No one should be surprised by the popularity of Bernie Sanders, even if he calls himself a “democratic socialist” – which sounds kind of scary. He’s not a Democrat. He never was one. He just ran as one, a matter of convenience more than anything else – or maybe because the Democrats are really “democratic socialists” who are just afraid of that second word there. Words matter. If Bernie Sanders had won the 2016 Democratic nomination that second word there would have haunted him. Donald Trump, or any other Republican nominee, would have pointed at him, smiled, and said that word – socialist – and the election would have been over before it even began. Bernie Sanders would have had nowhere to hide.
Much of this is nonsense. Jonathan Cohn had already explained that this sort socialism is not all that scary:
The label socialist isn’t as toxic as it was a generation ago, but the concept remains decidedly less popular among the population as a whole. Socialism – as commonly understood by Americans – means widespread government ownership of business. A candidate or a party seemingly calling for that would alienate most of the public – even in a lefty, earthy-crunchy state like Vermont.
That, however, was not what Sanders was talking about:
Democratic socialism, as generally conceived in the U.S., is a milder, more aspirational form of the ideology. Democratic socialists might not recoil at the thought of government running large industries, but they don’t actively pursue that goal. Instead, they focus on decidedly less radical objectives – like making the welfare state more generous, giving workers more power, limiting the influence of money on politics and policing the practices of business more closely.
You can see that agenda in the initiatives Sanders has proposed and the causes he has championed. He’s a longtime supporter of universal health care in what some would say is its purest form: A single-payer system, in which the government provides insurance directly rather than subsidizing private insurers. He’s called for making taxpayer-funded child care available to all parents, right up through kindergarten. He supports breaking up the big banks and imposing a carbon tax to slow climate change. He opposes trade deals that lack what he considers adequate protection for labor. And he supports the public financing of campaigns for federal office.
Some of these ideas are more popular than others. How you feel about them will depend, inevitably, on your own ideological predispositions and, to some extent, how you interpret available evidence on their effectiveness. But none of these ideas is loopy. Most Western democracies have some of these policies, while some Western democracies have all of them. A few have produced such strikingly positive results – variations on single-payer work very well in France and Taiwan, for example – that it’s hard to understand why they don’t get more serious hearings in the U.S.
(Actually, the U.S. does have a form of single-payer health insurance. It’s for the elderly, it’s called Medicare, and it’s incredibly popular – which is one more reason many people think it should be available to everybody.)
That means that Sanders was, at the time, not that far out:
Clinton is a mainstream liberal, and these days, mainstream liberals tend to want the same things that Sanders does – a stronger welfare state, more regulation of business, higher wages for the lower and middle classes, action on climate change. The question is how aggressively and enthusiastically she promotes these causes, via rhetoric and actual policy proposals.
The answer to that question became obvious. Hillary Clinton did not promote any of that aggressively and enthusiastically. She has turned out to be a careful politician, one who knows how to offend the most people the least. She was sort of with Sanders on all of this, but careful not to come off as some sort of wild-eyed radical. She was the calm and steady one – all this stuff should be done, perhaps, but carefully and slowly. Things could get out of hand. And of course that left the passion to Bernie Sanders – but at least she wasn’t a socialist. She had that going for her. It wasn’t enough.
She had been too careful. That was apparent back in April 2009 when a Rasmussen poll showed this:
Only 53% of American adults believe capitalism is better than socialism. The latest Rasmussen Reports national telephone survey found that 20% disagree and say socialism is better. Twenty-seven percent (27%) are not sure which is better.
But that can be subdivided:
Adults under 30 are essentially evenly divided: 37% prefer capitalism, 33% socialism, and 30% are undecided. Thirty-somethings are a bit more supportive of the free-enterprise approach with 49% for capitalism and 26% for socialism. Adults over 40 strongly favor capitalism, and just 13% of those older Americans believe socialism is better. …
Investors by a 5-to-1 margin choose capitalism. As for those who do not invest, 40% say capitalism is better while 25% prefer socialism.
There is a partisan gap as well. Republicans – by an 11-to-1 margin – favor capitalism. Democrats are much more closely divided: Just 39% say capitalism is better while 30% prefer socialism.
