The Post On Single Payer

I'll confess I am something of a politics junkie (in case you hadn't puzzled that one out already!) but keeping up with this week's insane Trumpapalooza has been a bit much for me. I honestly started to tune it out and had to read Matt Ygleisas's "Voxsplainer" on the Niger-Ambush-Gold Star-Phone Call-Kelly-Tape Affair (or whatever we are going to call it) matter Friday afternoon.

So let's talk about something other than Trump or the likely upcoming LA vs NYC World Series that will probably suck.

Recently Ed Kilgore wrote a nice piece about the politics of converting our healthcare system to some sort of single payer model. Here's how he sums up the political reality of what single payer advocates are asking for:

Yes, Medicare for All would almost certainly improve insurance for all but a small minority of Americans, and, yes, the tax increases might be more than offset by the abolition of premium payments and big out-of-pocket expenses. But these are arguments, not instantly appreciated facts, and any serious push for single payer will face the largest and most expensive campaign of conservative and insurance industry pushback in the history of public policy. A political calamity not just for health-care policy but for Democrats is a distinct possibility.

If anything I think that's a bit of an understatement. Remember 150 million Americans get their health care coverage through their own or a family member's employment. Market surveys of these people generally show their approval of their plans in the mid to high 60's, which is lower than Medicare enrollees'  satisfaction. But those numbers tend to be in the low to mid 70s so while Medicare-for-All (or whatever) might be more popular than "Obamacare", I really doubt "you lose your nice healthcare plan and existing medical networks for an vaguely government program" would poll that high.

To put it another way, the Obama Administration caught holy hell for presiding over the cancellation of a few million shitty health care plans that didn't cover much of anything for years. Canceling 150 million employer provided plans that most people like would be YUGE political problem. Even if you promise on scouts honor the new government program is going to be wonderful.

Don't get me wrong, I'm not opposed to a single payer in the least. I think having such a program could have a lot of advantages over our strange jerry-rigged health care system we have now. But I think it's a lot more helpful to think about political efforts in tangible and practical ways, rather than vague platitudes about making something a "right".

Long time health care researcher and writer Harold Pollock put it this way in an excellent article entitled "Single Payer Is Not A Principle":

Single payer is not, in itself, a principle. It is one way to organize health-care financing. A regulated patchwork of private insurers undergirded by public subsidies and the individual mandate is another. In other words, these arrangements are means to an end, not ends themselves. After all, most American progressives would be thrilled to see the Dutch or German health-care systems enacted here, though neither of these is actually single payer in the sense that Medicare is.

Now normally when someone like me whines about the vagueness of slogans like "single payer" or "health care is a right", or reads the laundry list of massive political hurdles that would have to be overcome to enact a Medicare for All system (the fact the Roberts Court would probably rule such a law unconstitutional is my favorite) there is a typical response that goes like this: Most ideas about positive social change begins as a crazy harebrained idea! Be that the idea of a "March of Washington" or letting gay people get married! And yes whinny white liberals like you Longwalk often come up with reasons for why "now not the right time!"

These are fair points, but as I see it this back and forth just sort of shows that there are two possible scenarios for the outcome of what will happen when it comes to the politics of single payer health care. The "optimistic" or "Longwalk is a idiot" school of thought would say that the recent rather impressive move among Democratic elected officials towards embracing Bernie Sanders recent Medicare for All bill is, well, a great first step! Like gay marriage or women being allowed to vote it once seemed crazy, but is now becoming more normal, and liberals like me should embrace this new path or get out of the way.

But as much as I'd actually like this to be true (yes I want to be seen as an idiot on this occasion) I am also growing concerned that single payer is becoming a sort "identity politics" for lots of liberals and more "left" people, even as it remains as devoid of substance as it's ever been. In other words I worry about a "pessimistic" or "Longwalk is a cynical genius" possibility where people keep going on about about "single payer" as an abstract ideal that they demand politicians adhere to, and become cynical and jaded when the "sausage making" of crafting actual legislation fails to live up to these ideals.

In this is "pessimistic" account single payer dreams are becoming something a bit like Trump's famous wall. That is a sort of absurd promise that supporters none the less believe in and become quite jaded when they learn it was a "metaphor" or something.

And we're seeing this all over Republican politics these days. Its' not just that there won't be a wall and Hillary also won't be going to jail. It's also that coal jobs aren't coming back. Culture will keep becoming more liberal. And Trump's "winning" seems have been reduced to shouting at various professional athletes on Twitter.

Political scientist David Hopkins's summed up the price of this style of politics for the Republican Party pretty well back in the summer. As he put it:

...a party that rewards skill at stoking such sentiments rather than policy fluency or governing competence is asking for trouble—and now the trouble is here. Democrats, of course, find nothing to celebrate in Trump's record so far. But Republicans who prioritize the implementation of sound conservative policy are also being primed for disappointment. The GOP is in such a state that it cannot, by its own admission, be counted upon to avoid a government shutdown or a possible default on the national debt this year—much less to develop and enact successful initiatives on health care, taxes, financial regulation, and other topics.

After just four months, a remarkable despondency has set in within Republican ranks about the prospect of a legislatively productive 115th Congress. Despite holding unified control of government, the party is simply unequipped for serious policy-making—a deficiency for which Trump is both cause and symptom.

Does anyone think things have gotten better for the Republican Party since early June when Hopkins wrote that?

One of the stranger and seemingly easiest tasks a political party that's out of power has in our system of democracy is to, well not get all crazy. The Republican Party clearly failed on that part when it came to the Obama years, and thus when the cyclical nature of elections returned them to power the result was the insane Reality TV show that is the Trump White House and a do-nothing Congress that could very well shutdown the government over Christmas.

In other words I hope that I'm an idiot, but I'm growing increasingly concerned that far to many liberal and "left" people are emulating some of the same political pathologies that have made the GOP incapable of functioning nationally.

The last thing we need is outraged liberals screaming about how Sanders betrayed them after he realized on January 22nd 2021 that ending all union negotiated health care plans overnight would be less than ideal. This may seem crazy, but then again lots of people seemed to really have believed, or said they believed, that there would be a giant wall come 2018 that Mexico would pay for.

One dysfunctional political party has already brought the Republic to it's knees, we don't need another.