How Liberals Tried to Kill the Dream of Single-Payer
Incrementalism only works if you have a vision and long-tern goals.
https://newrepublic.com/article/131251/liberals-tried-kill-dream-single-payer
Let’s first admit the obvious: The political terrain for transformational health care reform is currently quite adverse. A single-payer bill would encounter colossal resistance from, for instance, the health insurance lobby, which is understandably in no great rush to be legislated off the face of the planet (nor does the pharmaceutical industry look forward to long-avoided price negotiations with the government). It’s also true that a Democratic sweep of both houses of Congress is unlikely in the coming election. And Democrats are, in any event, divided on the issue, as this primary election demonstrates.
To proceed, however, from an admission of these facts to an acceptance that the cause should be abandoned is to concede the contest before the first shot has been fired. This is something the Democratic Party has excelled at—with disastrous consequences—for decades. Conservatives, in contrast, have been far more willing to adopt ambitious, long-range political goals, even when contemporaneous political forces are arrayed against them.
As Daniel Stedman Jones describes in his Masters of the Universe: Hayek, Friedman, and the Birth of Neoliberal Politics, the articulation of an initially unpopular, highly ambitious, anti-New Deal “neoliberal” program—outlined and promoted in the decades following World War II by economists like Friedrich Hayek and Milton Friedman and associated think tanks—took decades to “bear fruit.” But when political and economic circumstances changed in the 1970s, conservatives had an ambitious program ready to launch, and the right-wing revolutions of Ronald Reagan and Margaret Thatcher could begin in earnest.
The liberal retreat on single-payer is in line with a long history of centrist Democratic thinking that haplessly confuses rearguard action with political vision. Passing a federal single-payer bill would, no doubt, necessitate key electoral victories, a powerful campaign at the governmental level, and a formidable grassroots struggle. Useful initial steps in this direction might include the election of a president determined to pass single-payer, the restoration of single-payer to the platform of the Democratic Party, and vigorous support for such reform by pundits and scholars in high places. That none of these things may wind up happening is a cause of the alleged political “impossibility” of single-payer—not its result.
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Second, proposals for “Medicare-for-all” usually call for the elimination of cost sharing, which is to say no copayments, deductibles, and co-insurance. I’d argue that this is an essential aspect of real universal health care (with some notable exceptions, such payments are absent from the systems of Canada and the United Kingdom). The harms of such payments are all too real: As a result of out-of-pocket exposure, an analysis of survey findings published by the Commonwealth Fund last year put the number of underinsured Americans—the insured who lack sufficient coverage against the cost of medical care—at 31 million in 2014. Though discarding such out-of-pocket payments might sound like a pricey proposition, to the extent that these monies are already being spent, their elimination would be a wash, with no net effect on overall national health expenditures. But again, as is the case with the uninsured, insofar as some individuals and families are avoiding health care because of out-of-pocket payments, the elimination of these financial barriers would result in some real increases in health care utilization.
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