Tapped: The Prospect Group Blog

McCain Pulls a Bait-and-Switch on Vets

Almost as soon as Senator John McCain had finished working with Senator Bernie Sanders to craft the veterans’ health-care bill now known as the Choice Act in 2014, the Arizona Republican set out to renege on his promise that Choice would be temporary, and began floating plans to make it permanent. 

Part of the Choice Act was the establishment of the Commission on Care, whose deliberations the Prospect has covered extensively. This week that Commission is meeting to hammer out its final report, which will include recommendations about what the VHA should look like in 20 years. Instead of waiting to see what the Commission mandated by his own bill recommends, McCain has once again jumped the gun. He is lobbying hard for a bill that would not only make the Choice program permanent, but would eliminate any restrictions on veterans’ access to private-sector health care.

McCain’s gift to veterans is a bill misleadingly labeled The Care They Deserve Act. The subject of hearings on Capitol Hill the week of June 23, the bill would make the Choice Act—a three-year experiment enacted following revelations of delays in care at VHA facilities in Phoenix and elsewhere—permanent. Choice allows veterans to seek care from private-sector health-care providers if they face more than a 30-day wait for an appointment, or trips of 40 miles or more to the nearest VHA facility.

Under McCain’s new plan, the nine million veterans eligible for VHA care would be free to use any private health-care facility or provider, for any form of service, with the federal government paying the tab—no questions asked. McCain has gathered seven other Republican sponsors for his bill, all of them pushing the new conservative narrative that the VHA is broken beyond repair. This, of course, ignores reports by a Choice Act-mandated Independent Assessment of the VHA, which documents that its veteran/patients actually receive better care, at lower cost, than millions of Americans who rely on private sector health care.  

What’s wrong with The Care They Deserve Act? Just about everything, which is why many veterans service organizations like the Disabled American Veterans (DAV) and Vietnam Veterans of America oppose the plan, and why the VHA’s own undersecretary for health, David Shulkin, has proposed a more sensible alternative. 

Economists advising the Commission on Care estimate that McCain-style privatization could triple the cost of veterans’ care to almost  $450 billion a year—money that would not be well spent. The VHA’s clinicians and other staff specialize in the complex health problems related to military service, and deal with patients who are older, sicker, and poorer, with more mental health problems that those cared for in the private sector. The average elderly patient in the private sector shows up presenting between three to five physical problems. The “co-morbidities” of a Vietnam vet, for example, can number from nine to 12. That’s why VHA primary care providers spend at least 30 minutes with their patients per visit, compared to the ten or 15 minutes allotted to patients in the private sector. Will private sector providers want to take the time to care for aging, sometimes homeless, often mentally ill, veterans? Even if they do, will they be able to detect the difference between ordinary type 2 and Agent Orange-related diabetes, or be equipped to parse the myriad symptoms of PTSD?

McCain’s bill promises veterans a choice between VHA and private sector care. In reality, it would ultimately erode choice by weakening the VHA option, putting the entire veterans’ health system at risk. The VHA’s current budget is determined by how many veterans use the system and for what services. If far more eligible veterans start using private sector health care, there will be less funding available for VHA services that are unavailable elsewhere, and for maintaining the agency’s highly specialized research and clinical expertise in military-related health problems. As funding for costly private sector care eats up more of the VHA’s annual budget, there will be hospital and clinic closings, along with VHA staff layoffs. To reduce expenditures on veteran health care, Congress may also be tempted to make eligibility for veterans’ health-care benefits even more restrictive than it is today.

If Congress wants to improve the VHA, it should embrace the reform proposals of Shulkin and those Commission on Care members who want to allow veterans access to private sector providers in networks coordinated by the VHA. With luck, this recommendation will appear in the Commission’s June report. Strengthening the VHA, and giving veterans the choice to see outside providers if necessary, would really give veterans the care they deserve.

Is Donald Trump a Bald Bald-Faced Liar?

Elizabeth Frantz/Concord Monitor via AP

 

It is well established that Donald Trump is a liar. Many journalists have documented his consistent disregard for the truth. For example, the highly regarded Politifact points out that 76 percent of Trump's statements are “mostly false,” “false,” or “pants-on-fire” outrageous lies.

