In her new book, “What Happened,” Hillary Clinton writes that Senator
Bernie Sanders “isn’t a Democrat.” Technically, she’s right. Sanders’s
own Web site describes him as
“the longest serving independent member of Congress in American
history.” But as Clinton sets out on her promotional tour, it is
Sanders, the losing candidate in last year’s hotly contested Democratic
primary, who is helping to set the Party’s policy agenda.
“This is where the country has got to go,” Sanders
told the Washington Post’s David Weigel on Tuesday, a day before he
unveiled a single-payer health-care-reform bill in the Senate. “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.”
The slogan “Medicare for all” is another term for a single-payer
health-care system, in which the federal government insures everybody
and finances the scheme from tax revenues. Under Sanders’s proposal,
which broadly mimics a proposal he put forward during his Presidential
campaign, every American under the age of eighteen would receive
a “universal Medicare card” as soon as the bill was signed into law. For
everybody else, there would be a four-year transition period. Almost all
forms of medical coverage, from preventative care to major surgery,
would eventually be covered, and there would be no payments. “When you
have co-payments—when you say that health care is not a right for
everybody, whether you’re poor or whether you’re a billionaire—the
evidence suggests that it becomes a disincentive for people to get the
health care they need,” Sanders told Weigel.
With Republicans in control of Congress, there is obviously no immediate
chance of Sanders’s bill becoming law. But, in the days leading up to
its unveiling, the trickle of senators who had agreed to co-sponsor the
measure turned into a torrent. In the end, there were sixteen
co-sponsors. They included Tammy Baldwin, of Wisconsin; Cory Booker, of
New Jersey; Al Franken, of Minnesota; Kirsten Gillibrand, of New York;
Kamala Harris, of California; Jeff Merkley, of Oregon; Brian Schatz, of
Hawaii; and Elizabeth Warren, of Massachusetts.
One thing all these politicians have in common is that they have been
mentioned, with varying degrees of plausibility, as possible
Presidential candidates in 2020. (So has Sanders himself.) Since Donald
Trump has been in the Oval Office for less than eight months, it might
seem crazy to be thinking about the next election. But that is the
reality of Presidential politics these days: a semi-permanent campaign.
And, as a number of progressive groups have already expressed support
for the Sanders bill, anyone looking for their support in 2020 would
be taking a risk by not falling in line. A poll taken during the summer
by the Kaiser Family
Foundation indicated that sixty-four per cent of self-identified Democrats now
support a single-payer system. A more recent survey from
Gallup produced similar results. These are the voters who will decide who wins
the Democratic primaries.
For the more centrist could-be candidates, such as Booker and Harris,
supporting the “Medicare for all” bill is a good way of signalling that
they understand the Party’s center of gravity has moved to the
left. “This is something that’s got to happen,” Booker
said to NJTV, in explaining his decision to support the Sanders bill.
“Obamacare was a first step in advancing this country, but I won’t rest
until every American has a basic security that comes with having access
to affordable health care.”
And it isn’t only Democrats who respond positively to the notion of a
national health-care plan. The Kaiser survey from this summer showed that
fifty-three per cent of all respondents say they favor a single-payer
health-care system. In recent years, the biggest gains have come among
self-identified independents, fifty-five per cent of whom now express
support. Only among self-identified Republicans is the Sanders approach
unpopular. Even in this group, though, a substantial minority
(twenty-eight per cent) said that they would support a single-payer
system.
One reading of these figures is that most Americans have had their fill
of the private health-care system, and, when they are presented with
an alternative that offers them the prospect of no longer having to deal
with insurance companies, they like the sound of it. “I think the
American people are sick and tired of filling out forms,” Sanders told
Weigel. “Your income went up—you can’t get this. Your income went
down—you can’t get that. You’ve got to argue with insurance companies
about what you thought you were getting.”
Shifting from the current system to a single-payer system would,
however, be a huge transformation, and, when pollsters point out to
survey participants some of the things such a change would entail,
support for the Sanders approach tends to drop quite sharply. For
example, after the Kaiser researchers told people who initially said they
favored a “Medicare for all” system that it would involve many Americans
paying higher taxes, almost four in ten respondents changed their minds.
The number opposing the proposal went from forty-three per cent to sixty
per cent.
Eying numbers like these, Chuck Schumer and Nancy Pelosi, the two
Democratic leaders in Congress, have reacted cautiously to Sanders’s
proposal. Eager to exploit Trump’s unpopularity in next year’s midterm
elections, they know Republicans are keen to label the Democrats as the
Party that wants to raise taxes and impose a government takeover of
health care. Schumer and Pelosi are also keen to keep the focus on
saving the Affordable Care Act, which the White House seems intent on
undermining.
When Schumer was asked about the Sanders bill on Tuesday, he was
noncommittal. “Democrats believe that health care is a right for all,
and there are many different bills out there,” he
said.
“There are many good ones.” Pelosi also declined to endorse the Sanders
bill, saying it should be put on the table with the other Democratic
proposals. “Right now, I’m protecting the Affordable Care Act,” she
said.
“None of these other things . . . can really prevail unless we have the
Affordable Care Act protected.”
Sanders, at this stage, doesn’t seem keen to engage in the details about
how to pay for his plan. His draft legislation doesn’t address the
issue, and he told Weigel that there would be a separate bill to deal
with it. “Rather than give a detailed proposal about how we’re going to
raise three trillion dollars a year, we’d rather give the American
people options,” he said. Last month, Sanders told National Public Radio
that the real goal of his bill was to start a national conversation.
That is all very well. For decades, many have regarded the idea of
establishing a national health-care system with truly universal
access—something almost all other advanced countries already have—as
too radical to get any traction. Sanders deserves a lot of credit for
bringing it into the mainstream. But, since his new bill is lacking key
details, it should be regarded as the legislative expression of a shared
aspiration rather than as a blueprint for action, or as a death knell
for the Affordable Care Act.
Many of the bill’s co-sponsors seem content to see it in this
light. “I always have believed that our goal must be universal health
care coverage for everyone, and my support for Sen. Bernie Sanders’
Medicare for All legislation being introduced this week is a statement
of that belief,” Baldwin
wrote,
in an an op-ed for the Milwaukee Journal Sentinel. She also described
the Sanders proposal as “one of many paths we can take to expand
coverage and lower health care costs.”
On his Facebook page, Franken struck a similar note. “This bill is
aspirational, and I’m hopeful that it can serve as a starting point for
where we need to go as a country,” he
wrote. “In
the short term, however, I strongly believe we must pursue bipartisan
policies that improve our current health care system for all
Americans—and that’s exactly what we’re doing right now in the Senate
Health Committee, on which both Senator Sanders and I sit.”