Today is single-payer day. Bernie Sanders is introducing the Medicare for All Act of 2017, and this time he’s no lone socialist crying in the progressive wilderness. A total of 15 Democratic senators are backing his bill, including most of the top Democratic contenders for the presidency. As the Washington Post’s Aaron Blake observed yesterday, “The dam is breaking.” The New Republic, among others, is even arguing that single-payer is becoming the newest “litmus test” for the party’s presidential hopefuls, and given the speed with which the far Left transforms fringe ideas into moral mandates, I’m not surprised.
Sober-minded Democrats should be terrified. They just might be handing Trump two terms. There are three reasons why.
First, and most obviously, single-payer health care comes with an extraordinary tax bill. The very instant voters saw their take-home pay plunge — often by an amount that far exceeds their traditional employee contribution to their employer-provided insurance — they would realize that “free” health care isn’t free. For now, Sanders is concealing how he’ll pay for his bag of goodies, but any single-payer plan would be crushingly expensive. Here’s the Washington Post editorial board, on June 18 this year, describing the costs:
When Sen. Bernie Sanders (I.,Vt.) proposed a “Medicare for all” health plan in his presidential campaign, the nonpartisan Urban Institute figured that it would raise government spending by $32 trillion over 10 years, requiring a tax increase so huge that even the democratic socialist Mr. Sanders did not propose anything close to it.
Indeed, Sanders’s 2016 revenue plan was a staggering $18 trillion short and still imposed more than $14 trillion in new taxes. To put this in context, the current total national debt — accumulated over the previous two centuries of the nation’s existence — is $20 trillion. These numbers are almost too huge for the human mind to grasp, but the mind can certainly grasp a substantially smaller paycheck.
Defenders of single-payer, however, claim that their system will ultimately cost less — pointing to lower costs in other nations. The Washington Post responds:
The public piece of the American health-care system has not proven itself to be particularly cost-efficient. On a per capita basis, U.S. government health programs alone spend more than Canada, Australia, France, and Britain each do on their entire health systems. That means the U.S. government spends more per American to cover a slice of the population than other governments spend per citizen to cover all of theirs. Simply expanding Medicare to all would not automatically result in a radically more efficient health-care system. Something else would have to change.
American government health care is more expensive than European government health care for multiple reasons, but let’s start with this one: Americans don’t live the same lives as citizens in other countries. We’re the most obese major developed nation, according to the Organization for Economic Cooperation and Development’s 2017 “Obesity Update,” and our rates of drug use, smoking, and alcohol abuse also differ substantially. Different nations will have different outcomes, and the American experience suggests that government cost savings will be far more elusive than Sanders supporters hope.
Moreover, voters are “richer, whiter, and older” than nonvoters. In other words, they’re the people who are most likely to have stable health plans. Older voters are already on Medicare. Would they want to pay more taxes for no measurable increase in benefits? Employed voters tend to enjoy a menu of employer-provided health plans, and they often like the plans they have. With single-payer, the Democrats couldn’t even pretend that “if you like your plan, you can keep your plan.” By design, more than 100 million of those plans would disappear, to be replaced by one of the world’s most immense government bureaucracies.
Democrats keep generating political ideas that appeal primarily to their urban base — and no one else.
But the reasons why the single-payer push helps Trump and the GOP go well beyond the health-care debate itself. This emerging litmus test is symptomatic of a larger problem: The Democratic party is increasingly the wholly owned subsidiary of the progressive base, and the progressive base has become too radical for widespread electoral success.
Here, the results speak for themselves. President Obama’s personal popularity obscured the unpopularity of his policies, and the Democrats have steadily collapsed as a national political party. Its appeal is concentrated in densely populated coastal urban enclaves, and it keeps generating political ideas that appeal primarily to this urban base — and no one else.
That same dense urban concentration yields the groupthink that very quickly becomes angry intolerance. Debates quickly move to the extreme, and name-calling substitutes for argument. Don’t think a man can get pregnant? You’re a bigot. Do you believe that students accused of sexual assault should enjoy the right to counsel or the right to cross-examine witnesses? You’re a rape apologist. Are you wary of government-run health care, and do you believe the free market can deliver better care? Then you’re killing people.
Many, many Democrats have always viewed Donald Trump as an opportunity, not a threat. And, incredibly, they still do.
Finally, let’s not forget that many, many Democrats have always viewed Donald Trump as an opportunity, not a threat. And, incredibly, they still do. They wanted him to win the nomination, believing he’d be easy to beat. Then, when they recovered from the seismic shock of Hillary’s loss, they replaced their electoral confidence with confidence that he’d implode in office, and the GOP would be utterly discredited. They looked at poll numbers showing Sanders doing better than Hillary and grew convinced that anyone else could take him on and win.
So why not double down on the progressive wish list? Why compromise on, well, anything? After all, Trump’s election isn’t so much a defeat as it is victory delayed — maybe even victory guaranteed.
They might be right. Trump’s support may well collapse with the general electorate while he keeps enough of his base to stave off a primary challenge. He may limp into a general election so damaged that any Democrat not named Hillary Clinton will win back the Midwest and sweep Trump out of office. But let’s be clear: The Democratic decision to keep moving left is minimizing their electoral chances. It’s increasing their risk of loss.
Last November, millions of Americans held their nose and voted for Donald Trump. With their embrace of single-payer and their continued migration to the hard, intolerant left, the Democrats seem hell-bent on making sure those same Americans make the same choice again.
— David French is a senior writer for National Review and a senior fellow at the National Review Institute.