In New York’s 19th congressional district, seven Democrats cage-fight over health care
(The second in a series of diaries from the oddest congressional race in America)
Early evening, May 23rd, a fire station in Liberty, New York. Brian Flynn, a Democratic candidate for Congress, is getting ready to hold a town hall on health care issues.
Flynn, a businessman and former Citibank executive who personality-wise resembles the engaging Dave version of Kevin Kline, chose the right spot to talk about health care. Liberty is in Sullivan County, which for the eighth straight year was just ranked the second-unhealthiest county in New York state.
This area used to be home to a thriving hotel and resort business but is now mostly an economic dead zone chewing up map space between cities – in this case between relative metropolises Binghamton and Poughkeepsie. The county went for Trump 55-41 after going 53-45 for Obama in 2008. Flynn understands why.
“It’s not about Trump. He’s the result, not the cause,” Flynn, himself a well-to-do businessman, sums up. “In my opinion it’s been going for 40 years. And we’ve ignored the American worker.”
He goes on to say Democrats have done a bad job in small towns and rural communities, that the party needs to own this, and that the failure of both parties to pay attention to signs of decline – which include women making a “fraction of what they’re owed” and government “doing worse by communities of color” – has led to widespread anger, skillfully taken advantage of by Trump.
“Arthur Miller says betrayal is the only truth that sticks,” he says. “When I’m out there talking to people, I say, ‘Hey, I get it. I understand exactly why you voted for him.’ And then I basically say, ‘But listen, we’ve learned our lesson. We own it. But they betrayed you. They said they weren’t gonna try to take away your health care; they did. They said they were gonna cut taxes for you; they cut it for the rich.'”
One of the ways to get these voters back, Flynn says, is by making proposals that are tangible and easy to understand. The health care debate is a great example.
There are seven Democratic candidates in this primary race, and five of them, including Flynn, say they are in favor of Medicare for-all legislation.
This is remarkable – “unheard of” is the way one Hill aide put it to me. Not long ago, Medicare-for-all was at best a fringe position in the Democratic Party. At the start of the 21st Century, there was exactly one Senator pushing universal single-payer concepts, Paul Wellstone. Now, Bernie Sanders has 15 co-sponsors for a Medicare-for-all bill.
But the Senate still seems to be lagging behind its electorate. Polls show 74 percent of Democrats now support a single-payer plan.
Flynn, who’s the second-leading fundraiser in the race at $1.4 million, says he is unequivocally a Medicare-for-all candidate. His two main rivals in terms of money raising are former Akin, Gump associate Antonio Delgado (the leader at over $1.9 million) and Iraq vet and cyber-surveillance contractor Pat Ryan ($1.3 million). Both are more equivocal on the health issue.
“As you know, two of the guys running don’t believe in [Medicare-for-all],” Flynn says. “And I’m like, ‘What? Are you kidding me?'”
Flynn goes on, referencing some other popular Democratic positions on health care from the past, which tended to hint at full coverage as a future target, rather than a realistic present goal.
“When anyone talks about universal coverage or universal access or whatever,” he says, “it’s complete bullshit.”
A few minutes later, the town hall starts. Flynn has put together a local five-person committee of doctors and health care professionals to advise him. They’re seated at the front of the hall and all five offer spirited arguments in favor of a Medicare-for-all system.
The panelists offer all the standard talking points in favor of the program: They say giving Medicare to all would lower costs by putting everyone in the system, that it would improve outcomes by stepping up preventive care, and it would eliminate bureaucratic waste by putting the labyrinth of roughly 6,000 different insurers under a single unified billing system, and so on.
Flynn himself adds some interesting tidbits. He wonders why we’ve allowed ourselves to be conditioned to expect our employers to be tied to our health care. He asks: By that logic, why don’t they insure our cars?
“It’s creepy,” he says.
About a half-hour in, a woman raises her hand.
“Is your Medicare-for-all the same as all the other Democrats’ and progressives’ Medicare-for-all?” she asks.
