A fight for the soul of the party. In the unlikelihood that a presidential candidate doesn’t bring out that musty cliche, you can bet a headline writer or two will summon it from the Happy Acres Home for Political Banalities. Declaring that a battle is underway for the “soul of the party” is an effort to imbue your campaign (or your campaign coverage) with transcendent (and usually exaggerated) significance.
But the current Democratic scrap between the party’s left and moderate wings over health care really does involve stark differences over how to cover millions of uninsured Americans and reform a sector responsible for 18% of GDP. To be single-payer or not to be single-payer: That is the question, the answer to which hinges on Democrats’ souls, their essential philosophy of government and politics.
Granted, the progressives, led by Bernie Sanders and Elizabeth Warren, and the moderates, Joe Biden most prominently, are closer to each other than either is to the Republicans. Both Democratic wings support universal coverage; what little gray matter GOP leaders possess goes to dreaming up wrecking balls for Obamacare, while leaving Donald Trump’s fantasy of a better, cheaper plan in the fog-bound recesses of his mind.
Still, smart Democrats should root for the moderates to prevail in this intramural squabble.
Sanders says we moderates criticize his Medicare for All plan, which Warren endorsed, because we cringe before ideas “of energy and excitement, and of vision.” Actually, we criticize it because it’s unwise, in the same way that wasting money on bloated defense budgets when we could protect the nation for less is unwise. Creating Obamacare for All — for example, by adding a “public option” government plan that Americans could choose but wouldn’t be dragooned into joining — could get us to universal coverage at a bargain compared with single-payer.
Real life offers multiple examples of nations covering every citizen via private insurance. Warren’s pigheadedness in recognizing that has no less a progressive than the Nobel economist Paul Krugman, normally her admirer, reconsidering her alleged policy chops.
While single-payer is expensive, it does work in other countries. But Sanders, in drafting his own plan, didn’t sweat the details of what other countries do. During last week’s televised debates, the senator preened that his current Medicare for All bill would one-up the original Medicare: “For senior citizens, it will finally include dental care, hearing aids and eyeglasses.” Yet Canada’s single-payer system, which Sanders also touts, does not pay for dentistry or vision care; most Canadians use private insurance for those.
And while other countries' single-payer systems require some cost-sharing by patients, Sanders’s plan shuns that except for pharmaceuticals. Bottom line: By ignoring global experience, the Sanders scheme would require needlessly staggering tax increases.
He and Warren will tell you that those taxes would be equal to or less than the premiums Americans now pay for private insurance. (The duo must be tapping divine revelation, as experts find the economic consequences of Sanders’s plan murky.) What they don’t tell you is that hospitals depend on private insurance’s higher payments to make up for Medicare’s lower reimbursements. With Medicare for All paying only Medicare-level reimbursements, some hospitals might have to close. That wouldn’t necessarily be bad in all cases. But single-payer advocates are heedlessly blithe about the risks.
They also don’t tell you that public support for single-payer tanks when people learn that it would end private insurance, most of whose customers want to keep it. If Sanders’s plan flunks on policy grounds, it’s equally daft politically. Why risk securing universal coverage by picking a legislative brawl on behalf of a radioactive idea? Perhaps he’s forgotten the titanic struggle just to pass Obamacare in 2010.
Sanders, animated by theological hostility to private insurers, attributes U.S. health care costs, among the world’s highest, to “the profiteering of the drug companies and the insurance companies.”
He’s only half right, as insurers’ profit margins are modest. Real cost control (some of it practiced in countries like Germany that Sanders overlooks) would target drug makers, hospitals, doctors and, to the extent it focused on insurers, their administrative waste.
“I don’t understand why anybody goes to all the trouble of running for president of the United States just to talk about what we really can’t do and shouldn’t fight for,” Warren famously said during last week’s debates.
Her time would be better spent asking why she’s going to all the trouble of running for president just to hand a political howitzer to a racist, corrupt president Democrats should be moving heaven and earth to beat next year.