even if they switch or lose their jobs. Medicare-for-all would let them do so.

Second, it’s wrong to assert that taxes will rise without talking about what health care currently costs Americans in premiums, co-pays and deductibles. The average American family with employer-sponsored insurance incurs more than $28,000 dollars in health-care costs per year, of which about $15,800, or 56 percent, is paid by employers. And many argue they still can’t get the care they need. Americans are smart enough to be asked questions like: Would you be willing to pay more in taxes each month if you saved more money by not paying private insurance premiums, deductibles and co-pays and were guaranteed high-quality health care?

Third, it is simply false that labor unions don’t want Medicare-for-all. Sure, they fought hard for employer-sponsored health insurance plans for their workers. But they, above all others, recognize that the rising costs of insurance premiums are directly related to stagnating wages and, more and more, the pressure of those costs hurts worker power at the bargaining table. Take a look at the unprecedented number of unions that have endorsed our bill, all of which know Medicare-for-all is necessary.

Fourth, comparisons of Medicare-for-all to the GOP’s push to “repeal and replace” the Affordable Care Act are simply unfounded. Republicans are the only ones trying to take away health care. There is absolutely no daylight between leading on Medicare-for-all and fighting to shore up the ACA right now, or stopping the GOP from stripping care away. The Affordable Care Act made profound improvements to our health-care system. But it was never meant to be the end goal, since it does not address the real disease in our system: a profit motive that leaves millions either without access to care, bankrupt or unable to afford medication in the world’s richest country. We can strengthen the ACA and work toward Medicare-for-all at the same time. Even former president Barack Obama agrees.

Fifth, we simply cannot expect to bring down the costs of health care in the United States without taking on the for-profit insurance and pharmaceutical corporations, which are raking in billions of dollars at the cost of American lives. Incremental steps such as a public option might sound appealing but would still leave more than 10 million people without coverage while keeping in place a costly private-insurance middleman that eats up 25 to 30 percent in administrative waste and profits. If we want to achieve true universal health care while containing costs, Medicare-for-all is the only answer.

Finally, Democratic candidates should stop using one-liners from industry front groups and Republican playbooks — such as “Medicare-for-all would shutter hospitals," or telling seniors that “Medicare goes away as you know it. All the Medicare you have is gone.” These claims — amplified by contributions from the private health-care industry — are designed to incite fear and sow confusion. I’ve spoken with several hospital CEOs who see Medicare-for-all as a lifeline for their hospitals — particularly safety-net and rural hospitals that are barely surviving under the current system. And my Medicare-for-all bill improves Medicare for seniors by adding additional benefits such as dental, vision, hearing and long-term care.

As the debates continue, I hope that my fellow Democrats will take a good look at our bill and get the facts right. The Medicare-for-all movement has overwhelming public support, unprecedented grass-roots organization, and a serious plan that is ready to change our health-care system right now.

Health care is the top issue for voters, and they deserve to know the truth about the solutions we are proposing. I’m willing to debate Medicare-for-all with anyone — but we owe it to all Americans to stick to the facts.

The Potential Trouble With Nominating a DNI From Trump's Central Casting

By David Priess, Lawfare

02 August 19

he nomination-by-tweet of Republican Rep. John Ratcliffe of Texas as director of national intelligence (DNI) to replace outgoing DNI Dan Coats has drawn rapid and harsh condemnation from many political observers and even former intelligence officers for his apparent partisanship and lack of experience.

Senate Minority Leader Chuck Schumer of New York announced on Twitter, “If Senate Republicans elevate such a partisan player to a position that requires intelligence expertise and nonpartisanship, it would be a big mistake.” Retired CIA operations officer and manager Steven Hall tweeted, “I wonder what Ratcliffe will do the first time he sees intel (say, for example, on Russia or N Korea) that he knows Trump will hate. Will he squash it? Take it to Trump but say it’s BS?” And former National Intelligence Council Chairman Gregory Treverton commented, “I worry about the combination of amateur and political, especially since he seems quite ideological.”

