Politics & Policy

Democrats Embrace Single-Payer, Sort of

Prominent Democrats have backed Bernie Sanders’s proposal for single-payer health care, while others not on board with Sanders’s exact plan have endorsed the general notion of a single-payer system. Among that group are Elizabeth Warren, Cory Booker, Kamala Harris, and Kirsten Gillibrand — all ambitious politicians expected to run for president in 2020.

Jason Willick at The American Interest writes that, on health care, the proverbial Overton window has shifted leftward:

It seems certain at this point that the party’s 2020 nominee will campaign on something to the left of Hillary Clinton’s pro-Obamacare incrementalism; in all likelihood, that something will be a version of single-payer.

Meanwhile, the Republicans have proven unable to reverse president Obama’s landmark legislative accomplishment. The GOP proposal that is still making (increasingly lonely) rounds in the capitol, Cassidy-Graham, is more of a reform of Obamacare than a repeal.

Willick’s analysis is worth reading. He points out an important reason we’re in this state of affairs: Republicans are divided on the issue. They failed to coalesce around a coherent alternative, nor could they develop one that had popular appeal. The future Willick envisions — one where Republican moderates try and “blunt the push for single-payer” by proposing only “moderate reforms” while hardliners seek a “total repeal” to stop the slide down the slippery slope — seems all too likely.

Even if the Overton window has shifted, though, it’s hard to take these Democrats at face value. After all, it’s easier to support single-payer health care when that support can be expressed in the subjunctive mood. Senator Booker might back the Sanders plan, but would President Booker really marshal support for it?

The relevant example here is how Republicans discussed health care when they were out of power. Having voted to repeal Obamacare a number of times during Obama’s presidency, Republicans eventually appeared to reach an agreement: In June 2016, Paul Ryan touted his replacement plan as a “first-time-in-six-years consensus” among Republicans. But that unity disintegrated when the party actually had to govern, and the Cassidy-Graham bill is all that remains.

And just as the Republican party faces an ideological divide, Democrats can’t seem to agree on what their party stands for, either. A burgeoning socialist movement has elevated folks like Sanders and Warren, and made social-democratic reforms more attractive to ambitious politicians like Harris. No doubt that the Democratic base wants socialized medicine. No doubt some of its politicians do, too. But a number of commentators, donors, and high-ranking Democrats would rather be dubbed liberals than leftists. Among them, support for single-payer is less reliable.

The bitter — and ongoing! — fight between the socialistic wing of the Democratic party and its liberal establishment will not be resolved anytime soon. The socialists naturally want class consciousness to come first; the establishment prefers identity politics. So while the party’s up-and-comers are embracing single-payer for now, some of that support seems like opportunism. Some of its elders, meanwhile, are resisting: Nancy Pelosi won’t back the Sanders bill, and still insists that the United States is a capitalist country. It’s true that retrenching the welfare state is harder than adding to it. As Willick suggests, that is part of the reason for the divide on the right. Nonetheless, crafting and implementing a single-payer system would be an arduous process that could deepen cracks on the left into fissures.

Winning used to solve problems. Today, for our two political parties, losing might be more effective at papering over divides.

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