Imagine it is June 2027. We’ve made it through more than half of Trump’s second term and the Democratic presidential primary is in full swing. Fifteen candidates gather for their first televised debate. They’re in Atlanta, Georgia, symbolic of the progress made in 2020 and the ground lost in 2024. The first question from Substacker Terry Moran is for all candidates: “Show of hands—who supports eliminating private health insurance?” Two hands pop up. Other candidates start glancing around the room. Three more hands pop up. Then a few more. You sigh and mumble to yourself, “how did we end up here again?”
This hypothetical could become our reality if Democrats don’t solve our creativity crisis. This piece is my argument for why Democrats need to develop exciting, new policy ideas to win future elections. I’ve also included some thoughts on how we ensure these new ideas are winning ideas.
I’ve been writing components of this piece for a while, though I am finally inspired to press “publish” because of a recent Shane Goldmacher story. He scooped that Andrei Cherny, co-founder of Democracy Journal, has pulled together a board of mostly current or former D.C. think tank leaders to “draft a ready-made agenda for the next Democratic presidential nominee.” Cherny is calling his effort “Project 2029.”
I’m not going to provide extensive comments on Cherny’s project because I don’t know much more about it than what is in the Goldmacher article. I previously wrote about why Project 2029 is a terrible idea for Democrats. Cherny is borrowing the name inspiration from Project 2025, but I’m not sure he is borrowing the underlying concept.
Instead, I want to comment on the larger conversation the Goldmacher piece sparks regarding whether Democrats need new ideas and how we develop new ideas that help us win elections.
Before I dive in, a bit of personal background: I was the national policy director for Joe Biden’s winning 2020 presidential campaign. For a variety of reasons, we were not an especially creative campaign. We won anyways and I am very proud of our policy work. However, a future campaign could be even more effective with a bit of added creativity. The lessons here are learned from my experience and reflection.
Now, back to 2027…
The Great Health Care Debate Demonstrates Why Democrats Need New Ideas to Win
Democrats are moving full steam ahead toward a 2028 presidential primary where support for or opposition to Medicare for All is a key issue, just like it was in 2020.
During the 2020 primary, health care was a top issue for voters. On one side of the Democratic spectrum, Bernie Sanders stood firm on his proposal to establish Medicare for All and end private health insurance. On the other side, Joe Biden opposed Medicare for All. Instead, Biden proposed to create a public option (which he did not successfully enact) and to increase Affordable Care Act premium subsidies (which he did successfully enact). Between Biden and Sanders, candidates took a variety of positions that were mostly on a slippery slope toward establishing Medicare for All and eliminating private health insurance. I’m convinced that Kamala Harris’s flip flopping on Medicare for All and Elizabeth Warren’s inability to explain how she would pay for her health care plan seriously hurt their candidacies.
How did so many 2020 primary Democrats end up on the slippery slope to Medicare for All? One important element of a Democratic presidential primary is that candidates want to explain how they will be different from the Democratic president before them. Campaigning against the current Republican in office is necessary but not sufficient to win. During the 2020 Democratic primary, candidates wanted to explain how they would go bigger than Obamacare.
During the 2028 Democratic primary, candidates are going to want to explain how they will go bigger than Obamacare with the Biden additions. Yes, they can and should talk about how Trump is kicking millions of people off Medicaid and Affordable Care Act-subsidized health plans. But, to win, 2028 Democrats are going to have to do more than critique Trump’s horrendous policies.
Some 2028 Democratic primary candidates will propose Medicare for All and the elimination of private health insurance. They will face the same challenge Warren did (the American people don’t like big tax increases and it is hard to pay for Medicare for All without a big tax increase). I hope a candidate proposing Medicare for All does not win the 2028 Democratic primary. A Medicare for All candidate will likely not win the general election or deliver on that proposal while governing (setting him or her up for a difficult reelection battle).
Some 2028 candidates are going to propose Medicare for All, so the question Democrats need to grapple with now is what the other Democratic candidates can propose to improve health care. If we don’t have an answer that feels like a big and bold leap forward from where we were in the Biden Administration, a larger subset of the Democratic primary candidates will be tempted to start down that slippery slope to Medicare for All.
Democrats need a creative plan to transform our health care system so it lowers health care costs while accomplishing one big goal: give every American five or 10 years of additional healthy life. (Medicare for All would help achieve this goal if enacted, but it isn’t going to be enacted. It will not advance this goal.) I’m working on some ideas in this space and I know many others are, too. If you have ideas and want to collaborate, let me know.
I share this health care hypothetical because it illustrates a point that applies to a broader range of issues. Democrats need creative ideas that will win the support of the majority of the electorate or else candidates are going to run toward less popular ideas in search of something new.
How Democrats Can Foster Creativity That Helps Us Win Elections
Developing new ideas that are also winning ideas takes even more creativity than developing new ideas that are losers. Here are five lessons I’ve learned about creativity that could help Democrats foster creativity that actually helps Democrats win.