That word – socialism – was already losing its punch, because of that other word, its opposite:
It is interesting to compare the new results to an earlier survey in which 70% of Americans prefer a free-market economy. The fact that a “free-market economy” attracts substantially more support than “capitalism” may suggest some skepticism about whether capitalism in the United States today relies on free markets.
Other survey data supports that notion. Rather than seeing large corporations as committed to free markets, two-out-of-three Americans believe that big government and big business often work together in ways that hurt consumers and investors.
Things had changed. No one should have been surprised by the popularity of Bernie Sanders. He’s always had a base, one that excludes the investor class, the Wall Street folks who have always been fine with Bill and Hillary Clinton, and excludes Republicans of course. His base may be larger than anyone supposes.
There was a flashpoint for all this – Obamacare – socialized medicine – but that wasn’t so:
PolitiFact editors and reporters have chosen “government takeover of health care” as the 2010 Lie of the Year. Uttered by dozens of politicians and pundits, it played an important role in shaping public opinion about the health care plan and was a significant factor in the Democrats’ shellacking in the November elections…
By selecting “government takeover” as Lie of the Year, PolitiFact is not making a judgment on whether the health care law is good policy. The phrase is simply not true.
Of course it wasn’t true. Obamacare offered light central planning of a system that subsidized the purchase of now-standardized healthcare policies from the for-profit insurance industry – paid for by slightly higher taxes on the rich. It was an awkward half-free-market hybrid that also included expanding Medicaid to cover those who couldn’t afford even the subsidized policies, but it worked, and is working. Half the nation knows that. Poll after poll shows that less than a quarter of the nation thinks the rich have been treated unfairly in all this.
That makes any replacement for Obamacare a hard sell. What’s the alternative? Why is this or that alternative better? That calls for deep policy discussions about the details of funding, and just what would be funded, and why – which is a discussion of the proper role of government in relation to personal responsibility, and the relationship of personal responsibility to the social contract, if there is such a thing.
It’s complicated. Trump won the election partly on the promise to repeal and replace ObamaCare. He had a solidly Republican House and Senate, but every alternative they came up with was loathsome. Twenty or thirty million Americans would lose their health insurance, and the cost of health insurance for everyone else would skyrocket. Their alternatives were not socialism, but so what? They knew they were pushing nonsense. Their last alternative died in the Senate. They couldn’t find even fifty Republican votes for it. Vice President Pence was waiting in the wings to break any fifty-vote tie, as vice presidents can do. He left early. Donald Trump had insulted John McCain one too many times – or McCain knew nonsense when he saw it. He cast the deciding Republican vote against that last alternative. There are things worse than socialism, or at least worse than socialized medicine.
That was the end of it, but not quite, as Talking Points Memo’s Alice Ollstein reports here:
After a year of backroom, closed-door, GOP-only meetings on health care, and a bitter, partisan floor fight over repealing the Affordable Care Act that eventually collapsed, senators from both parties came together to hold nearly half-a-dozen public hearings and hammer out a bill to stabilize Obamacare’s vulnerable insurance exchanges by the end of September.
But beneath the bipartisan bonhomie, there is trouble in paradise.
In exchange for funding Obamacare’s subsidies to insurers that cover care of low-income people with severe health needs, Republicans are demanding that some of the ACA’s protections and mandates be waived – and have suggested rolling back the requirement that every insurance plan cover essential health benefits like maternity care and mental health treatment.
They seem to think that the now-standardized healthcare policies required from the for-profit insurance industry are socialized medicine – socialism. They’ll have none of that, and the Democrats think they’re being stupid:
Senate Democrats say they’re open to some increased “flexibility” but worry that allowing too many regulatory rollbacks will lead to more expensive and worse quality health coverage for millions of people. Though many proposals have been tossed onto the table over the past few weeks, the key battle is currently over loosening the rules around Obamacare’s “state innovation” waivers – which states obtain from the federal government to test different health care systems. Some states, including Alaska, have used these waivers to set up reinsurance programs, which have brought down the number of uninsured residents and lowered costs. But other states are seeking waivers for plans that health care experts say would create “barriers to enrollment.”
“Flexibility needs to increase health care for people, not decrease it. If it’s flexibility to take health care away, that’s not something I would support,” Sen. Debbie Stabenow (D-MI) told TPM. “I believe that health care is a basic human right and we’re going to make sure that everyone has health care.”
