3 Takeaways From the Chaotic Iowa Caucuses

3 Takeaways From the Chaotic Iowa Caucuses

Printer-friendly version
Plus: Medicare could save billions on insulin
Tuesday, February 4, 2020

3 Takeaways From the Chaotic Iowa Caucuses

Partial results from Monday night’s Iowa caucuses, released late Tuesday afternoon, show Pete Buttigieg leading in state delegates and Sen. Bernie Sanders leading in overall votes, with 62% of precincts reporting.

Sen. Elizabeth Warren was third in delegates and former Vice President Joe Biden, who still leads in national polling, was fourth, well behind the top candidates.

While those results aren’t final — and the candidates have already moved on to New Hampshire — the messy Iowa caucuses offer a few lessons for those focused on health care:

1. A boost for Buttigieg and Sanders. Before the results were released, The Washington Post’s Paige Winfield Cunningham noted that entrance polling indicated that health care was the No. 1 issue for Iowa Democrats — and that Sanders and Buttigieg topped the field with health care voters: “Forty-two percent of caucus-goers last night said health-care is their top issue, according to entrance polling conducted by The Post and Edison Media Research. Of those voters, a quarter said they support Sanders while another quarter were Buttigieg fans.”

2. A win for Medicare for All? The entrance polling also found that 57% of voters support replacing all private health insurance with a single government plan while 38% oppose the idea. “The conservative wing of the Democratic Party has been telling us voters won’t swallow Medicare-for-all once they learn they will lose their insurance,” Matt Bruenig, founder of People’s Policy Project, a social Democratic think tank, told the Post’s Jeff Stein. “But these results show voters are ready for Medicare-for-all. What more is there to say?” Among those who oppose a single-payer plan, Buttigieg was the top candidate, followed by Joe Biden.

3. An opening for GOP critics of Democratic health care plans. The delay in reporting caucus results, and technical and user issues with the app developed to deliver those numbers, led President Trump and others to question Democrats’ ability to govern.

Trump tweeted that the Democratic caucuses were an “unmitigated disaster” and brought up the troubled launch of the Obamacare website. Trump campaign manager Brad Parscale piled on. “It would be natural for people to doubt the fairness of the process,” he said. “And these are the people who want to run our entire health care system?”

Conservative Washington Post columnist Marc Thiessen echoed that point: “If you liked the Iowa caucuses, you’ll love government-run health care. The same party that could not manage calculating the votes of about 200,000 Iowa caucus-goers wants you to trust them with managing one-tenth of the U.S. economy.”

Medicare Could Save Billions on Insulin If It Were Allowed to Negotiate Prices: Study

Medicare spent nearly $8 billion on insulin in 2017, but it could have cut that bill by more than half if it had been allowed to negotiate with drugmakers in the same way the U.S. Department of Veterans Affairs does, according to a new research report published Monday in JAMA Internal Medicine.

The researchers calculated that Medicare Part D spent $7.8 billion (after rebates) on 31 different types of insulin, and then compared the prices paid to the prices negotiated by the VA. If Medicare used the same prices as the VA, it would have saved $2.9 billion. If Medicare used the same prices and a national formulary — a list of approved drugs, which typically cuts down on the number of options while increasing price competition among those that remain on the list — it would have saved $4.4 billion, the researchers said.

More broadly, the researchers found that Medicare would have saved $14.4 billion on the $32.5 billion it spent in 2016 on the 50 costliest Medicare Part D oral drugs.

"Medicare now accounts for a third of all drug spending,” said Harvard Medical School’s Dr. William Feldman, the study’s lead author. “Legislation allowing Medicare to negotiate prices and establish a central formulary would help save taxpayers money.”

Fiscal Policy Still Boosting the Economy, but Not For Long

Tax and spending policies at the local, state and federal levels boosted economic growth in the fourth quarter of 2019, according to the newly updated Hutchins Center Fiscal Impact Measure from the Brookings Institution. Fiscal policy added 0.7 percentage points to GDP in the last three months of the year and is projected to add about 0.5 points to GDP in the first quarter of 2020.

“Fiscal policy has been boosting economic growth modestly for several quarters, and the FIM [Fiscal Impact Measure] is now near its highest values since 2010, when the American Reinvestment and Recovery Act was supporting the economy,” the new Brookings report says.

Starting in the second quarter of 2020, however, fiscal policy is expected to start acting as a drag: “Looking forward, tax and spending policies at all levels of government are expected to be slightly contractionary in 2020 and 2021.” One reason for the negative fiscal impact is that tax payments are expected to rise as a share of GDP in 2020, Brookings says.

Tweets of the Day

Ahead of tonight's State of the Union address, economist and New York Times columnist Paul Krugman said that the Trump economy is benefiting bigly from the government's large and growing budget deficits:

Quote of the Day: Yellen Says US Debt Path ‘Completely Unsustainable’

“The details change from year to year but for more or less the last 20 years at least, what you see is the U.S. debt path is completely unsustainable under current tax and spending plans and the exact way in which it takes off moves around from year to year depending on what happens but that fundamental problem of the U.S. debt path is not sustainable, I think is something that most people don’t understand and I see very little evidence of concern about it in recent years.”

– Former Federal Reserve Chair Janet Yellen, in an interview Tuesday at a Bipartisan Policy Center event

Poll of the Day: What Voters Want to Hear in Trump’s SOTU

From Morning Consult and Politico:

Taxing TV? CBS Will Air a DC Drama Called “Ways & Means”

CBS has reportedly picked up the pilot for a Washington, D.C. drama called “Ways & Means,” starring former “Grey’s Anatomy” heartthrob Patrick Dempsey. No, it’s not going to be about tax policy. Per Deadline:

“Ways & Means centers on a powerful Congressional leader (Dempsey) who has lost faith in politics. He finds himself working secretly with an idealistic young Congresswoman from the opposing party to subvert the hopelessly gridlocked system he helped create; together, they’ll attempt to save American politics… if they don’t get caught.”

Trump's State of the Union is tonight at 9 ET. You can watch it here.

Send your tips and feedback to yrosenberg@thefiscaltimes.com. Follow us on Twitter: @yuvalrosenberg, @mdrainey and @TheFiscalTimes. And please tell your friends they can sign up here for their own copy of this newsletter.


Views and Analysis