But Politifact didn't bother to investigate Trump's comments about one of his most interesting characteristics—his hair. Last year, Today's Emily Sher compiled Trump's statements about this important topic, including this explanation, which Trump tweeted in April of 2013: “As everybody knows, but the haters and losers refuse to acknowledge, I do not wear a ‘wig.’ My hair may not be perfect, but it's mine.”

Last August, at a campaign rally in Mobile, Alabama, Trump said: "If it rains, I'll take off my hat, and I'll prove once and for all that it's mine."

The color, cut, and combing of Trump's hair beg the question: Is the GOP's nominee-in-waiting also lying when he claims that his hair is his own?

In other words, we know that Trump is a bald faced liar. We just don't know for sure if he's a bald bald-faced liar.

This has been the subject of much journalistic investigation and speculation.

In “An Illustrated History of Donald Trump’s Hair,” Vanity Fair offered photos of the evolution of Trump's hairstyle over many years, but came to no conclusion about whether the mop on top was actually his.

In “The 100 Greatest Descriptions of Donald Trump’s Hair Ever Written,” The Washington Post's Monica Hess explored the many ways, over 30 years, that people have categorized and labeled Trump's hair (both color and style), but refused to resolve the question: real or fake?

Earlier this year, for an article headlined “Hairdressers Reveal the Secrets of Donald Trump's Hair,” The New York Post's Doree Lewak talked to Louis Licari, who colored the hair of Trump's first wife, Ivana, for 20 years. Licari told Lewak: “I think it's all his hair—through transplants,” adding, "I saw him several times in the office of Dr. Norman Orentreich in the early '80s,” referring to the specialist who, in 1952, performed the first-ever hair transplant.

In an extensive investigation for Gawker, “Is Donald Trump's Hair a $60,000 Weave?” Ashley Feinberg reached a bolder, as well as balder, conclusion: Trump probably wears a $60,000 hair weave.

In light of Trump's obvious insecurity about his masculinity, his vanity and his narcissism, it will hardly be surprising if an independent PAC tries to get under Trump's skin (and on top of his scalp) by running an ad showing The Donald without any hair, accompanied by the headline, BALD BALD FACED LIAR?”

Trump is likely to go ballistic.

History books might record the ensuing controversy as the Battle of the Mane.

CFPB Takes Aim at Payday Loan Debt Traps

For two decades, the payday loan industry has preyed on low-income workers by offering short-term loans with sky-high interest rates and fees. Now the five-year-old Consumer Financial Protection Bureau is taking the first major steps to curb the sector’s predatory practices.

Under the proposed regulations announced this week, payday lenders must ensure that a borrower can afford the loan and meet his or her major financial obligations and basic living expenses. The rules would also limit the number of times a lender may withdraw money from a borrower’s bank account without reauthorization after two unsuccessful attempts. The final rules are expected to take affect in late 2017.

Typically, a borrower goes to a payday lender company and writes the lender a check for a specific sum of money—on average, Americans write payday loan checks for $375. The borrower then receives cash. The lender cashes the check or, on the individual’s next payday, withdraws the funds from the borrower’s bank account.

Payday lenders do not require borrowers to offer proof of financial ability to repay a loan: To qualify, a borrower only needs to provide checking account details, valid identification, and pay stubs or other proof of employment. The proposed regulations would prohibit payday lenders from providing funds to borrowers who have not been prequalified for short-term high interest loans.

The payday loan industry rakes in $7 billion in fees annually. According to the CFPB, the median fee for every $100 borrowed is $15. Interest rates are astronomical, averaging about 300 percent or higher. Coupled with the repeated attempts to withdraw funds from the borrower’s account, which lenders are permitted to do once the repayment period begins, repaying the loan can quickly become unmanageable.  

“The most profitable borrowers are the ones who can’t repay the loan,” said Mike Calhoun, the president of the Center for Responsible Lending, a nonprofit organization that promotes fair financial practices, during a telephone news conference.

Most payday lenders set up shop in low-income communities and communities of color, areas that often lack access to mainstream banking institutions. “This vulnerability is what payday lenders are counting on,” said Lindsay Daniels, the director of National Council de La Raza’s Wealth Building Initiative.

The payday lending industry is pushing back against the consumer watchdog’s regulatory push, claiming that these businesses provide a vital service to people with scant financial resources. Critics of the industry counter that borrowers have other options. “Even a pawn shop is better than these payday loans,” said Hilary Shelton, the director of the NAACP’s Washington Bureau. “Some credit unions make short-term loans available that are not as nearly predatory or costly,” he added.