These hot takes are not surprising. Ratcliffe, after all, has been prominent within the Republican clique alleging anti-Trump bias at the FBI, building on his previously expressed ire against then-FBI Director James Comey for the bureau’s investigation of Hilary Clinton’s use of a private email server. More recently, during the July 24 public testimony of Robert Mueller, Ratcliffe stood out due to his full-throated criticisms of the former special counsel’s office, its investigation and its findings.

Putting the political views of a potential intelligence community leader front and center is legitimate in the confirmation process, especially to assess his or her ability to put aside such views to present unbiased, objective intelligence to the president and other senior officials.

There’s probably greater value, however, in taking a wider look at experiential factors that will affect a nominee’s potential success as a leader of the intelligence community, drawing lessons from those who have gone before.

Let’s first compare the pre-DNI resumes of the five men who have held that job since its inception in 2005 to that of Rep. Ratcliffe:

• John Negroponte (DNI from 2005 to 2007) was one of his generation’s most experienced diplomats, having more than 40 years in the Foreign Service, including time as an assistant secretary of state as well as in ambassadorships to the United Nations and to countries from Mexico to the Philippines to Iraq. He also served as deputy national security adviser to Ronald Reagan, often briefing the president on the nation’s most exclusive intelligence document, the President’s Daily Brief.


• Mike McConnell (DNI from 2007 to 2009) spent almost three decades in the U.S. Navy, where he reached the rank of vice admiral. During the first Gulf War, he served as the Pentagon’s J2, or chief of intelligence, working closely with Secretary of Defense Dick Cheney and Chairman of the Joint Chiefs of Staff Colin Powell. And he led the National Security Agency as director for four years.


• Dennis Blair (DNI from 2009 to 2010) served more than 30 years in the U.S. Navy, culminating as commander in chief, U.S. Pacific Command. His career also included an intelligence community leadership role: an assignment as the first associate director of central intelligence for military support.


• James Clapper (DNI from 2010 to 2017) wrapped up more than three decades in U.S. Air Force intelligence with four years as director of the Defense Intelligence Agency. He continued his service after his military retirement by working as director of the National Geospatial-Intelligence Agency and as undersecretary of defense for intelligence.


• Dan Coats (DNI from 2017 to now) had four terms as a congressman from Indiana under his belt before his election to the Senate, where he would ultimately serve 16 years, including three years on the Senate Select Committee on Intelligence. He also spent almost four years as U.S. ambassador to Germany, where he received top-secret intelligence briefings, and was on George W. Bush’s shortlist to become secretary of defense.

By contrast, John Ratcliffe was chief of anti-terrorism and national security for the Eastern District of Texas for three years; a U.S. attorney for one year; and mayor of the town of Heath, Texas, for eight years. Since joining Congress in 2015, he’s served on the Homeland Security Committee—though not its Counterterrorism and Intelligence Subcommittee. He has been on the House Permanent Select Committee on Intelligence for just more than six months.

Perhaps it’s unfair to relate Ratcliffe to only these five predecessors. Maybe these men, who served across 14 years and were nominated by three presidents of different political parties, are all somehow too exceptional to use as comparisons.

So let’s broaden the comparison to include former CIA directors, too, all of whom before 2005 wore a dual hat as director of central intelligence—performing the intelligence community-management duties now within the DNI’s purview. By looking at this wider sample, it becomes clear that success leading the U.S. intelligence enterprise correlates less with the absence of powerful preexisting policy preferences, even extreme ones that pundits find counterproductive, than with experience running large organizations and with the wisdom that often comes with extended exposure to intelligence. Incoming leaders who lacked deep management experience and fell on the younger side of the directors’ age distribution curve tend to have hit speed bumps early and often during their tenures—suggesting a different logic than politics by which Ratcliffe could expect a rough road as an intelligence leader.