Creativity comes from deep expertise and experience.
The best thing I did when I started the White House Office of Gun Violence Prevention was bring in two individuals who were serious experts in gun violence prevention but had never worked on the issue from within the federal government. Before I locked in those hires, some of my colleagues questioned why I was not hiring people with more federal government experience. I had enough federal government experience on my own; I needed the creativity that only comes with deep subject-matter expertise and a fresh look at federal powers.
To come up with new, creative ideas, Democrats need to bring new voices to the table. Yes, we need a new generation of elected officials. We also need a new generation of staff and advisors. A team solely led by policy experts who have worked for the past three Democratic presidents and Hillary Clinton is not going to solve our problems.
I am not proposing that we kick to the curb everyone who has been working in Democratic policy for the past 20-plus years. Experience in the federal government is one type of valuable expertise. However, that expertise will only help Democrats if it is paired with both an openness to learning from what we got wrong in the past and an openness to the leadership of new voices.
In addition, Democrats need to lean on the expertise of people outside of Washington. Policymakers and other political professionals are experts in technical policy changes. We need the expertise of health care providers, scientists, entrepreneurs, industry leaders, and people with other types of technical expertise in order to develop creative solutions that will deliver results.
Democrats also need to defer to the expertise of the American people regarding the problems they face. The lack of socioeconomic diversity among Democratic staff hampers our creativity. We need to learn from Americans who are struggling to make ends meet.
Creativity should focus on solutions, not problems.
We do not need to spend creative energy identifying problems. This is not the moment to come up with some esoteric concern that is intellectually interesting but not top of mind for voters. We already know what people care about most at this moment: lowering costs, reducing crime, and restoring sensible immigration policies. We should spend our creative juices solving the problems that the American people tell us are their priorities instead of trying to convince them to reprioritize.
Creativity does not mean expensive or radical.
Sometimes, when Democrats think “creative” they instinctually think “expensive” or “radical.” But “expensive” and “radical” won’t win presidential elections or elections in purple states and districts. As illustrated by my health care hypothetical, we need new ideas that creatively pull the levers of power to tackle our problems but also have the potential to be popular among the electorate.
Creativity is a process.
Traditional Democratic efforts to develop policy ideas – conferences, journals, working groups – will lead to modest improvements to the same old policies we have proposed in the past. Creativity is not an outcome but a process. We need to develop policy ideas by engaging with the electorate through podcasts and other social media. We need real-time feedback from the American people. By running a creative process that involves the American people, we will also ensure our creativity leads to policies that resonate, not policies that are so convoluted that not even all-star messengers like Pete Buttigieg could sell them to voters.
Creativity requires saying “no” to some ideas.
Democrats should not aim to develop one comprehensive agenda supported by the majority of the party. Instead, we need different parts of the party all putting forward their best ideas as a menu of options for Democratic candidates. Candidates can then select the policies that most align with their values. This menu approach has two key benefits. First, it allows the electorate to decide what is a good idea instead of the Democratic elites who will make the wrong choice. Second, it allows candidates to pick policies they support without carrying the political and fiscal weight of a comprehensive agenda (like Project 2025).
Plus, I am tired of candidates promising a comprehensive agenda of huge policies when we all know they will only deliver one or two big changes. I expect the American electorate feels similarly. It would be refreshing to hear a candidate say their priority in their first term is [insert big policy proposal here] and that’s what they are going to spend their political and fiscal capital on; they will work to make incremental progress on other issues. No president is going to deliver major progress on every problem in a single term, but I bet Americans will take some progress over a bunch of empty promises. Creativity that wins requires sometimes saying “no.”
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I have heard you and Matt Yglesias argue that Medicare for All is a bad idea, but not with a compelling reason why. Voters don't want it? Okay, why not? I don't think it's very productive to lay out alternate proposals without communicating what problem they are meant to solve.
I would've thought that the barrier to M4A wasn't so much voters as medical business interests, and that an adequate solution to that problem might be a gradual switchover: to reduce the age of eligibility for Medicare by one year, every year. In 2016 I was thinking if Obama did that instead of ACA, Medicare would've already covered a whole lot more people by then.
But yes, creativity, let's have more of that.
In looking for new ideas on healthcare, arguing over how to expand health insurance is only a small part of it. Being insured is necessary, but if you struggle to find access to a provider it's only worth so much. The other half of the equation is the supply side. That's going to entail a lot of deregulation in some areas.
Some ideas that I think would be good are raising the cap on residencies by increasing the money Medicare spends on it, increasing funding for the NIH and NSF to find more cures, automatically approving any medicine that's approved in Europe, Canada, Japan or some other place with a legitimate regulator, allowing in more doctors, NPs, PAs and nurses from abroad, not requiring immigrant doctors to go through a residency no matter how experienced they are.
Those ideas will encounter plenty of resistance from established players like the AMA, but they would do a lot of good and could be framed in populist ways, i.e., fighting medical cartels. It goes very well with the so-called abundance agenda, too.