However, the proposed regulations are not a cure-all. Daniels says that the regulations don't go far enough to protect borrowers from practices like loan flipping, whereby lenders compel a borrower to renew a loan even though the individual has been unable to repay the original amount borrowed. “We are concerned that people will continue to experience problems because there are loopholes,” she said.

The Hidden Irony of GOP Outrage over the VA Secretary’s Disney Comparison

Poor VA Secretary Bob McDonald. Neither he nor the Veterans Health Administration he oversees can ever catch a break.

On May 23, a reporter questioned McDonald about the VHA’s tracking of patient appointment times around the country. McDonald’s predecessor was forced to quit over allegations of appointment delays and a cover-up at a Phoenix VHA hospital, and McDonald has often been on the defensive about the issue as the agency tries to hire the additional caregivers needed for the influx of Iraq and Afghanistan veterans.

In his response to the reporter, McDonald suggested that in the meantime, the VHA’s performance should be judged by a broader set of metrics. “What really counts is how does the veteran feel about their encounter with the VA?” McDonald said. “When you go to Disney, do they measure the number of hours you wait in line? What is important is your satisfaction with the experience.”

Unfortunately for the secretary, his invocation of the Magic Kingdom triggered a pack-journalism social-media response. The Koch-funded Concerned Veterans for America (CVA), a leading advocate of VHA privatization, immediately denounced McDonald on its website. According to CVA, McDonald showed disrespect for all VHA patients: “The sacrifice that accompanies earning that care is not the same as the sacrifice of taking a road trip to Florida,” the CVA declared. “Shame on Bob McDonald for trivializing veteran wait times this way.”  

American Legion National Commander Dale Barnett was similarly offended. House Speaker Paul Ryan called the remark “disgusting” and “beyond the pale,” a sentiment shared by House Veterans Affairs Committee Chair Jeff Miller, a frequent critic of McDonald and ally of CVA in seeking to dismantle and privatize the VHA. There was even talk of calling for McDonald’s resignation.

After two days of negative news coverage, McDonald, a veteran himself, issued a clarification and apology to any veteran who felt his comments trivialized the VHA’s “noble mission.”

But lost in the Republican baying for more blood was a great political irony: Throughout private-sector health care, Disney’s corporate model for gauging customer satisfaction is now widely used to determine patient satisfaction and to regulate the patient “experience.”

Quality patient care requires an application of skills, experience, and teamwork quite different from the prerequisites for good “customer service” in the hospitality or entertainment industries. Yet treating sick people as “customers” has become part of mainstream management thinking.

The Disneyfication trend took off ten years ago after consultant Fred Lee published the bestselling If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently. Patient surveys using methods and metrics from resort hotels and amusement parks are now the norm in U.S. health care. A hospital’s results on the Hospital Consumer Assessment of Healthcare Providers and Systems standardized survey even determine, in part, its reimbursement rate for federally subsidized patients.

Disneyfication has spawned a huge crowd of high-priced consultants, like Lee, or Quint Studer of the Studer Group, who teach hospitals how to improve their patient-qua-customer experience to score well on questionnaires. As Studer puts it in his HCAHPS Handbook, hospital administrators need to “manage the patient’s expectations” to succeed, by convincing patients they are receiving good personal care—even if the hospital has poor nurse-patient ratios or lousy patient safety records.

In some hospitals, nursing staff trained and managed under this model have been forced to use scripts when interacting with patients and families. They are coached to smile and repeat words and phrases (such as “excellent care”) that administrators want to see echoed in patient surveys.

Some hospitals now designate an employee to be “chief patient experience officer” (CXO), a position enjoying executive status. As CEO of the Cleveland Clinic, Delos “Toby” Cosgrove, now vice-chairman of the VA Commission on Care, has overseen annual patient-experience conferences for the past seven years. Despite having both a CXO and a patient experience office, the Cleveland Clinic has been investigated for patient-safety lapses that almost resulted in the hospital’s suspension from the Medicare program. Some suspect Cosgrove withdrew his name for consideration as VA secretary because confirmation hearings would have led to negative publicity for the clinic.