There’s silence in the hall.
“Or,” she goes on, “are they different versions of them?”
“Is she a plant?” another woman in the crowd asks. The room breaks out in laughter.
Are all Medicare-for-all positions the same? And why is it suddenly so popular?
Marlboro, New York, a place called Frank’s Village Market & Deli. They make very good chili here. A guy who used to work behind the counter as a kid, the still very young-looking former gubernatorial aide Gareth Rhodes, is talking health care. You can eat up a lot of time rattling off depressing statistics about the crisis in rural health services, and Rhodes has some doozies to rattle off about the 19th.
“Delaware County is bigger than the state of Rhode Island,” he says, “and it has no maternity wing.”
He notes neighboring Schoharie County doesn’t have maternity services, either. That means a contiguous area nearly twice the size of Rhode Island – over 2,000 square miles – has little to no prenatal care.
A lot of this has to do with the fact that birthing services are incredibly expensive. And even insured people are not always covered for births, leaving the insurance business with little incentive to pony up for “luxuries” like epidural pain blockers (which can cost $1,000 a pop).
This echoes something that a New Paltz-based doctor named Maggie Carpenter said at Flynn’s panel: “The only people who can give birth in some of the counties around here are people who’ve chosen midwives to deliver at home.”
Rhodes goes on: “There is no financial incentive to have a maternity ward in Delaware County … We’re the wealthiest country on Earth and we’re giving birth in emergency rooms?”
Rhodes is an interesting character. He was raised in a nearby Bruderhof community, which resembles a less intense, less bearded, more motorized version of the Amish. “Similar to, like, the Mennonites,” he says, shrugging.
The Bruderhof are socially conservative but don’t wig out about members exploring non-Bruderhof existence, which Rhodes did early in life, moving to an apartment up the road and then walking south until he knocked on the door at this very deli to ask for work.
Rhodes does not give off a sectarian vibe. He seems more like that guy we all knew in high school who was doing extra-credit AP-history projects and raising money for Haitian earthquake victims while you were doing bong hits. He worked in the Obama White House when he was about nine and is now taking time off from Harvard Law School to run for Congress. I desperately want to hate him, but it’s not happening.
Rhodes’ campaign strategy is to visit each township in the geographically enormous 19th district by Winnebago. It’s an old political trick. Iowans even have a name for it: The “Full Grassley,” after Senator Chuck’s annual tradition of visiting all 99 counties. (Rick Santorum, before the Iowa caucuses, was another devotee and Beto O’Rourke is doing it down in Texas as part of his quest to unseat Ted Cruz.)
The “Full Rhodes,” however, sounds less like a frat stunt than a fact-finding mission. The stories Rhodes tells of the information gathered in his travels around the increasingly impoverished/isolated nooks and crannies of this New Jersey-sized district sound like a Star Trek episode about a visit to Planet Fucked.
Many of the counties and towns lack public transport, EMTs or doctors. A carpenter cuts his hand open and has to have a nurse practitioner fix it up with the aid of a faraway doctor on Skype.
Many of these places have been lost to Democrats for a while. Rhodes describes a visit to the district’s northernmost town, St. Johnsville, which had a whopping 23 Democrats vote in the last congressional primary.
“I went to this bar called Cosmo’s, and everyone had this orange wristband that cost $5,” he says. This town, where about 2 of 3 voters went for Trump, was raising money for a local girl who couldn’t afford her third round of chemo.
“Everywhere you turn, it’s a spaghetti dinner,” he says, referring to the fundraising efforts.
Rhodes slides one arm forward to show that he, too, is wearing an orange wristband. The cynic in me feels like a movie date just noticing an arm around her shoulder, but Rhodes doesn’t come across as manipulative, just very serious. He goes on to point to the St. Johnsville visit as illustrative of the problems facing Democrats.
“It struck me sitting there, this is who the Democratic Party is,” he says. “This is union town, union workers. This is a town that’s united around the need for some sort of better healthcare system. Yet no Democrats go here.” In sum: “This is why I’m a Medicare-for-all person.”
