In what was already a deeply polarized race, few issues divided the Democratic primary field quite like health care reform. Misleadingly, at least for many voters, the debate has masked itself as being about policy, framed around questions like “should people be given the option to choose between a private insurance plan and a government one?” and “what about existing plans secured by unions in collective bargaining?”
At times, the debate also appeared to be one of strategy, constituting the most significant front in what many liberals saw as a wider battle pitting savvy pragmatism against left-wing purity.
Seen in these terms, the position championed by Bernie Sanders — which loudly put Medicare For All (M4A) front and center as an unqualified demand — was, at best, crudely maximalist and naive about the opposition any meaningful push for nationalized health insurance would face in Congress. The sensible, realist position lay somewhere between the Affordable Care Act (ACA) and M4A.
But, as is so often the case in American politics, what appeared to be a good-faith debate over policy and strategy was mostly about something more straightforward: the overbearing influence of corporate donors and the apparently irresistible urge among liberal politicians to genuflect in their direction.
The political center of gravity being what it is in an environment so thoroughly dominated by industry lobbyists and organized wealth, the Sanders strategy understood that only direct confrontation with both would yield the possibility of success.
What called itself the realist position was naive on its face about where the Democratic reflex to triangulate on health care would almost certainly wind up: in yet another round of minor tweaks and patches to a system that is structurally incapable of serving average people’s health care needs.
It’s hard to imagine a better vindication of this assessment than the recent revelation that Democrats may be preparing to retreat from the position they’re currently campaigning on should Joe Biden be elected president in November. In theory, Biden supports a public option for health care — that is, a government-run insurance scheme that would compete alongside private providers. But, as the Hill reported earlier this week:
Once the arena shifts away from the campaign trail to Congress, where the proposal would have to pass via a narrow margin in the Senate and despite fierce opposition from well-funded industry groups, Biden’s plan would become a daunting challenge to enact. Surveying this landscape, some Democratic congressional aides and outside health care advisers, who spoke on the condition of anonymity, said they expected the party would start next year with a more modest package of fixes to ObamaCare that did not include a public option in an effort to get some early points on the board…A Senate Democratic aide…noted that if Democrats win back the Senate, it will be through red or purple states, and there will be plenty more moderate members in the caucus.
In other words, the public option — the very plan supposedly easier for Democrats to pass than M4A — could be abandoned outright in January as party leaders preemptively capitulate to opposition from both the insurance industry and their own more conservative members.
It’s only August, so there is no Democratic presidential administration in place to carry out such a surrender. But the political landscape already has noticeable parallels to that of 2009 and 2010, when Democrats last walked back their support for a public option.
Then as now, liberal politicians failed to fight for the reforms they’d promised with any real conviction and, as opposition intensified, quickly retreated further — a pattern that seems likely to repeat itself, if the recent reporting is correct. Now, as before, no amount of Democratic triangulation will ever be enough to mitigate resistance from an industry that would sooner see millions without health insurance than relinquish its profits.
With such resistance inevitable, the only course with any chance of success is thus one of direct confrontation with corporate power. Riding a wave of popularity after a landslide win in 2008 and equipped with a filibuster-proof majority in the Senate, Democrats still failed to legislate a public option into existence.
Barring an unexpectedly large margin of victory in 2020, there’s little reason to believe they’ll have anything like the same congressional latitude in 2021 — or a newfound impetus for whipping votes in support of legislation certain to meet fierce opposition from private health interests once again.
Medicare for All was never going to be easy. But there can be little doubt that a Democratic campaign that embraced it wholeheartedly would have an easier time passing something transformative than one running with minimal conviction on a compromise that is almost certain to be compromised further. Bernie was right: it’s still Medicare for All or bust.