Inappropriately treating—and, in fact, trivializing—sick patients as customers is a central feature of health-care corporatization, and represents everything the VHA has never been and should not become. If it’s not good for veterans, it shouldn’t be good for any of us. But that would mean Republican critics would apply the same standard to the VHA as they do to private-sector health care. Dream on.

Poll Shows Asian Americans, Pacific Islanders Flocking to Democratic Party

Record numbers of Asian Americans and Pacific Islanders are supporting the Democratic Party, according to a new survey of one of the country’s fastest growing demographic groups. Disenchanted with the rhetoric of Donald Trump and other Republican candidates, this key group of swing voters has taken a hard left turn, which may prove to be a key factor in the 2016 presidential race.

Trump fared poorly in the poll: 61 percent of Asians and Pacific Islanders held unfavorable views of the presumptive Republican nominee. On the Democratic side, 62 percent of those polled viewed Hillary Clinton favorably, compared with 48 percent for Bernie Sanders. The poll also found that voters preferred the Democratic Party in U.S. House and Senate races.

The poll, released on Monday, was conducted by Asian Americans Advancing Justice, Asian and Pacific Islander American Vote, and AAPI Data. The survey, conducted over landlines and cell phones from April 11 to May 17, tallied the responses of 1,212 Pacific Islander and Asian American registered of Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese descent. The poll’s margin of error is plus or minus three percentage points.

The Democratic Party came out on top by a wide margin: 66 percent of Asians and Pacific Islanders surveyed had favorable views of the party; 28 percent of those polled had a favorable view of the Republican Party, a drop of 11 percentage points since 2014.

The survey found that Asian American and Pacific Islanders find topics such as education, health care, the threat of terrorist attacks, jobs and the economy, gun control, retirement security, and the environment as “extremely important election-related issues.” Moreover, the voters surveyed believe that the Democratic Party holds a “sizable advantage on several issues” over the GOP.  

The survey indicates that divisive comments aimed at Muslims and immigrants are shaping voting preferences: More than 40 percent of the Asians and Pacific Islanders polled said that they would not vote for candidates who expressed negatives views about either group. The survey’s authors concluded that “Asian Americans are paying close attention to political discourse,” and “will not vote for a candidate expressing exclusionary rhetoric.”

Asian American and Pacific Islanders have traditionally been swing voters, but they are also the least likely to be contacted by political campaigns: 62 percent of those surveyed reported no contact from Democratic campaigns 73 percent reported no contact from Republican campaigns. 

When asked “Compared to previous elections, are you more enthusiastic than usual about voting this year or less enthusiastic?” 51 percent of Asians and Pacific Islanders responded that they were more enthusiastic—an increase of 24 percentage points since 2014. 

Since the 2012 presidential election, many Asian Pacific Islander Americans have moved into the ranks of eligible voters because they have turned 18 or have become American citizens: 60 percent of new Asian American and Pacific Islander voters gained the right to vote through naturalization.

Asian Americans currently comprise about 4 percent of all eligible voters; By 2044, that figure is expected to increase to 10 percent.

Pennsylvania Offers Clean Slate to Ex-Offenders

Pennsylvania is poised to become the first state in the nation to limit access to criminal records for certain nonviolent offenders. In April, the Pennsylvania General Assembly took up the consideration of bills that aim to help ex-offenders reintegrate into society without the permanent stigma of a criminal record.

Under the Clean Slate Act, people convicted of nonviolent misdemeanors would have their criminal records automatically sealed after ten years. Juvenile records would be sealed after seven years and records for most minor offenses, known as summary offenses in Pennsylvania, would be sealed after five years. People who are charged with an offense, but not convicted of a crime, will have those records sealed after 60 days. Today, eligible ex-offenders must hire an attorney or file a petition to have their records sealed. Nearly three million Pennsylvanians have criminal records.

The Pennsylvania Senate Judiciary Committee voted unanimously to move its bill to the Senate on Tuesday and the House Judiciary Committee is expected to follow suit with its plan, which is identical to the Senate version. The bills have broad support from Democrats and Republicans in the General Assembly as well as from Democratic Governor Tom Wolf. “We’re hearing nothing but three cheers for ‘clean slate’ across the aisle,” says Rebecca Vallas, the managing director of the Center for American Progress’s Poverty to Prosperity program.

