Why I’m Not for Single-Payer Either

It should come as no surprise that as a young, white, northeastern liberal, I have a lot of friends who are Bernie Sanders supporters. While I have come to feel the same frustration that Clinton ’08 supporters felt toward us Obama folks, I have been quick to note that I appreciate the way Sanders’ candidacy has been moving the Overton window leftward. That having been said, I’ll make a confession: I think some of Bernie Sanders’ actual ideas are pretty lousy.

Single-Payer is one of these.

Yes, other countries have Single-Payer (or its cousin, Socialized Medicine) and yes, health care in those countries is much cheaper than it is here, for about the same quality of care. Yes, I believe that universal healthcare is an essential piece of the liberal cause, and no, I don’t believe that “Obamacare” is sufficient in its current state.

“So what’s the problem?” you ask. “Are you going to give me that old, ‘America is different because of its political system’ stuff? We’re trying to change the political system!”

Except, of course, that you haven’t got any strategy to change the political system, besides voting for Bernie Sanders. And, frankly, that’s not a plan.

Guys, millions of people stood up in 2008 and said, ‘enough is enough.’ President Obama won by millions of votes, picking up electors from surprising places like Indiana and Omaha, Nebraska. It was a mind-blowing victory. But it didn’t change conservatives’ minds, and it didn’t intimidate their representatives in Congress. I know this is hard for people like myself to understand sometimes, but Republicans in Congress have zero incentive to go along with liberal policy initiatives, especially ones like free college tuition and Single-Payer healthcare.

Conservatives, who are the ones voting in Republican primaries, aren’t against our methods of achieving universal healthcare or better college access. They’re against the goals. What we liberals call a social safety net, they call an “entitlement.” They don’t want American families to feel “entitled” to food or healthcare or a living wage, because they think these things promote laziness. That’s why, instead of jumping on board when Democrats pursued healthcare reform in 2010, they did their very best to stop the law and, even if that didn’t work, at least make it as unpopular as possible. And at least on the second half, they succeeded! “Obamacare” is unpopular. So when exactly are they supposed to have learned the lesson that cooperation with liberals is good for them?

Okay, but how about if the Political Revolution rolls across the nation and the Dems (and/or Democratic Socialists) retake both houses of Congress? Sure, Bernie Sanders has done nothing to make this happen, refusing to campaign or fundraise for other Democratic candidates (unlike Hillary Clinton), but what the hell. Let’s say his coattails are so unusually powerful that Democrats across the nation win the popular vote by some 10-12 percentage points, which is what it would actually take for them to win back the House (the 2010 redistricting process was a disaster for Democrats). Sure, that’s hugely unlikely, but it’s not impossible. Maybe there’s a Silent Majority in this country that yearns for Democratic Socialism, but never turned out before because they just couldn’t bear to settle for plain old liberalism.

Yes, that strikes me as a bit ridiculous, but I’d certainly like to believe it, and I’m willing to concede this premise in order to finally get to why I don’t think American Single-Payer is a goal worth pursuing in our era.

So let’s say that we get Democratic majorities in both houses of Congress, and President Sanders rallies the troops to pass his “Medicare-for-all” plan. But let’s stipulate that we’re still operating in this universe, not some utopia where conservatives don’t exist and Bernie Sanders is not just President of the United States but also an immortal pop star astronaut who can cure diseases with his mind. Regular president, modest Congressional majorities.

The Democratic Congress – which of necessity still includes conservative Democrats like West Virginia’s Joe Manchin – wants to pass Medicare-for-all. The law is projected to eliminate the entire health insurance industry, end employer-sponsored health insurance, etc, and by cutting out the middlemen, save taxpayers money. Yay! As Bernie’s platform states, the law will cover everyone for everything.

But again, the Republicans haven’t disappeared, nor is every Democrat in Congress a Sanders clone. So let me ask a couple of questions that they will inevitably ask too.

Will the law cover undocumented immigrants?

Will it cover abortion?

There’s two poison pills right there, and I’m not some Machiavellian genius like Mitch McConnell or Ted Cruz. The law that covers everyone for everything can’t pass, even with improbable Congressional majorities. For goodness’ sake, the abortion issue almost derailed Obamacare, even though the law left the odious Hyde Amendment intact and basically didn’t change abortion law at all. If you don’t believe me, go look up Bart Stupak.

I have a friend who insists that Bernie Sanders is a pragmatic politician, and that while Medicare-for-all is a strong opening bid, it should not be taken as evidence that Bernie Sanders is a rigid ideologue. So let’s game through the possibilities here.

A) No compromise. Democrats put their necks on the line to pass good, proper, Northern-European-style Single-Payer without any yucky compromises, and they fall. Hard. The cause is set back a generation.

B) Democrats agree to throw women and immigrants (and who knows who else) under the bus, and the bill fails anyway because now the liberals in Congress want nothing to do with it. Not only is the liberal cause set back a generation, but the Democratic party loses the trust of some of its most important constituents.

C) Democrats agree to throw women and immigrants (and who knows who else) under the bus, and bill actually passes. Now there are zero health insurance plans that will cover abortion, and the medical system basically locks undocumented residents out. The law saves taxpayers money by greatly reducing hospital payments, so hospitals can no longer afford emergency room care for insurance-less people, forcing the ones that serve higher numbers of undocumented immigrants into bankruptcy. Now people can’t even get emergency room care anywhere near their communities, and they’re dying in the streets. Oh, and when the next tax-cutting Republican wins the White House, we hand over our entire medical system to Rand Paul, Secretary of Health and Human Services. Or to Michael “Heck of a Job, Brownie” Brown, or some other outrageously biased and willfully incompetent anti-government crusader. Congratulations! Isn’t this so much better than just trying to build on Obamacare?

Look, Obamacare is a kludgy, inefficient way to get people covered while controlling costs. I get it. It would be great if we could tear the whole system down and build something better. I mean, all these other countries did it, right?

Actually, no. The Northern and Western European countries that have universal health care all built their systems upon pre-existing systems that lent themselves to specific types of improvement. And they all had political cultures that made the whole thing sustainable. The European right wing is predominantly racist and nationalistic, not inherently anti-government. Think Donald Trump. Mister Mexicans-are-rapists still says “we’re going to take care of people that are dying on the street.” That’s the European Right. They are not against the very notion of universal health care.

The European Right isn’t full of Evangelical Christians either, nor do they have a whole lot of anti-science Creationists and Second Amendment militiamen. They’re not climate change deniers. Every country has its idiosyncrasies, but ours is especially unusual. In England, half the Democratic party would be Tories. Half the Republican party would be institutionalized.

But you engage in politics in the country you have, not the country you wish you had. And even if you concede every electability argument, every numbers-based economic argument, you still end up with a set of choices that make Single-Payer look no better than the messy system we already have.

***

N.S. Dolkart is the author of Silent Hall, available for pre-order at any bookstore in the US, UK, Canada, South Africa, Australia, or New Zealand. It’s coming out in June, and it’s really good. You should buy it.

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