The most obvious challenge to an outsider is recognizing and resisting politicization—the sin within the intelligence business of changing an intelligence assessment based on policymakers’ policy wishes. Telling the boss what he or she wants to hear is, indeed, a daily temptation for intel leaders. Pundits are right to focus on that latent risk with any nominee who is closely aligned with the president politically.

Core career instincts scream out to make compromises to keep the boss happy: Convince the authors of a contentious intelligence product that they aren’t seeing the “big picture” and ask them to change their judgments. Tell them that no harm comes from taking out this particular part or inserting this little thing, just to make sure the president and those around him won’t react negatively. Find a way to “nudge” the assessment when presenting it.

But telling intelligence officers to change their conclusions or soft-pedaling the core message of an assessment while delivering it undermine the very reason we invest so much in intelligence collection and analysis. There’s a reason the CIA has these words carved on the wall in its main lobby: “And ye shall know the truth and the truth shall make ye free.” Accusations against Robert Gates of such manipulation of intelligence assessments nearly derailed his bid to become director in 1991—and prompted him to institute internal safeguards to help minimize politicization when he ultimately got the job.

The men and women who have been confirmed for and served as CIA director have brought with them experience in one or more of three areas, some of which better prepare them than others do to recognize and resist politicization. Several—Allen Dulles, Richard Helms, William Colby, Gates, John Brennan and Gina Haspel—rose within the agency itself for most of their careers. Of the other directors, several had senior executive branch leadership experience before starting as director. George H.W. Bush, William Webster and Leon Panetta stand out in this regard. Porter Goss and Mike Pompeo stand out as outliers, with service primarily in the House of Representatives.

Intelligence leaders who came in with extensive intelligence or other executive branch experience, whether in the military or in civilian departments, generally succeeded at seeing politicization for what it was and managing its tensions better than the others. This makes sense; no element of the U.S. government involved in the formulation and implementation of foreign policy and national security completes its mission without intelligence inputs to clarify the unknown and reduce uncertainty. Working in the executive branch provides day-to-day lessons on the benefits of good intelligence processes and the downside of bad intelligence ones. Perhaps that’s why 50 U.S.C. § 3026(a)(3) says: “Any individual nominated for appointment as Principal Deputy Director of National Intelligence shall have extensive national security experience and management experience.” It seems folly to apply a markedly lower standard to the DNI position.

While intelligence leaders haven’t always gotten it right as a result of senior executive experience, they often do—as evidenced by the relatively high marks former directors like Helms, Webster and George Tenet usually receive. Helms had served decades in increasingly senior management positions at the CIA, including the deputy director slot, enabling him to manage Watergate’s minefields ethically. Webster brought to Langley lessons learned from running another large bureaucracy (the FBI) and a heightened sense of integrity. Tenet had less executive-level experience, but his time as senior director of intelligence programs at the National Security Council and then as deputy director and acting director of the CIA helped him earn the confidence of not only two presidents of different parties but also a workforce demoralized by post-Cold War funding and personnel cuts.

Compare their experiences to someone whose management background consists of running a small town in Texas, leading a U.S. attorney’s office for a year and managing a personally directed congressional office. It’s telling that of the former congressmen who became leaders within the intelligence community—Bush, Goss, Panetta and Pompeo—the most successful by the majority of accounts were Bush and Panetta. Why? Bush had served a mere four years as a U.S. representative before becoming ambassador to the United Nations and de facto ambassador to China. In other words, he wasn’t appointed to run the intelligence community because he was a congressman but seemingly despite it. Even Panetta—generally seen as an intelligence outsider when Barack Obama nominated him to lead the agency—had gained high-level management experience and a window on intelligence after he’d stepped down as a congressman by serving as Bill Clinton’s director of the Office of Management and Budget. Then, as the president’s chief of staff for two and half years, he had serious management responsibilities as well as daily access to the President’s Daily Brief.

Experience, and the wisdom that comes with it, matters. Among the most seasoned directors—bringing with them hard-fought lessons from myriad management successes and failures—were Webster, Panetta and Mike Hayden. All were well over 60 years old when confirmed. Each learned to champion the nonpolitical career professionals within U.S. intelligence while maintaining a quality working relationship with the commander in chief.