The bill garnered praise early on from a bipartisan coalition working on criminal justice reform. “We’re encouraged that Pennsylvania is taking a step forward to improve access to jobs and remove hurdles to educational opportunities for residents across the Commonwealth,” said Andy Hoover, the ACLU of Pennsylvania’s legislative director, in a statement.

Tim Head, executive director of the Faith and Freedom Coalition, a right-wing Christian non-profit based in Georgia, released a statement calling the bill an “important first step in putting a stop to the vicious cycle of incarceration and, instead, providing an opportunity at redemption for those exiting the justice system and working to rebuild their lives.”

A criminal record can hinder a person’s access to housing, employment, and education opportunities, which are critical ways to get re-established in a community. In turn, the failure to get back on one’s feet after being released from prison helps fuel recidivism rates among ex-offenders. State recidivism rates have been declining, but 60 percent of ex-convicts in Pennsylvania re-offend within three years, according to state Department of Corrections data.

Vallas believes that many people will no longer face these barriers under the new law. “I think it is safe to say that it’ll be in the hundreds of thousands,” she says.  Other states are also likely to enact “clean slate” laws. Last fall, Michigan Republican Senator Rick Jones announced his intention to introduce similar legislation.

Veterans’ Groups: Don’t Scrap the VA’s Health Care System

As they meet again in Washington, D.C., this week, the congressionally mandated Commission on Care, tasked with determining a 20-year strategic plan for the Veterans Health Administration, would do well to heed the voices of veterans and veterans service organizations that it has too often sidelined from its deliberations.

In its April meeting, the commission heard from leaders of the largest veterans service organizations (VSOs)—Veterans of Foreign Wars, the American Legion, Disabled American Veterans, Iraq and Afghanistan Veterans of American, Vietnam Veterans of America, Vietnam Veterans of America, Paralyzed Veterans of America, Got Your Six, and Military Officers Association of America. All of them adamantly rejected the dismantling of the VHA, which had been recommended by seven of the commission members in their so-called Strawman Document. 

What the VSO representatives argued for was a program like the one VA Undersecretary for Health David Shulkin has proposed. Within limits, veterans would be able see private-sector providers who have been vetted by the VHA. The VHA would still coordinate the care they receive, thus attempting to integrate private-sector providers into a larger VHA network.

What these VSOs do not want is the kind expansion of the current Choice program envisioned in new legislation proposed by Senator John McCain and sponsored by seven other Republicans. The Permanent Choice Card Act would eliminate current restrictions that limit the program to veterans who cannot get a VHA appointment within 30 days, or who live more than 40 miles from a VHA facility. Under this bill, any eligible veteran can go anywhere, to any private-sector provider, for any condition. This would lead to higher costs and, the VSOs fear, to even more limitations on access to services. Veterans with complex physical and mental conditions would receive no care coordination from the VHA which, given the reality of private-sector health care, would mean no care coordination at all.   

As Rick Weidman, executive director for government and policy affairs at Vietnam Veterans of America, explained at the hearing, care coordination is critical because veterans have far more complex problems than the average private-sector patient. Which is why Weidman also urged commissioners to move beyond anonymous data when estimating future VHA use. Yes, the number of veterans the VHA serves will diminish as World War II, Korean, and Vietnam War veterans die.  The veterans who still use the VHA, however, will be sicker than the average private-sector patient. Most older adults, for example, have three or more problems, while the average Vietnam veteran, Weidman reminded the commission, has nine to twelve, which are both military- and age-related. Iraq and Afghanistan veterans have even more complex conditions.

While some commissioners seemed to be listening, VSO leaders remain concerned about those who persisted in “misunderstanding” their positions, by insisting that VSOs favored removing the current 40-mile or 30-day restrictions on the use of Choice. On April 29, seven of the VSO leaders wrote a follow-up letter to the commission, making it completely clear what they and their members want: “the development of local integrated community networks in which VA serves as the coordinator and primary provider of health care to veterans; non-VA community care would be integrated into this network to fill gaps and expand access.”

In a letter to sent to the commission, a veteran of the Iraq war put it even more eloquently: “Your solution of sending us to private healthcare providers is the wrong direction. … There is no private health care provider office that can offer me this type of care. So just fix our VA because it belongs to us not to the private sector.”

Warren Calls on Banks to Invest in Minority Neighborhoods, Businesses

Senator Elizabeth Warren recently warned that minority families and businesses continue to suffer disproportionately from the lingering effects of the Great Recession and called on the country’s banks to step up to assist local communities.

