A single-payer healthcare system appears closer than ever but to make it a reality we must avoid the pitfalls of the past
Sun 16 Sep 2018
Barack Obama dropped a bombshell into the healthcare debate roiling the Democratic party last Friday. “Democrats aren’t just running on good old ideas like a higher minimum wage,” he said, “they’re running on good new ideas, like Medicare for All …” His endorsement made headlines, and for a good reason: until recently, real universal healthcare had long resided on the margins of the American political discourse. Obama’s announcement, then, was yet one more indication that this idea – also called single-payer healthcare – had migrated to the mainstream. The shift is an encouraging development for proponents, to be sure, but there is also cause for caution: as history shows, formidable political obstacles and pitfalls lie ahead.
It is difficult to overstate how far single-payer has recently moved. Consider, for a moment, where things stood after Democrats took the presidency and both houses of Congress in 2008. “The White House and Democratic leaders have made clear,” the Washington Post reported the following year, “there is no chance that Congress will adopt a single-payer approach … because it is too radical a change.” Single-payer supporters didn’t even have a seat at the table (and some were arrested when they showed up anyway).
Following the passage of the Affordable Care Act, however, several developments pushed single-payer to the fore. First, although Obamacare expanded coverage to some 20 million people – achieving much good – it raised hopes that universal healthcare would be achieved while failing to deliver it: some 29 million remain uninsured today, while many more face onerous deductibles, restrictive insurance networks, surprise bills, unaffordable medications, medical bankruptcies and disruptions in care with every change in insurance plan.
Next, there was the 2016 election of Donald Trump, which made it obvious that Republicans lacked even a semi-serious alternative. Congressman Paul Ryan’s long-awaited ACA repeal bill was mostly a mechanism to transfer healthcare dollars from the poor into the savings accounts of the rich, and it seemed to satisfy no one except for wealthy donors.
Finally, there was a marked progressive shift within the Democratic party, beginning with the 2015-16 presidential primary campaign. Former secretary of state Hillary Clinton opposed single-payer, saying it would “never, ever” happen, but it was central to the platform of Vermont senator Bernie Sanders. Sanders lost the primary, of course, but he advocated better ideas.
Obama’s endorsement of single-payer on Friday (despite having previously said something similar) is therefore tantamount to a major shift in the Overton window, reflecting years of activism by single-payer supporters as well as a historic intra-party shift.
Today, in primary contests across the country, progressive Medicare-for-All proponents are ousting more centrist and establishment candidates – Alexandria Ocasio-Cortez’s surprise primary win in New York’s 14th congressional district being the most popular example. At the same time, public support has soared: a recent Reuters poll found that 70.1% want Medicare for All, including 84.5% of Democrats. One might even argue that for people who want a job as a Democratic politician, in other words, supporting single-payer is nearly becoming a prerequisite.