The Dictatorship
Democrats need to start thinking beyond Obamacare
The government shutdown is over, and Democrats have failed to obtain an extension of subsidies for plans under the Affordable Care Act. That means premiums will skyrocket for the tens of millions of Americans who get their insurance through the ACA marketplaces. While Democrats look for other ways to save the subsidies, though, the party also needs to lay the groundwork for a bigger fix to America’s broken health care system.
It’s been a decade and a half since President Barack Obama signed the ACA into law, which in turn came a decade and a half after Bill Clinton’s failed attempt at health care reform early in his presidency. For the last 15 years, Democrats have said the same thing about the Affordable Care Act: The law has done a tremendous amount of good, but it’s far from perfect. Despite the ACA’s successes, our health care system is still a failure in multiple ways, and only one party wants to fix it. The time is now to start planning for the next phase.
Every Democratic president in the 80 years since Truman made at least some attempt to move toward universal coverage and containing costs.
In 1945, President Harry Truman proposed that the federal government provide health insurance to all. “Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health,” he said. “Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.”
That time, in fact, kept arriving; every Democratic president in the 80 years since Truman made at least some attempt to move toward universal coverage and containing costs. There were successes along the way, including Medicare, Medicaid and the ACA itself. But most Americans are unhappy with the U.S. health care system as a whole, even if many are happy with their own insurance.
Although health care is typically one of the party’s strongest issues, Democrats have largely been on the defensive since the ACA was passed in 2010. They’ve worked hard, mostly with success, to beat back Republican attempts to repeal or undermine it. This has been a necessary and noble effort: Since the ACA’s passage, the share of Americans without health insurance has been cut in halffrom 16% to 8%. But 27 million Americans are still without coverage. That number is expected to increase dramaticallyboth because of the expiration of enhanced subsidies and because Trump’s “big, beautiful bill” includes massive Medicaid cuts and restricts access to ACA marketplaces.
That means Democrats have no choice but to come up with a new plan they can present to the public for health reform — and it has to be more than just reinforcing the ACA.
This will require both policy work and political advocacy, which was exactly what the party did after Clinton’s reform failed. Health policy experts spent years researching and developing ideas, and by the time the 2008 election arrived, the party had coalesced around an outline of what would become the ACA — a combination of subsidies for people in the middle to buy insurance, an expansion of Medicaid and a mandate for everyone to get covered. While Obama, Hillary Clinton and John Edwards argued about the details in that year’s presidential primary, their differences were minor because they were working from a policy consensus that had already taken shape.
Twelve years later, there was another intense debate over health care in a Democratic presidential primary. And though it seemed in 2020 that there was a gulf between the ideas from progressives, such as Sen. Bernie Sanders’ proposal for a single-payer system, and those from the more moderate candidates, including Joe Biden, in truth the whole party had moved left. Even Biden’s plan, which centered on a public option, was far more progressive than the ACA.
Opponents of health care reforms count on Americans believing that we can’t have anything better.
But once he took office, Biden essentially put that plan in a drawer and never spoke of it again. You can argue that he wouldn’t have been able to pass it through a closely divided Congress, but he never tried to build the support that would have made it possible.
So what should Democrats do now? The answer is that they should spend the next couple of years debating it among themselves. Task the policy experts with devising a menu of options, talk to voters, begin advocacy for real reform and see where support builds. Then, when 2028 comes, have the debate during the presidential campaign when the largest number of Americans are paying attention.
My own preference would be to model our next reform on the combination of public and private insurance that’s used successfully in various forms in countries such as Australia, Canada, France and Denmark. In this system, the government provides basic insurance that covers everyone, and people are free to buy supplementary private insurance if they want more benefits. Liberals like it because of the universal coverage, and conservatives like it because rich people can still buy all the benefits they want.
We could get there by expanding Medicaid — which already covers more than 77 million Americans — to everyone under 65, while allowing seniors to keep Medicare. Yes, there would be many details to work out. And powerful forces will array themselves against meaningful reform — not just the GOP, but the many people, organizations and companies that benefit handsomely from the current system.
Opponents of health care reforms count on Americans believing that we can’t have anything better, or at the very least that it can only be a little bit better. But we know that isn’t true, because every other industrialized country on Earth has a national system that is far less expensive than ours, yet still insures all or virtually all residents.
Last weekend, President Donald Trump proposed sending money to Americans instead of to insurance companies. He later said that people will “feel like entrepreneurs” when they’re “able to go out and negotiate their own health insurance.” It’s an incoherent and nonsensical idea that will only make health care expensive. But Republican lawmakers quickly signaled support, with Sen. Rick Scott of Florida saying he was “writing the bill right now.”
