By Branco Marcetic for Jacobin Magazine. Photo: BRENDAN FITTERER | Special to the Times. Some attendees at a meeting with Rep. Gus Bilirakis, R-Palm Harbor, last month favored expanding Medicare. Ironically, the GOP could end up clearing the way for single payer.
Single-payer health care has always been a goal of the Left. But Democrats have turned it into a punching bag.
Establishing some sort of universal health care in America has been a cherished goal of the broad left since at least as far back as Harry Truman’s administration, when a proposal for a single-payer national health insurance system was buried under a barrage of right-wing, red-baiting attacks. Since then, while president after president has tried and failed (or, more recently, simply abandoned) similar efforts, most liberals and Democrats have persisted, at least rhetorically, in fulfilling Truman’s now-seventy-two-year-old promise.
That is, apparently, until now.
The possibility of achieving single payer is “a bigger problem” than America’s already broken health-care system, according to one Democratic governor; it’s a boondoggle that would require a “massive tax increase,” says a Colorado senator; one liberal commentator charges that it “doesn’t make sense,” and shows an “indifference to real-world consequences.”
The push for “Medicare for All,” one high-profile liberal pundit tells us, is simply based in “outrage that private insurers get to play any role,” and aims to “punish or demonize insurance companies.” Oh and by the way, it’ll “never, ever come to pass” anyway, according to the Democratic Party’s former standard-bearer. How times have changed.
Hearts and Minds
To be sure, the attempt by some Democrats to “triangulate” on health-care reform isn’t exactly new. When Jesse Jackson and his Rainbow Coalition challenged the Democratic establishment back in the 1980s, with a single-payer system one of their chief demands, the center-right Democratic Leadership Council used its new influence to push the Democratic Party rightward.
Virginia Democratic senator Chuck Robb, one of the DLC’s founders, warned in 1989 that “policies forged in the economic crisis of the 1930s and the social and cultural schisms of the 1960s” were irrelevant to most Americans. Two years later, Bill Clinton’s issue director Bruce Reed, who doubled as policy director for the DLC, made sure to distance Clinton from single payer.
The issue flared up again during the 2008 Democratic primary fight, where both Obama and Hillary Clinton tried hedging their bets. Clinton put forward a plan that was basically Obamacare while insisting that “Medicare for All” could still be on the cards under the right circumstances. Meanwhile Obama repeatedly flip-flopped, at one point telling an audience that “the Canadian model won’t work in the United States” and that “we’ve got to develop a uniquely American approach,” and nine days later hinting to a different audience that over time single payer may be on the table.
DLC leaders felt reassured however, telling the New York Times they were “pleased that none of the Democratic candidates supports a single-payer health-care system.”
So Democrats’ attempts to quell their base’s clamoring for a comprehensive, public health-care system isn’t new. What is new is the open, public disparagement of such a goal — not just by Democratic leaders, but by leading liberal commentators, too.
Ironically, this appears largely to have been due to the Sanders campaign — or rather, the challenge it posed to Hillary Clinton’s previously wide-open road to the White House. Needing to differentiate herself from Sanders’s unabashed progressivism, and to dampen popular enthusiasm for his message, Clinton began attacking his policies, despite her historic sympathy toward single payer.
Sanders’s proposals were “ideas that sound good on paper but will never make it in real life,” she told crowds; for good measure, she insisted that single-payer health care “will never, ever come to pass.”
Two years earlier, she explained her opposition to the policy on the basis that “we don’t have a one size fits all; our country is quite diverse.” In January 2016, she warned breathlessly that Sanders’s plan would “end all the kinds of health care we know” and claimed it would “send health insurance to the states,” while her daughter warned that it would “dismantle Obamacare” and “strip millions and millions and millions of people off their health insurance.”
As late as October, Clinton’s team was still trying to distance herself from Trump’s accusation that she — heaven forbid! — “wants to go to a single-payer plan,” with her spokesman directing Politifact to an earlier fact-check confirming her lack of support for the policy. (Lest we mistake this for mere expediency, we can rest assured that at least some of the Clinton camp really felt this way: campaign manager John Podesta declared in an email to ThinkProgress editor-in-chief Judd Legum that Sanders’s “actual proposal sucks, but we live in a leftie alternative universe.”)
These doomsday warnings didn’t seem to sway the public. By May 2016, Gallup polling found that more than half of Americans favored replacing Obamacare with a single-payer system, including a whole 41 percent of Republicans.
The same can’t be said for well-placed liberal columnists and Democratic lawmakers, who during —and since — the Clinton campaign have followed her lead and continued pouring cold water on the idea.
New York Times columnist Paul Krugman’s about-face on the issue, for instance, is well-documented. Krugman went from regularly writing screeds about the superiority of entirely government-controlled health care to insisting that “single payer just isn’t a political possibility” and running column after column attacking Sanders’s policy.
To be fair, Krugman had always been wary of the political feasibility of single payer, writing in 2007: “In an ideal world, I’d be a single-payer guy. But I see the chance of getting universal care, imperfect but fixable . . . And I want to grab that chance.” But by 2016, Krugman’s criticisms of single payer went beyond this, at one point cautioning that “switching to single payer would impose a lot of disruption on tens of millions of families who currently have good coverage through their employers” and warning of tax hikes on the middle class.