Warren noted that most Americans experienced severe hardships during the economic downturn. “In 2013, the median income of white households was 13 times that of black households,” she said. But she also underlined the fact that large financial institutions had specifically targeted minority homebuyers with subprime loans that had a devastating impact on their finances.

“The housing collapse destroyed trillions of dollars in family wealth,” the Massachusetts Democrat told the Center for Global Policy Solutions’ “Color of Wealth” summit in Washington last week. “But the crash hit African American families like a punch in the gut.” “White households lost on average 11 percent of their wealth,” she added, “but black households lost over 30 percent of their wealth.” Given these disparities, Warren argued that “the federal government [needs] to make real investments in communities of color.”

The Center has released a study, “The Color of Entrepreneurship,” that documents racial disparities in the business sector. According to the report, racism has blunted the benefits of minority-owned businesses: The U.S. economy continues to forgo about 1.1 million minority-owned businesses due to historic and current instances of discrimination. The report concluded that if those businesses were up and running, they would potentially create nine million jobs and increase the U.S. national income by $300 billion.

The center’s analysis of business ownership survey data from the Census Bureau found that while the overall number of minority-owned businesses grew, the number of firms owned by African American men dropped by 2.3 percent. Black men were the only group to experience a decline.

Minority- and women-owned businesses have also experienced declines in average sales. In 2012, firms owned by men regardless of race had higher average sales than companies owned by women. Among male-owned businesses, white-owned firms saw the highest average sales in 2012, and black-owned firms the lowest. Similarly, firms owned by white women had the highest average sales and those run by black women, the lowest.

Most minority-owned businesses saw a decline in average wages as well. Employees working for companies owned by American Indian women saw a 6 percent drop in average pay, the biggest drop in the survey.

American Indian men and Hispanic men also experienced steep declines in wages, at 5.8 and 5.6 percent respectively. Employees working for firms owned by white women and white men saw a 0.2 percent and 1.3 percent decrease in average wages, respectively. However, workers employed by firms owned by black men saw a 1.2 percent increase in average pay.

The report suggested several ways to close the wealth gap, ranging from tax credits for new minority entrepreneurs (which could attract venture capital) to staving off tuition and fee hikes at state universities so that young entrepreneurs leave college with less debt and more money to invest in a business.

Warren proposed expanding the Community Reinvestment Act, a Carter administration-era reform that encourages commercial banks to invest in low-income communities. Federal officials make “deliberate policy choices that favor those with money and power,” said Warren. “The American people are holding up our end of the bargain. But for too long, many banks have not been holding up their end, and that has got to stop.”

This post has been updated. 

Pentagon Continues to Mull Over Lifting Ban on Transgender Troops

LGBT advocates were elated when Defense Secretary Ash Carter announced that the Pentagon intended to lift the military’s longstanding ban on transgender members, saying that the current policy was an “outdated, confusing, inconsistent approach that’s contrary to our value of individual merit.” Nine months later, the transgender community is still waiting for the department to make its move.

Last July, Carter commissioned a task force to look into the implications of lifting the current transgender service ban and gave the group six months to investigate. At the end of 2015, a Pentagon spokesperson said that the task force’s initial report would be completed in January, but the findings have yet to be made public. (Several media outlets reported that the Pentagon would end the ban on May 27, but department officials have pulled back from that timeline.)

Currently, the military bans openly transgender people from enlisting and public disclosure of one’s transgender status is grounds for discharge. Carter also announced in July a change in the process for discharging currently enlisted transgender service members. The move made it easier for transgender individuals to remain on duty while top Pentagon officials consider lifting the ban, “but it is still unsafe for troops to be out,” says Aaron Belkin, director of the Palm Center, a San Francisco-based research center that publishes reports on gender, sexuality, and the military.

A New York Times editorial noted that 77 service members have disclosed their transgender status to their superiors in the past year. A 2014 UCLA Williams Institute report estimated that there were 15,500 transgender people in the military. After the most recent military force reductions, Belkin now estimates that there are about 13,000 transgender people in active service.

Two years ago, a commission co-chaired by former U.S. surgeon general Jocelyn Elders reported “that there is no compelling medical rationale for banning transgender military service, and that eliminating the ban would advance a number of military interests.”

