What Do We Want? Universal Coverage!

Let’s look at some good news. Paul Waldman writes that Democratic politicians are finally embracing single payer.

While some of us have been predicting for a few months that support for some version of single payer health care would gradually become the default position for those seeking the 2020 presidential nomination — and thus for the party as a whole — it’s happening faster than one might have thought.

A bunch of potential candidates, including Cory Booker, Kirsten Gillibrand, Elizabeth Warren, and Kamala Harris, have moved from their previous position — a somewhat vague support of single payer in the abstract — to becoming co-sponsors of Bernie Sanders’ single payer bill, which is set to be released this week. Today Sen. Tammy Baldwin of Wisconsin, who’s up for reelection next year, added her name to the list, and so did Sen. Richard Blumenthal of Connecticut and Mazie Hirono of Hawaii, joining a number of others. A single payer bill in the House is cosponsored by more than half the Democratic caucus (though Nancy Pelosi is notably holding off).

I know some people will argue that a few of these politicians — Harris and Booker in particular — are just trying to kiss up to the progressive left. And what’s wrong with that, I say? It means they are taking us seriously, instead of brushing us off as unicorn lovers.

For starters, it would be better if we referred not to “single payer” but to “universal coverage,” since the latter is the real goal, while the former is just one way to achieve that goal (see Harold Pollack for more on this). One big question about Sanders’ plan is whether it will be the kind of “Medicare for all” he’s advocated in the past, or something like “Medicare for all who want it,” which would retain a role for private insurance. There are multiple paths to universal coverage, and no one who is serious about the complex policy questions involved believes that a true single payer plan is the only way to get a system that does what we want it to. But that reality may be powerless in the face of the fact that “single payer” is a simple two-word slogan that people are already rallying around.

This is right; we might have to be careful about the “single payer” slogan.  It’s also the case that the same person who might say yes to a program labeled “single payer” might say no to the same program labeled “socialized medicine.” We also will have to fight off the inevitable “but it will raise taxes” arguments and explain that people will end up with more money in their pockets, anyway. We have a lot of educating to do.

One thing we can say, however, is that Democrats probably don’t need to be too paralyzed by fear of the inevitable Republican charge that it would represent big government controlling your life. As Republicans discovered when they tried to kick millions of people off Medicaid and undermine the program, the American public is perfectly fine with the government helping to give people health coverage. Medicare and Medicaid are both extremely popular with their recipients, who in total now number about 130 million….

… But single payer offers Democrats something extremely powerful: an ambitious policy change that will motivate their own voters to haul themselves to the polls.

Wow, actually promising to work for something grand that we’ve wanted for several years, instead of telling us that we’re naive and unpragmatic and believe in fairies and unicorns? What a concept!