We go knocking on doors in Marlboro. The first person we meet is a Republican who bitterly notes that he and his wife are paying a collective $2,400 a month for health care. Later, a physical therapist complains she can’t get insurance companies to reimburse her.
At a sporting-goods store up the street, the shop’s husband-and-wife owners angrily complain they were doing “just fine before Obamacare.” They tell a tale of being excluded from a state insurance program because their household income was too high.
The punch line there was that the state officials, in determining the shop owners’ qualifications, couldn’t tell the difference between gross and net income, leading them to repeat a common conservative talk-show trope: “We’d be better off if we didn’t work at all.”
Rhodes does not mention expanding Medicare in this visit, but says merely that he’s going to “fight for a better system.”
The Medicare-for-all debate is the perfect window into the widening divisions within the Democratic Party.
It was not long ago, after all, that a popular new president named Barack Obama was using every last penny of political capital to pass the Affordable Care Act, the signature accomplishment of his administration.
The ACA was a political magic trick of gargantuan, Copperfieldian proportions. Delivering something one could describe as affordable full coverage without alienating big-dollar donors from either the insurance or pharmaceutical industries was a nearly impossible task.
It was like trying to walk across Manhattan without laying eyes on a taxi, or passing a bill reining in Internet surveillance while being sponsored by Google, Facebook and Amazon.
You had to hand it to the Democratic leadership for the sheer stones required to even try to pull this needle-threading act off.
Nonetheless, the serpentine contortions the bill had to make on its way to law left it full of problems. This is why an exultant Obama upon the bill’s passage still made sure to point out that his signature bill was unfinished – “just a first step,” he said, like “a starter home.”
Over time, though, the unmade steps in the ACA fostered divisions within the party. How can you pass health care reform and leave in place a rule prohibiting Medicare from negotiating lower drug prices? Or: How do you do it without ending the antitrust exemption for insurance companies? Without allowing for drug reimportation?
These carve-outs were essentially subsidies left in the ACA to buy off the cooperation of the for-profit health lobby, which had memorably killed off the previous effort to pass a health bill during the Clinton years.
This is why the Affordable Care Act is considered both Obama’s greatest achievement and his greatest failure. Incredibly, surveys show both Democrats and Republicans feel this way. The sweet spot for discontent seems to be among people not quite poor enough to be eligible for Medicaid, not old enough for Medicare, and also without the right employer – typically, the employee of a small business.
As the income inequality problem worsened, and fewer and fewer small businesses could afford insurance, this pool of unhappy people has grown more vociferous. This is one of the reasons Medicare-for-all has gained momentum in both the House and the Senate.
As with most controversial Democratic Party issues, the bitter health care debate mostly comes down to money. The ACA, conceptually, was the working-with-business vision of universal health care. Medicare-for-all is the screw-the-donors version.
This is why many candidates extol Medicare-for-all intellectually, but see it as too difficult a political goal to reach at present. The argument is really about when to start pissing off the health lobby: now, or later.
Thus there’s an element to this race that will involve evaluating a candidate’s willingness to infuriate an entrenched bureaucracy in the here and now. If that’s the criteria, there’s not much question which candidate in the 19th is the clubhouse leader.
Watching Jeff Beals wrangle with the Democratic Party and its slate of primary candidates is like watching a gibbon let loose in an Aristocrats’ ball: Bits of silver crashing against the walls, food flying everywhere and landing in wigs, screams and screeches, etc.
The other Democratic candidates talk a lot about focusing on the Republicans and being nice to each other. But the Woodstock history teacher, who is endorsed in this race by the Justice Democrats and has just picked up the endorsement of People for Bernie, another national Sanders group, isn’t much for kumbaya. He seems as determined to be an Uncontrolled Variable as party officials seem to be to shut him up.
On health care, Beals baldly says many of his opponents are full of shit on Medicare-for-all. He singles out Flynn for particular disapprobation.