Recent research bears out those conclusions. According to the Times, a forthcoming RAND Corporation study found that lifting the service ban was unlikely to affect unit cohesion, that only a very small number of individuals would seek gender transition–related medical care annually, and that those costs would be “negligible.”

The Pentagon has been criticized for the delays and for a lack of transparency on transgender issues. Earlier this month, Brad Carson, an acting under secretary of defense who had been the Pentagon’s top civilian official on personnel matters and a key player in the efforts to open the military to transgender service members, resigned after a combative Senate Armed Forces Committee confirmation hearing earlier this year.

Lifting the ban on transgender military service would be another milestone in the Obama administration’s efforts to remove the some of the remaining barriers to military service for certain groups. In 2010, Congress repealed the controversial “Don’t Ask, Don’t Tell’ policy that prevented gay, lesbian, and bisexual service members from serving openly. Last December, Carter announced that all military combat positions, including those in elite units like the Navy SEALs, would be open to women.

Vice President Elizabeth Warren?

AP Photo/Jacquelyn Martin

Senator Elizabeth Warren speaks on Capitol Hill in Washington. Warren, the populist senator from Massachusetts, told The Boston Globe in September that she would likely endorse a presidential candidate during the primaries, but has since remained coy. 

 

The Boston Globe has reported that Hillary Clinton is considering picking a woman running-mate, and the optics suggest that this means Elizabeth Warren. The Globe quotes an on-the-record interview with no less than Clinton campaign chairman John Podesta.

So what’s this about? Is it the Clinton campaign signaling to Sanders supporters that she would reach to her left in selecting a vice presidential candidate? Is it just a trial balloon? Would Warren take the job? And is it a good idea?

I have no inside information. But you don’t put something like this out there without first clearing it, lest you get shot down. Clearly, there must have been conversations with Warren before Podesta just ran the idea up the flagpole.

Would this be a smart move for Clinton? I think it would. For starters, it would energize the Sanders wing of the party like almost nothing else, other than putting Bernie on the ticket.

Second, it would jump start the excitement of a gender breakthrough. Clinton has not produced the thrills that the prospect of the first woman president should produce, because she is kind of old news and a little shopworn. But Warren herself, and an all-women ticket—that would really be something. A double breakthrough!

Wouldn’t it scare off some men? Not much. The men who are not going to vote for Hillary would not be deterred by having a man as her running mate; and there aren’t many more men who would be repulsed merely by the presence of a second woman on the ticket.

Third, it would help in the white working class areas of the Midwest, where the election will be decided. Trump is cleaning up his act, hiring speechwriters, trying to look presidential. If he is the nominee, and the Republicans have, say, a Trump-Kasich ticket, it could be a close election.

Clinton needs shoring up with white working class voters in key states such as Ohio, Michigan, and Pennsylvania. Warren could help.

But is this a good idea for Warren? What if Clinton put her on the ticket, and then mainly ignored her?

This would be a risk for Warren if she accepted a cabinet position. But don’t forget, the vice president is the one person in a president’s administration who can’t be fired.

Warren has her own national constituency. She is a genius at combining an astute inside game with a superb outside game. If Vice President Warren pitched an idea at President Hillary Clinton, and Clinton was lukewarm, Warren is entirely capable of going out and making speeches.

And what about her Senate seat? In the past, the idea of Warren as VP has been seen as a nonstarter because Massachusetts Republican Governor Charlie Baker would get to fill the seat and the new Senate is likely to be Democratic or Republican by a vote or two either way; every seat counts.

But there is more to it than that. Massachusetts law requires a special election within 145 to 160 days after a Senate seat is vacated. So Baker’s interim appointee would serve for less than six months before the Democrats in deep blue Massachusetts took back the seat.

This idea of course is far from a done deal. It’s a trial balloon. Warren has not endorsed either Sanders or Clinton, and it will take a lot of fancy footwork for Sanders not to be offended, for Warren not to feel used just for her symbolic value, and for Clinton as presumed nominee to make a final decision.

But having raised this idea, Clinton now runs the risk of looking like a trimmer if she eventually goes with someone centrist such as Virginia Senator Tim Kaine or another conventional choice.

Clinton, more than anything, needs a shot of excitement and enthusiasm. Warren would surely bring that. And the fact that Warren herself has not closed the door is doubly interesting.

Whadda year!

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