The same man who once called an anti-health-care reform editorial “vile and stupid” and charged that the “greed of the medical-industrial complex” was the only thing standing in the way of universal health care in the United States began complaining about “demonization” from the Sanders campaign, accusing it of painting “anyone raising questions about the senator’s proposals” as “a corrupt tool of vested interests.”
Krugman wasn’t as concerned about civility back when Obama abandoned the public option element of his health-care plan in 2009, complaining that “the inspiring figure progressives thought they had elected comes across, far too often, as a dry technocrat,” calling him “weirdly reluctant to make the moral case for universal care” and defending the “progressive backlash” over his falling short. (Puzzlingly, seven years later, Krugman praised Clinton as being “pretty good” on policy for having a proposal that was identical to the final version of Obamacare that 2009-era Krugman appears so disappointed with).
Krugman was by no means the only one. In January 2016, the centrist Brookings Institution called single payer an “impossible (pipe) dream,” something that “was, is, and will remain a dream,” because “it is radical in a way that no legislation has ever been in the United States.” A month later, New York magazine columnist Jonathan Chait complained with respect to Sanders’s single-payer proposal that Sanders was “not merely pushing the envelope of policy imagination,” but had a platform “predicated on completely ignoring mainstream economic analysis.” (Curiously, nearly half a year earlier, Chait had lamented that “socialized medicine” had “never caught on in the United States.”)
Vox’s Ezra Klein labeled Sanders’s plan “vague and unrealistic.” The American Prospect’s Paul Starr, who helped work on Bill Clinton’s original unsuccessful health-care reform, wrote two separate columns that warned in part that Sanders’s single-payer plan would lead to a scary and unprecedented centralization of power in Washington.
Even when single-payer reform appears to dodge such concerns, powerful Democratic and liberal interests can’t bring themselves to get behind it. Nancy Pelosi recently told frustrated town hall attendees that “if you want to move to single payer, what you should do . . . is support state options,” referring to state-level campaigns for single payer.
She should tell her own party. When a ballot initiative popped up in Colorado in the middle of the presidential campaign that would have encoded a single-payer health-care system in the state’s constitution, Democrats fell over themselves to discourage the initiative, echoing Clinton’s rhetoric in the process.
The state’s Democratic governor John Hickenlooper said that “it would be premature to dramatically remake our health-care system at this time” while existing reforms were “just beginning to bear fruit.” He complained behind closed doors to a powerful lobby of business leaders and political operatives that the “cost [is] going to be huge.”
The state’s Democratic senator Michael Bennett told a local paper that single payer wasn’t “the right approach to solving our health-care problems,” partly due to the “massive tax increase” involved. (Incidentally, both politicians received a ton of money from the health-care, insurance, and pharmaceutical industries).
Other Colorado Democrats opposing the measure were the state’s previous governor, Bill Ritter, state House majority leader Crisanta Duran, and Kelly Brough, president of the Denver Chamber of Commerce. Coloradans for Coloradans, a group that fought the measure, cited Democrats’ opposition to it to defend their efforts, and even bragged that they had “Democratic consultants running the campaign.”
Meanwhile, liberal group ProgressNow Colorado also came out against the measure, which was ultimately defeated — likely in part because high-profile Democrats fought it. (In a perfect feedback loop, one liberal commentator has recently used the Colorado example to dampen renewed calls for Medicare for All).
Liberals’ newfound antipathy to one of the Democrats’ traditionally long-coveted goals survived the end of Sanders’s primary campaign. In July, the Clinton campaign’s appointees on the Democratic Party’s platform-drafting committee united to vote down a plank advocating for a single-payer system — particularly galling given the plank’s merely symbolic status.
Most recently, as California considered instituting a state-wide single-payer system on the eve of a possible GOP repeal of Obamacare, the state’s Democratic governor Jerry Brown rubbished the idea, asking: “Where do you get the extra money? . . . How do you do that?” He compared it to solving a problem “by something that’s . . . a bigger problem,” which “makes no sense.”
With the GOP repeal having devolved into utter failure, Clinton confidante and Center for American Progress president Neera Tanden — who as late as January this year seemed to be suggesting that progressives should get on board with a future Sanders push for single payer — recently penned a USA Today op-ed about what was next for health-care reform. Single payer wasn’t in it. (Tanden happened to have been one of the Clinton delegates on the platform drafting committee who voted against the single-payer plank last year).
The particularly bizarre thing about many of these attacks on single payer from prominent liberals and Democrats is that they’re fundamentally conservative arguments: single payer is too radical and far-reaching a change; it’s too expensive; it’ll mean raising taxes; it’ll involve giving the federal government too much power.
Do Democrats and liberals really want to be making these arguments? After all, they can be (and have been) used against virtually any policy favored by progressives and the Left more broadly, which typically do cost a lot of money, necessitate extra taxes to pay for them, require a great deal of government involvement to successfully implement, and tend to temporarily disrupt people’s lives as new rules, regulations, and systems are put in place. Go ahead and look up conservatives’ attacks on Obamacare as it was cobbled together — virtually every liberal complaint now made about single payer was launched by the Right against Obamacare.