Unlike their opponents, Democrats need to be serious about health care. And that means finding the next big proposal to get closer to a system that all Americans can actually count on and afford. It won’t be an easy process, and it won’t be quick. But that makes it all the more important to start now.
WASHINGTON (AP) — U.S. President Donald Trump and Vice President JD Vance say their interim deal to end the war with Iran will deliver a financial windfall to American farmers.
But the Iranians deny it. And in the absence of more details, sanctions experts are flummoxed over exactly how billions of dollars’ worth of Iranian assets would make their way to the American heartland from the escrow accounts where they’ve been locked for years by U.S. sanctions.
A tentative agreement reached last week would reopen the Strait of Hormuz, through which a fifth of the world’s oil and natural gas once passed, and allow Iran to start selling its oil freely again during a 60-day period when the two countries will continue negotiating key issues. The memorandum of understanding also promised to unfreeze Iranian assets.
Trump’s deal has come under fire for failing to address the reasons the president cited for going to war with Iran on Feb. 28, including curbing Tehran’s nuclear ambitions, its missile program and its support for militant groups such as Hezbollah in Lebanon and Hamas in Gaza.
Lashing back at critics Tuesday on his Truth Social media platform, Trump said U.S. farmers would get a payday: The U.S. Treasury Department, he wrote, would release the Iranian assets “into escrow, controlled by the U.S.A., and will be used for the purchase of food and medical supplies, exclusively from the United States, including Corn, Wheat, and Soybeans from our great American farmers. These are things that are desperately needed by Iran.’’
Vance, who spoke about the proposal after high-level talks in Switzerland, and Trump say that any frozen funds and assets held outside of Iran will be used to buy U.S. crops.
But the Iranians deny that’s part of the deal. A spokesperson for the Iranian Foreign Ministry, Esmail Baghaei, said any agricultural purchases would be based on “prices and quality,’’ not terms dictated by Washington.
“It is interesting that the philosophy and goal of the war, which was the destruction of the Iranian civilization and the collapse of Iran, has become enriching American farmers,” Baghaei said.
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Iran’s ambassador in Geneva, Ali Bahreini, rejected Vance’s contention that the U.S. and Qatar would dictate how Iran uses unfrozen funds. “Iran is the only country who decides what to do with those assets,” he told reporters.
A U.S. official dismissed the contradiction, asserting that Iranian leaders were speaking to their domestic audience. The official spoke on condition of anonymity because they were not authorized to speak on the record.
Joseph Glauber, a research fellow emeritus at the International Food Policy Research Institute, said Iran was unlikely to abandon its other trade partners on food.
Iran’s major suppliers include Brazil, India, Turkey, the European Union, Canada, Australia and Argentina, he said. Trump’s demand to buy from the U.S. would “create some hard feelings with some of our competitors.”
Under previous sanctions, the U.S. has required that money foreign countries spend on imports from Iran — such as South Korean purchases of oil and Iraqi purchases of Iranian electricity — be locked in escrow accounts and typically released only if the Treasury approves and if the proceeds go toward “non-sanctionable’’ items such as food and medicine.
On Monday, the U.S. Treasury approved the sale of Iranian oil, petrochemicals and petroleum products through Aug. 21. It did not mention any escrow accounts.
Richard Goldberg of the Foundation for Defense of Democracies, who coordinated efforts to put diplomatic pressure on Iran in the first Trump administration, said in a post on X that he would welcome “a clarification that Iran is actually restricted to only buying U.S. agricultural products.”
Richard Nephew, senior research scholar at Columbia University’s Center on Global Energy Policy, said it’s unclear what the new U.S.-Iran agreement actually means for releasing restricted Iranian assets.
Could the U.S. require that the assets be used to buy American farm products?
“Well, we can try!’’ Nephew, who helped design Iran sanctions in the Obama and Biden administrations, said by email. “All you really need to do is to tell a foreign bank that they can move the money but only to a U.S. bank to buy soybeans or whatever.”
Banks do not have to comply, he said. If they refuse, the U.S. could sanction them as well.
But it’s rare for the U.S. to conduct itself that way, he added, “in part because we don’t usually like to give the impression that we treat national security issues as a cash grab.”
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Associated Press writers Josh Boak and Michelle L. Price in Washington contributed to this report.
Wednesday marks four years since the Supreme Court issued its landmark Dobbs decisionwhich effectively overturned Roe v. Wade and repealed the constitutional right to an abortion. On “Morning Joe,” co-host Mika Brzezinski explained how the ruling set off a domino effect across the United States, affecting not just abortion-related care, but also altering “the state of women’s healthcare as a whole.”
As Brzezinski noted, states across the country have enacted harsher abortion restrictions since the 2022 ruling, with 13 outright banning the procedure with very limited exceptions. This has created a climate of fear among those who treat pregnant patients, with many healthcare providers worrying that any care involving an abortion could violate the law, even when the mother’s health is at risk.