Perhaps that’s socialism, but so what? Still, that’s the sticking point:
During simultaneous Senate hearings on health care Tuesday morning, Republican senators and their conservative guest speakers proposed scrapping or loosening a host of Obamacare’s core provisions – from age ratings that limit how much insurance companies can charge older patients, to the individual mandate, to the requirement that all plans cover essential health benefits.
Without a concession or a win they can point to, GOP aides and lawmakers have said, it would be hard to get their caucus on board with funding the cost-sharing reduction subsidies or taking other steps to prop up Obamacare’s marketplaces.
“To get a Republican president and a Republican House and a Republican Senate just to vote for more money won’t happen in the next two or three weeks unless there’s some restructuring,” [Sen. Lamar Alexander (R-TN), the chair of the committee crafting the stabilization bill] Alexander said.
But Democrats on those committees remain staunchly opposed to the suggested changes, and said the “guardrails” built into the ACA must be preserved at all costs. The two sides are currently at an impasse.
This is a standoff. The Republican position is clear. Get rid of all the one-size-fits-all standards and rules and mechanisms in the current system – the socialism in it – or we’ll sabotage the current system and ruin everything for everybody. No one has a “right” to anything. That’s socialism. The Democratic position is also clear. Health care is a basic human right and we’re going to make sure that everyone has health care. Call it socialism if you want. We call it common sense and common decency.
This was the moment Bernie Sanders had been waiting for, and as David Weigel reports, he seized the moment:
Sen. Bernie Sanders (I-Vt.) introduced legislation Wednesday that would expand Medicare into a universal health insurance program with the backing of at least 15 Democratic senators – a record level of support for an idea that had been relegated to the fringes during the last Democratic presidency.
“This is where the country has got to go,” Sanders said in an interview at his Senate office. “Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational health-care system that guarantees coverage to everyone in a cost-effective way, the only way to do it is Medicare-for-All.”
He has a plan:
Sanders’s bill, the Medicare for All Act of 2017, has no chance of passage in a Republican-run Congress. But after months of behind-the-scenes meetings and a public pressure campaign, the bill is already backed by most of the senators seen as likely 2020 Democratic candidates – if not by most senators facing tough reelection battles in 2018.
The bill would revolutionize America’s health-care system, replacing it with a public system that would be paid for by higher taxes. Everything from emergency surgery to prescription drugs, from mental health to eye care, would be covered, with no co-payments. Americans younger than 18 would immediately obtain “universal Medicare cards,” while Americans not currently eligible for Medicare would be phased into the program over four years. Employer-provided health care would be replaced, with the employers paying higher taxes but no longer on the hook for insurance.
Private insurers would remain, with fewer customers, to pay for elective treatments such as cosmetic surgery – a system similar to that in Australia, which President Trump has praised for having a “much better” insurance regimen than the United States.
But the market-based changes of the Affordable Care Act would be replaced as Medicare becomes the country’s universal insurer. Doctors would be reimbursed by the government; providers would sign a yearly participation agreement with Medicare to remain with the system.
That’s the plan, and the Republicans pounced:
Republicans, bruised and exhausted by a failed campaign to repeal the Affordable Care Act, were giddy about the chance to attack Democrats and Sanders. At Tuesday’s leadership news conference, Sen. John Barrasso (R-Wyo.), a medical doctor, crowed that Sanders’s bill had become “the litmus test for the liberal left” and that Americans would reject any costly plan for universal insurance coverage.
In short, this is socialism, and expensive socialism at that. Americans hate that sort of thing, and of course there was the ghost of the careful and cautious Hillary Clinton fighting against him:
In 2016, when Sanders challenged Hillary Clinton for the Democratic presidential nomination, high cost estimates and the idea of wiping out private insurers kept many Democrats from embracing universal health care. While support for Sanders’s proposal has risen from zero to fifteen, several Senate Democrats are proposing alternate plans for Medicare or Medicaid buy-ins, and Democratic leaders caution that their party will take no one-size-fits-all position.
“I don’t think it’s a litmus test,” said House Minority Leader Nancy Pelosi (D-Calif.) of Medicare for All. “I think to support the idea that it captures is that we want to have as many people as possible, everybody, covered, and I think that’s something that we all embrace.”
In short, this is aspirational. Take Bernie Sanders seriously, but no one takes Bernie Sanders literally. No one ever has.