There Is a Season
Meanwhile, while liberals and Democrats attack single payer on “practical” grounds, they appear to have forgotten the importance of the moral case for such policies.
In their haste to defend Obamacare (and, by extension, a former president’s legacy) from often dishonest right-wing attacks, they ignore the very real and painful flaws and inadequacies of the law as it stands, which, for all the good it’s done, continues to leave people trapped in impossible, heart-rending situations and forces them to beg for money online in the hopes of paying their exorbitant medical bills.
What makes this steadfast opposition even more puzzling is the fact that the moment is ripe for making the push for single payer. It’s not just that the GOP has spectacularly failed to gut Obamacare. Polling suggests Americans are more amenable to the idea than ever (even if not all polls are as rosy as Gallup’s).
Meanwhile, the last few months have been a spate of editorials in local newspapers extolling the virtues of single payer and necessitating the need to pass it. The long list includes the: Redding Record Searchlight, Berkshire Eagle, Reno Gazette-Journal, Fort Wayne Journal-Gazette, Grass Valley and Nevada County’s Union, Winston-Salem Journal, Eugene, Oregon’s Register-Guard, Napa Valley Register, and the Florida Times-Union. Similar editorials have also appeared in major papers like USA Today, the LA Times, and the Baltimore Sun.
Even Mark Cuban has come out in favor of the policy. Do Democrats really want to be outflanked on the left by Mark Cuban?
The party should thank its lucky stars President Trump remains tethered to a radically anti-government GOP which hates the thought of the government stepping in to help people in need. Were Trump allowed to run free — and were his commitment to economic populism authentic and not just a cynical appropriation of a few slogans — he might actually adopt some form of single-payer proposal himself (no doubt with some pointed, Roosevelt-style “tactical” exclusions of certain marginalized groups), shoring up his standing as the self-proclaimed champion of the “forgotten man.” After all, such policies tend to be quite popular once ordinary Americans start receiving their benefits.
The Trump administration has been unwilling to launch the challenge to corporate interests that would be needed to make such an effort a success, perhaps because the Ayn Rand–worshiping GOP he has thrown his lot in with won’t entertain the thought. But the Democrats should be wary of leaving a space on their left open for a cynical right-wing populist to fill, whether now or down the line. After all, that’s a big part of what got them into their current predicament.
The good news is that the same popular, grassroots pressure that ordinary people successfully put on Republican lawmakers who were preparing to strip Americans of even the meager protections afforded by Obamacare can also be used to push Democrats to support single payer. As much as numerous pundits and politicians mocked Sanders’s concept of getting things done through a “political revolution,” the past few months of widespread activism by ordinary Americans have shown this was far from the out-of-touch fantasy many dismissed it as.
After all, it was years of grassroots organizing and agitation from the labor movement that forced Harry Truman to cite these simple moral imperatives while proposing a single-payer system all those decades ago: “that the health of this Nation is a national concern; that financial barriers in the way of attaining health shall be removed; that the health of all its citizens deserves the help of all the Nation.” There’s no reason those forces can’t force today’s reluctant Democrats to do the same.
NOTE FROM HEALTH OVER PROFIT: Today, conservative Charles Krauthammer of Fox News published an article in the Washington Post that concluded with:
“There is an ideological consideration that could ultimately determine the fate of any Obamacare replacement. Obamacare may turn out to be unworkable, indeed doomed, but it is having a profound effect on the zeitgeist: It is universalizing the idea of universal coverage.
Acceptance of its major premise — that no one be denied health care — is more widespread than ever. Even House Speaker Paul Ryan avers that “our goal is to give every American access to quality, affordable health care,” making universality an essential premise of his own reform. And look at how sensitive and defensive Republicans have been about the possibility of people losing coverage in any Obamacare repeal.
A broad national consensus is developing that health care is indeed a right. This is historically new. And it carries immense implications for the future. It suggests that we may be heading inexorably to a government-run, single-payer system. It’s what Barack Obama once admitted he would have preferred but didn’t think the country was ready for. It may be ready now.
As Obamacare continues to unravel, it won’t take much for Democrats to abandon that Rube Goldberg wreckage and go for the simplicity and the universality of Medicare-for-all. Republicans will have one last chance to try to convince the country to remain with a market-based system, preferably one encompassing all the provisions that, for procedural reasons, had been left out of their latest proposal.
Don’t be surprised, however, if, in the end, single-payer wins out. Indeed, I wouldn’t be terribly surprised if Donald Trump, reading the zeitgeist, pulls the greatest 180 since Disraeli “dished the Whigs” in 1867 (by radically expanding the franchise) and joins the single-payer side.
Talk about disruption? About kicking over the furniture? That would be an American Krakatoa.”
If the Democrats can’t see the writing on the wall and move quickly on a National Improved Medicare for All, perhaps the Republicans will do it. It will be a “yuge” political win for whomever does.