Mediocre policy isn't appetizing to voters
Overly complex policies make it difficult for Democrats to score political victories with working and middle class people. Public benefits should be universal - not just for those are 'poor enough' for subsidies. We are leaving the door open for resentment of our party and the social safety net as a whole, if our policies aren't clear and more means testing is adopted.
Take healthcare, where the ACA has covered over 22 million people who were previously uninsured; the healthcare system is more equitable with its subsidies and patients are more protected now. However, Democrats cannot spike the call after passing the ACA - even though we feel as if we should. It has major warts that make it unpopular with a large portion of country, outside of the disinformation, and there's much more work to do in order to reform the insurance industry and provide a truly universal healthcare benefit. The real world shows us why that's necessary.
I just spent over 2 weeks working at the C-level to select insurance plans for over 200 employees. My business offers the most generous benefits in the area, and is a U.S. based manufactured in central Michigan. The PPO rate went up over 15% and the HMO deductible increased, so we doubled the HRA budget for each employee to help them cope with that increase. We ultimately had to pick Blue Cross, because it has a lock on the state HMO market in Michigan, and having people self insure is still more expensive for them. Employees live elsewhere, but the plans in the exchange in PA and even NY State are terrible; there's no Blue Cross, Aeta, or United Healthcare on the NY State exchange for 2016 - just crappy HMOs, without any out of network coverage.
We also had United Health withdraw its quote, because it could. It didn't want to drop prices to earn our business. It's impossible for a business to budget for these increases every year, and executive time should go to running the business, not insurance. I also have to deal with stepping in the BCBS formulary, because it doesn't have a sweetheart distribution deal with the maker of a drug that I need to live, walk, and work without horrible pain and progressive damage to my body. Hillary's speciality drug plan which, caps drug prices arbitrarily, will result in insurance companies dropping 'higher tier' non-preferred drugs like the one that I need. I make too much for a subsidy.
(never mind medical and student loan debt out the wazoo)
I'm not exactly working class, but a less well off person with my illness doesn't have the resources to fight through a drug prior authorization. That's what motivates me to not settle for mediocrity. I also hear what people say on the plant floor about the "unaffordable care act" - a $3000 deductible is a big deal to a person who works hourly, even though we significantly beat the minimum wage. A woman told me that she wanted to be on her husband's lower deductible insurance, but the ACA took spouses off of plans. We did that, and we own it politically.
There's many people who aren't poor enough for Medicaid, and they can't get ACA subsidies if they work. Many of my friends and family earn too much for subsidies, are still struggling, and need help — even those who the government thinks are well off. They aren't poor enough to received benefits from the U.S. govt., which they pay hard earned tax dollars to, and they resent it. We need to fight for a public option, not mediocrity. We do have a choice in this if we demand better policy.
At least Sanders could compromise by adding a public option to the ACA exchanges - nothing Hillary Clinton proposes represents anything more than surrendering before negotiations and optics.
Alas, Hillary is also proposing to expand means testing and limited, walled garden benefits, to Social Security. It's a program that's universally popular, because everyone benefits. Only the most wealthy Americans mind it a little, but they sure do cash those checks every month. Means testing to increase benefits for vulnerable populations, instead of the majority of working people who haven't contributed much - or anything - to their high fees 401ks, puts the program at political risk. It also pulls it down into America's toxic racial politics and opens to door to killing it.
Hillary's plans don't solve the problems that I see in real life and business, outside of some democratic political talking points, and put faith in government at risk — among the people that our party is supposed to represent and fight for. We have to do better, or we risk losing working and middle class voters by not going the distance to expand universal benefits.
