So lots of Democrats are signing on to Bernie Sanders' new single payer bill. While I believe that universal coverage should absolutely be the Democratic Party's goal, and I think single payer would in the abstract be the best way to achieve universal coverage, I agree with Jon Chait that "Bernie Sanders's Bill Gets America Zero Percent Closer to Single Payer":
I'm with Max Weber, who described politics as "a strong and slow boring of hard boards." By all means let's have big ideas and rallies and enthusiasm. But political leaders who wave off the hard work required to actually make something happen aren't doing anyone any favors.
As much as I like the direction that many in the Democratic Party want to go, Bernie isn't leading anyone to the promised land. And if Democrats start making ill-considered promises they can't keep, they'll have all the problems that now plague the GOP.
In short, I'm not very excited that Bernie is leading this parade.
The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.
That is not a detail to be worked out. It is the entire problem.
. . . In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.
. . . There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.
Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.
Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
This has always been my problem with Sanders, and (credit where it's due) it's also a critique Hillary Clinton makes pretty well. Bernie has some aspirational ideas, but he hasn't a clue how to make them happen. And he scorns all of the "half measures" that in our system are the only way we'll ever achieve the goal of universal coverage. That is not a detail to be worked out. It is the entire problem.
. . . In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.
. . . There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.
Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.
Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
I'm with Max Weber, who described politics as "a strong and slow boring of hard boards." By all means let's have big ideas and rallies and enthusiasm. But political leaders who wave off the hard work required to actually make something happen aren't doing anyone any favors.
As much as I like the direction that many in the Democratic Party want to go, Bernie isn't leading anyone to the promised land. And if Democrats start making ill-considered promises they can't keep, they'll have all the problems that now plague the GOP.
In short, I'm not very excited that Bernie is leading this parade.