“Flynn is desperate to frame this issue as, ‘Five of the seven support Medicare-for-all,’ so he can wound the other two high-roller corporate candidates [Delgado and Ryan], and assume the mantle of ‘most-financed progressive,'” Beals says. “In fact, he’s just like his big-money peers but infinitely more brazen in his PR.”
Beals and Flynn have had a number of dust-ups in the race. One involved a candidates’ debate in December at Bard College.
A local group with an impressively verbose name and acronym was one of the hosts of the debate: “Indivisible The Fight Is On (ITFIO).” The debate had been a largely placid Democratic handholding session until Beals interrupted with a pointed set of remarks, aimed mainly at Flynn.
“We don’t have enough jobs, and the jobs that we have aren’t what they should be, because of corporate power and corporate greed,” Beals began.
“These problems are inside the Democratic Party, too,” he said. “Some of the candidates up here, one of them shut down a factory in Buffalo and moved jobs to the Dominican Republic, and moved his corporate headquarters to North Carolina…”
Beals didn’t mention the candidate by name, but he was referring to Flynn, who not long ago was the president of a Buffalo-based company called AccuMed, which made medical equipment – primarily textiles, medical sleeves and slings. In 2016, the company did indeed move some of its jobs out of Buffalo.
Much of AccuMed’s manufacturing is done in the Dominican Republic, with some of the factories located in the infamous town of Bajos de Haina, the subject of a documentary called City of Poison for its environmental record. It should be noted that many of these operations existed before Flynn ever got involved with the company.
In December 2016, AccuMed was sold off for $149 million to a Michigan-based company called Lear. Beals believes Flynn personally profited from the export of New York jobs, which Flynn denies.
“Like many other employees, my stock options vested when [the] Lear corporation bought the company,” Flynn replied when asked about this. “I received appropriate compensation from AccuMed in the neighborhood of $1 million, but nowhere near $146 million.”
As for the question of moving jobs out of New York: “AccuMed did not move jobs from the U.S. to the Dominican Republic. The 65 jobs mentioned [in a Bizjournals.com article] were part of a sale of a division to a Swedish company that transferred those jobs to the DR.”
He went on:
“Like most Democrats, I believe in the fair trade movement. In fact, Mr. Beals suggested recently that we need to help with economic development in Latin American countries in order to decrease undocumented immigration. That is exactly what we did in the Dominican Republic: We created hundreds of good paying jobs for people previously living in extreme poverty.”
Flynn is likeable in person. He has an effortless delivery and would be exceedingly marketable to liberal audiences as a businessman with a conscience. But I created jobs in the Dominican Republic to help decrease undocumented immigration is a weirdly maladroit answer to a question he’ll certainly be hit with if he makes it to the general election.
After the debate Beals, like the other candidates, received a letter from ITFIO indirectly chastising him for being, well, divisible.
It was a reminder that he should “promote [his] candidacy by focusing on why you should be selected and not by critiquing or disparaging your rivals, regardless of your own personal reservations about their qualifications.”
They went on:
One key factor in a successful Democratic campaign must be a united, harmonious and collegial commitment on our part… meaning that our leaders – yourselves included – must sublimate short-term tactics to shared strategic goals.
The letter summed up by quoting the Bible: “As the Book of Proverbs has it, ‘He that troubleth his own house shall inherit the wind’ – we’d prefer that one of you inherit district 19!”
Har! Beals was also told by the chair of the Dutchess County Democrats to stop committing “Dem-on-Dem violence.” When I reached said chair, Elisa Sumner, she said, “They have to be respectful. Jeff has not been respectful about his Dem-on-Dem violence.”
Later, ITFIO issued another warning, via its website, to the candidates, calling upon them to set aside their “petty differences.” They also noted that winners in primaries around the country “skew decidedly progressive” and that “observers wonder if this will hurt the chances of Democrats in November.”
The group even issued a Facebook statement worrying that negative campaigning might “creep in” and that if it did, you should behave as you might after spotting potential terrorist activity: “When you see something, say something.”