“We are talking about people dying when they’re miscarrying because doctors are too afraid to intervene and save their lives,” Amy Littlefield, abortion access correspondent for The Nation, told MS NOW.
Brzezinski said the laws have effectively limited women’s “access to lifesaving healthcare.”
The MS NOW host reflected on some high-profile stories of pregnant women who faced delayed care in states with near-total abortion bans, noting “the numbers of cases that we’ve covered here on the show of women who have had their lives threatened, have been forced to give birth to dying or dead babies, and then, by the way, denied the access to ever create life again, because they became sterilized in the process.”
“There’s an image I can’t get out of my head,” Brzezinski added, before sharing reporting from ProPublica about Porsha Ngumezi, a 35-year-old mother who died in Texas in 2023 after not receiving timely care for a miscarriage.
“For months afterward, Porsha’s 3-year-old son would chase after women who looked like her on the street, shouting, ‘That’s Mommy!’” Brzezinski said. “That’s the detail I can’t forget. I can’t stop imagining that little boy chasing after strangers on the street. And that story repeats itself.”
You can watch Brzezinski’s full comments in the clip at the top of the page.
Allison Detzel is an editor/producer for MS NOW. She was previously a segment producer for “AYMAN” and “The Mehdi Hasan Show.”
One of the biggest upsets in Tuesday night’s primaries came in New York’s 13th Congressional District, where Darializa Avila Chevalier, a 32-year-old democratic socialist, managed to beat incumbent Rep. Adriano Espaillat, 71, who was backed by establishment Democrats.
Chevalier, a doctoral student in sociology at the City University of New York, secured 49.4% of votes in the district — which encompasses upper Manhattan, Harlem and parts of the Bronx — defeating Espaillat, who received about 46% of the votes after representing the district for nearly a decade, according to The Associated Press. She now advances to the November general election, which she is presumed to win in the solidly Democratic district.
Chevalier’s primary win marks a major win for the Democrats’ left-wing flank that backed her, including New York City Mayor Zohran Mamdaniwho endorsed Chevalier last month during a joint interview on MS NOW’s “The Briefing with Jen Psaki.”
Here is what to know about Chevalier and the platform she campaigned on.
She has never held elected office
Prior to her congressional campaign, Chevalier had never run or held elected office. But she has been involved with advocating for issues that became political flashpoints, including helping organize the pro-Palestinian encampments at Columbia University, according to her biography on the website of the Justice Democratsthe progressive group that recruited her to run.
The daughter of Dominican immigrants, Chevalier also worked as an organizer for Families for Freedom, a New York City group that assists immigrants facing deportation.
Chevalier earned a bachelor’s degree in Middle Eastern studies from Columbia University in 2016 and later worked as a paralegal, according to her LinkedIn.
Chevalier faced scrutiny during her campaign over previously articulated stances and incendiary comments, including her appearance at a Times Square rally the day after Hamas’ attack on Israel on Oct. 7, 2023, where attendees reportedly suggested the attack was justified.
At a March candidates’ forum, Chevalier declined to condemn Hamas, saying that a request to do so “ignores the 75 years of occupation that the Palestinian people have been subjected to and the conditions that that folks were living under before this genocide began,” the local outlet City & State reported. Later, on local radio station WNYC, Chevalier said she did condemn Hamas when asked, adding, “As far as I know, the U.S. does not send a single dime to Hamas. What we fund is the Israeli military.”
In a series of since-deleted social media posts between 2018 and 2022Chevalier also used expletives to refer to former Vice President Kamala Harris and the Democratic National Committee, calling for abolishing borders and stopping all deportations, according to BLN. Other reports noted that she called former President Joe Biden a “rapist” and disparaged white people in some of her posts.
Chevalier has said she has “grown considerably” since writing those posts and that she regrets them. Mamdani defended her after the social media posts surfaced but said he was unaware of them before endorsing Chevalier.
She’s the left’s preferred candidate
Chevalier’s focus on affordability, expanding housing access and opposing war and deportations made her the preferred candidate of many progressive groups. In addition to the endorsements from Mamdani and the Justice Democrats, she was also backed by the New York City chapter of the Democratic Socialists of America and several progressive members of the New York City Council.
After her primary win, the Democratic establishment also seems to have rallied behind her, despite her previous expletive-laden critiques of them.
In a statement Tuesday, DNC Chair Ken Martin called Chevalier “a tireless advocate for the hard-working people of New York City” who “will fight for healthcare, affordable housing, public education, civil rights, and an economy that works for everyone.”
Julianne McShane is a breaking news reporter for MS NOW who also covers the politics of abortion and reproductive rights. You can send her tips from a non-work device on Signal at jmcshane.19 or follow her on X or Bluesky.
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