By contrast, the youngest and one of the most doctrinaire intelligence leaders to date, James Schlesinger, came to Langley like a bull in a china shop. He’d had only a few years serving as deputy director of the Bureau of the Budget and then leading the Atomic Energy Commission. Schlesinger took a “drain the swamp” approach to his leadership role at the CIA. He threatened to dismantle the agency’s entire Directorate of Intelligence, which compiles available information to provide analysis to policymakers. He barked at senior staff, reminding them bluntly whom they worked for. And he was gone within months.

Ratcliffe raises eyebrows on each of these fronts. He has neither a long track record of managing large organizations nor a history of engaging intimately with national-level intelligence.

Perhaps that’s an asset. After all, he’s a man of ambition and strong opinions—both of which have served some previous directors well and could put him in good stead with the current president. But caution is warranted when thinking of any leadership position within the intelligence community as a place to show off—or to serve as a springboard to a more prominent office. Of the more than two dozen DNIs and CIA directors to date, most have retired from government service upon leaving those roles. Only three have moved on to cabinet positions: Panetta and Gates, who both became secretary of defense, and Mike Pompeo, now secretary of state.

Only one director of central intelligence or director of national intelligence has ever been elected to national office after leaving Langley’s seventh floor: George H.W. Bush. Even he admitted that leading the agency seemed sure to end his political life. “When President Ford asked me to head up the CIA,” he told me, “I did not want to do it for two very specific reasons: (1) I was happily serving as our country’s envoy to China and was not ready to leave that post; (2) I was still interested in politics, and heading up the CIA would likely derail those ambitions.”

We now know that he was wrong. Bush became the single exception to an otherwise solid rule. Maybe that’s because, from the start of the job, he put aside politics. Bush took the early advice of senior agency officers, establishing his main office at CIA headquarters in Virginia rather than in the director’s small suite near the White House. He attended cabinet meetings only when the agenda included national security items—and, even then, he left the room whenever conversations drifted away from those topics. He deferred to intelligence officers’ judgments, becoming their champion with Ford.

If Ratcliffe finds a way to similarly place his views on the backburner and quickly absorb the unique challenges of leading in the intelligence community, he could shatter expectations. But it’ll be a tough climb because of how he got the nomination in the first place.

Unlike Bush, he hadn’t been ambassador to the United Nations or de facto ambassador to China. Ratcliffe’s main qualifications for receiving a nomination from Trump seem to be his aggressive defense of the president and his directed questioning of individuals the president doesn’t like. Back in the summer of 2018, he emerged as one of the most energetic questioners of former deputy assistant director of the FBI Counterintelligence Division Peter Strzok and former FBI lawyer Lisa Page during their depositions to the House Judiciary Committee—about their text messages and related matters more than about the nature of Russian interference in the 2016 election. A few months later, his name appeared on short lists as a replacement for Attorney General Jeff Sessions.

More recently, during Mueller’s testimony to the House Judiciary and Intelligence committees on July 24, he accused the former special counsel of violating “every principle in the most sacred of traditions” of prosecutors. He lectured Mueller that “Donald Trump is not above the law. He’s not. But he damn sure shouldn’t be below the law, which is where Volume 2 of this report puts him.”

And then he went on Fox Business News this weekend to declare that it had been “a train wreck of a week for the Democrats, and it was a great week for Donald Trump because of that.” He even engaged in the president’s favorite pastime, coming up with disparaging nicknames for Judiciary Committee Chairman Jerry Nadler and Intelligence Committee Chairman Adam Schiff, saying they were “starting to look more like Laurel and Hardy.”

Ratcliffe, in other words, came right out of central casting for Trump. But he looks quite different when compared to the men and women who have led the nation’s intelligence efforts for more than seven decades. Should his nomination go forward, senators have many valid questions to ask not only about his political tirades but also about how he plans to overcome his relative lack of intelligence exposure and senior management experience.