Just before press time, it got even weirder, as Beals was asked to sign yet another pledge asking him to be nice to his opponents. This pledge denounces “attacking Democrats with Trumpian tactics.” Co-signed by a bevy of local and state Democratic groups, including ITFIO, Democracy Matters and Blue Streak, it read, in part:
Today, the following Democratic activist groups, [INSERT NAMES HERE], and Democratic leaders [INSERT NAMES HERE], stand with Democratic candidates [INSERT NAMES HERE], who have all committed to running positive campaigns and to stand together against negative attacks from outside groups…
Beals refused to sign, saying, “Why don’t they send around a pledge where every candidate running as a Democrat pledges to support Medicare-for-all?”
One of the reasons Democrats have underperformed nationally for over a decade now is the party’s fear of internal debate. It has created a candidate-selection process that heavily emphasizes money and platform orthodoxy, and has repeatedly nurtured its candidates in intellectual bubbles, protecting them from hearing outside criticism.
This was the major problem with the “Deplorables” incident. It wasn’t necessarily that Hillary Clinton was wrong about many of Donald Trump’s voters, but more that it showed the intellectual bad habits one develops in echo chambers of internal non-criticism: If we lose, it must be because the voters suck, not us.
Beals may be a pain in the ass, but forcing Democrats to ask questions about who they are and why they’ve been losing isn’t “violence” – it would seem more to be his job, as a politician.
Another dynamic in play here is a basic difference of opinion about the definition of “Dem-on-Dem” violence.
This label never seems to apply to criticism of insurgent candidates, who are often accused of being “unserious,” “unrealistic,” “angry” or irrelevant except as a source of potential damage to the “real” candidates.
The “scorched earth” opposition paper against Texas progressive Laura Moser was an infamous example. Same with the even more damning incident in which Congressman Steny Hoyer was captured on tape trying to talk Colorado progressive Levi Tillemann out of challenging DCCC-endorsed corporate lawyer Jason Crow.
In that incident, Hoyer bluntly told Tillemann the Democrats would continue to shovel money to Crow because “a judgment was made very early on” to support him, and Hoyer hoped Tillemann would drop out because “it is not useful to the objective to tear down Crow.”
Such behavior is rarely described as “Dem-on-Dem violence” because the insurgent candidates are not really considered Democrats – at least not until they follow Barack Obama’s parting advice to “fed up” Democrats and express their disappointment with elected officials by running for office.
The distinction between Democrats, and Democrats who are only considered Democrats when they’re committing “violence” against other Democrats, may correlate to the Medicare-for-all issue. Tillemann was for Medicare-for-all, as was Moser, as is, of course, Beals.
Of course, Flynn says he’s unequivocally in favor of Medicare-for-all, as his panel discussion seemed to indicate. He said that he had some minor issues with the House version sponsored by John Conyers, H.R. 676, and that he was closer to the Senate version offered by Bernie Sanders. “You reconcile bills, that’s what you do in Congress,” he said.
At this, Beals scoffed: “We are running for the House of Representatives, not the Senate. If Flynn doesn’t support H.R. 676, then he can’t be counted on to pass Medicare-for-all. Period.”
When I asked Flynn about his clashes with Beals, he laughed. “Jeff’s a friend,” he says. “We play basketball together.”
Beals, humorously, wouldn’t even concede to this.
“The Y is [candidate Dave] Clegg’s haunt, and 20 minutes from my place,” he says. “I went to play with him. Flynn showed up. He drove about an hour in the snow.”
As for his “Dem-on-Dem violence” and the consternation caused by raising questions about Flynn’s Dominican businesses, Beals quipped, “How dare you ask about the DR?” he said. “Don’t you know he once drove a Volt?“
Beals was referring to an email circular sent by an environmentalist group, which highlighted the fact that Flynn had once driven an electric-powered Chevy Volt 10 years before it was fashionable.