That may change:
Many supporters of Sanders have contradicted Pelosi, portraying his plan as popular – 57 percent of Americans support Medicare for All, according to Kaiser Health News – and efficient. Our Revolution, founded by Sanders, has urged Democrats to sign on; Justice Democrats, created after the election to challenge Democrats in primaries if they bucked progressive values, has asked supporters to call their senators until they endorse the bill. And a web ad paid for by Sanders’s 2018 Senate campaign, asking readers to “co-sponsor” his bill, attracted more than half a million names.
America may be edging toward socialism, or at least democratic socialism, after all.
Jonathan Chait throws cold water on that:
The sight of 15 Senate Democrats, including many of the party’s likely presidential contenders, co-sponsoring Bernie Sanders’s single-payer health-care bill may look like a momentous step. “What that means,” writes Jake Tapper, “is that with the notable exception of former Vice President Joe Biden, every top tier(ish) 2020 Democrat is now on board with a policy proposal that Clinton said less than two years ago would ‘never, ever come to pass.'”
But this image of progress only holds true if you imagine the process as a series of continuous steps. In reality, single payer has always been, and remains, a political dilemma that nobody has been able to resolve, and there is no evidence the resolution has grown any easier. What looks like a large step forward is actually a party edging closer to a cliff it has no intention of going over.
The problem is structural:
The barrier to single payer is that the American health-care system has been built, by accident, around employer-based insurance. 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. The impossibility of this barrier is why Lyndon Johnson gave up on trying to pass a universal health-care bill and instead confined his legislation to the elderly (who mostly did not get insurance through employers), and why Barack Obama left the employer-based system intact and created alternate coverage for non-elderly people outside it.
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’s no getting around that.
There is nothing in Sanders’ rhetoric that indicates he even recognizes the shape of the political problem. Instead he employs the classic populist technique of imagining the people as a whole standing united around an obvious solution, and only the machinations of an invidious elite can thwart them…
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.
That is boring stuff, but that’s life:
Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’ 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.
That’s depressing – reality often is – but Josh Marshall goes the other way:
An effective politics needs a horizon that voters look toward. It’s “horizonal.” Franklin Roosevelt’s New Deal – John Kennedy’s New Frontier – Ronald Reagan’s tax cut and “A rising tide lifts all boats” – Bill Clinton’s “putting people first” health plan in 1992 – yes, Donald Trump’s wall and making America great again. John Kerry’s campaign in 2004 and Hillary Clinton’s campaign in 2016 had no horizon. They were mired in details or in “I’m with HER” and “stronger together” identity politics.
Medicare for All is a horizonal demand. It satisfies a basic need and does so by looking beyond the corrupt, meretricious system we now have. The activity of private insurance companies symbolizes much that is wrong with contemporary capitalism. You don’t have to be a left-winger from Park Slope to hate these companies. Believe me: a lot of those people who voted for Trump (whom the liberal elite dismiss as racists and misogynists) hate insurance companies.
This, then, is a good idea:
While Medicare for All would cause an upheaval in the health insurance markets, it is actually based on expanding a system that works and that has remained intact for over fifty years. It’s incremental in its own way. It is also very easy to understand, while most of the incremental reforms I’ve seen require a degree in healthcare economics to comprehend and rarely seem to apply to “you.”
Sanders’ and the fifteen co-sponsors’ support of Medicare for All – for its potential political pitfalls – is a step forward for a Democratic Party that has been mired in think-tank incrementalism and identity politics. It gives them something to talk about that an average voter and not just a policy wonk can understand.
Consider this Bernie’s revenge. Hillary Clinton turned out to be a careful politician, one who knows how to offend the most people the least. She was careful not to come off as some sort of wild-eyed radical. She was the calm and steady one – all this stuff should be done, perhaps, but carefully and slowly. Things could get out of hand. She left the passion to Bernie Sanders – but at least she wasn’t a socialist. She had that going for her. It wasn’t enough, but America may be edging toward socialism, or at least democratic socialism, after all. Give them something to talk about that an average voter and not just a policy wonk can understand – something useful to them but not quite impossible. They’ll catch fire. After all, there is what Captain Jack Sparrow said at the end of the first pirate movie. “Bring me that horizon!”
Everyone loves a pirate.