The 2016 presidential primaries are approaching, and I find I’m still undecided.
I think both Bernie Sanders and Hillary Clinton are fine candidates, and either would make an excellent president. This is especially true in comparison to the howling pandemonium that’s the GOP field, where all the other candidates are competing to be as vulgar, hateful and regressive as Donald Trump. (I co-sign every word of this post by John Scalzi.)
Of the Democrats, I think Bernie is generally the more progressive candidate (although Hillary has outflanked him from the left on guns). And I’m glad he’s running: we need someone like him who’ll raise hell, who’s not afraid to speak truth to power, who can carve out space for ideas that deserve a wider hearing in American politics. But I’m not fully on board with either of them just yet. You can probably guess what my concerns about Hillary Clinton are without my needing to fill them in, but there are things about Sanders that unsettle me as well. For this post, I’ll focus on one signature issue that’s a microcosm of the rest: his “Medicare for All” plan to scrap Obamacare and replace it with a single-payer system.
I’ve written that Obamacare is the greatest progressive triumph in the U.S. since the Great Society, and I still believe that. But even so, it’s a cautious, modest plan, meant to fill in the gaps of our existing health-care system while disrupting as few people’s coverage as possible. It’s based on conservative ideas, notably a 1980s proposal by the Heritage Foundation and Romneycare in Massachusetts.
But in spite of all this, Obamacare’s passage was the most hard-won, bitterly fought political victory in a generation. It faced unanimous, brick-wall Republican resistance in Congress, and only passed because the Democrats briefly had a filibuster-proof supermajority (and since every Democratic senator’s vote was needed and they knew it, this led to ugly compromises like the “Cornhusker Kickback” and the removal of the public option).
Even once Obamacare passed, that didn’t put an end to the scorched-earth warfare. The Republicans tried to sow panic about the imaginary threat of “death panels”. They voted to repeal it dozens of times and shut down the federal government in a failed attempt to kill it. They filed a blizzard of lawsuits that resulted in the Supreme Court coming within a hair’s breadth of destroying it, not once but twice. Republican governors have spitefully turned down free money rather than expand Medicaid to cover more people. The contraceptive mandate still faces legal trench warfare.
And when the law succeeded in spite of all these obstacles, it spawned an entire industry of denialism on the right. Conservative pundits continue to blindly insist it can’t be as effective as it is or cover as many people as it has.
Again, this is all for a cautious, modest reform based on a conservative idea. What Sanders is proposing is a much, much bigger change.
Unlike Obamacare, which was designed to create as little disruption as possible for people who already had health insurance, single-payer would affect every American in sweeping and hard-to-foresee ways. Unlike Obamacare, which was crafted to work with the insurance industry as much as possible so as not to draw their opposition, single-payer would put them out of business at a stroke. Unlike the relatively small (but still formidable) technical challenges in setting up state insurance exchanges, single-payer would require a massive top-to-bottom overhaul of the machinery of government and bureaucracy. It’s worth noting that even Sanders’ deep-blue home state of Vermont gave up on single-payer when it found the challenges were too great to overcome.
None of these are arguments about efficacy or desirability. (For the record, I’d be happy to see a well-designed single-payer system.) Rather, they’re questions of political feasibility. The chances are good that the Republicans will control at least the House after 2016, and possibly retain the Senate. It’s very likely that not even all Democrats would support this proposal. How would Sanders get it through Congress? I haven’t seen him speak candidly about the practical challenges this would present or how he thinks he can overcome them.
If he’s counting on a wave election that will sweep him into office and create huge Democratic majorities, then he needs to say that. That would at least be honest. However, what I fear is that Sanders’ camp subscribes to the “Green Lantern Theory” that the president can achieve any policy outcome if he wants it enough, regardless of the makeup of Congress. That’s just not how the American political system works. And while I understand the point of a campaign is to get your supporters fired up with grand visions of what’s possible, I’m concerned that Sanders has no fallback, no plan B. If he does win the presidency, but is unable to get his signature ideas through a hostile Congress, I worry progressive voters will be disillusioned and will withdraw from politics for another generation.
My personal belief is that the next president, assuming it’s a Democrat, will basically have to play defense no matter who it is: shoring up Obamacare, continuing the Clean Power Plan, and protecting and extending Obama’s other accomplishments against a Congress that will at best be gridlocked and at worst actively hostile. That’s frustrating, but it’s also the reality of American politics, where most positive change is slow and incremental.