Basketball aside, the Beals-Flynn fracas reflects an increasingly bitter subterranean struggle between two factions of the Democratic Party. Both seem to be jockeying for ownership of the semantics around Medicare-for-all, if not the actual policy.
Sanders, for instance, made Medicare-for-all a centerpiece of his 2016 run. He has always favored some version of a universal single-payer plan, going back over a decade, to his days in the House.
A Democratic Party-aligned group, the Center for American Progress,
has its own version of “Medicare-for-all.” It’s called “Medicare Extra for All.” This plan would allow everyone access to Medicare, but also preserve a choice for employer-based insurance.
In fact, just like the race in the 19th, there are five different Democratic Medicare-for-all proposals floating around the Hill these days.
This dizzying smorgasbord includes a “Medicare buy-in” plan by former Clinton running mate Tim Kaine, a “Medicaid buy-in” plan from Hawaii Senator Brian Schatz, and a different/expanded “Medicare buy-in” plan authored by Oregon’s Jeff Merkley and Connecticut’s Chris Murphy.
What makes this hard to sort out is that Democrats have a long history by now of favoring progressive-sounding positions during primary seasons, only to walk policies back in the general, or once in office.
Progressives turned out in droves for candidate Barack Obama, who promised many things on the trail. But President Obama ultimately didn’t close Guantánamo Bay, allow drug re-importation, end the carried-interest tax break, or fulfill a host of other promises, many of them on health care.
This history puts Democratic voters in the nearly impossible position of having to sort through a gaggle of candidates who may all be saying literally the same thing on the issue most important to them. Voters will be forced to make a subjective decision based upon which politician they believe means it the most. The candidates seem to understand this.
Rhodes, for instance, doesn’t just say he’s for Medicare-for-all. He travels much further down the road of intellectual belief, saying the health care question won’t be fixed as long as private insurers are allowed in the game.
“If your policy proposal is already the worst compromise there is, where are you going to end up?” he says. “Corporations are required to make money for their shareholders. While that’s the case, we’re never going to fix these issues.”
Some of the other candidates, on the other hand, use language like “a pathway to Medicare” (Erin Collier, who now speaks more unequivocally in favor of the program) or “moving in the direction of” Medicare-for-all (Delgado) or “steps… to ensure universal coverage for every American” (Ryan).
Clegg, the trial attorney who has lived in the district for the longest, seems to have been made a full convert on the issue 36 years ago, when his daughter was born with a life-threatening illness and insurance companies initially wouldn’t cover her pre-existing condition.
“All those who say they’re just going to incrementally improve the system,” Clegg says, “are just making it worse.”
Even Beals doesn’t doubt Clegg’s stance on this issue. The two men just differ on who will be most able to take on the health lobby.
There are a few lessons to be drawn from the health care debate in the 19th.
One is that there’s undeniably still a major health crisis in America, with huge portions of the country under-serviced by health care providers, which surely contributed to the discontent that fueled Trump’s election. That Trump immediately tried to reverse the Obama “step” toward universal coverage is immaterial – in 2016, anyway, he was still able to seize on this anger.
The second is that the Democratic electorate, in a relatively short time, has moved very far in the direction of demanding a full-blown, government-run single-payer universal health care system.
Some want to say that this is the influence of the 2016 Sanders campaign, but it seems just as likely that it was the other way around, that the Sanders campaign simply resonated with a movement that had already begun. The situation may just be so desperate that voters no longer have time for a policy “starter home.”
Which leads to the third obvious lesson of this race, which is that the next generation of Democratic candidates, on health care anyway, already sounds much different than the previous one.
“There’s a lot of people trying to get the progressive vote,” is how Clegg puts it. “And it’s a little hard for the voters to differentiate on the issue.”
Clegg, whose daughter is now 36 and volunteering for his campaign, knows full well how much of a mark the issue can leave on people, and how intense the anger toward the health industry can be. He experienced it himself.
“They put their profit over the life of my daughter,” he said. “And that’s something you don’t forget.”
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