On Krugman’s Critique of Sanders’ Single Payer Plan

I’m not going to attempt an exhaustive look at the critiques of Bernie Sanders’ single player health care plan. There are a lot out there, which is not surprising given how big an idea Sanders has put into play. For weeks the drumbeat from the Clinton campaign, surrogates and some in the press has been to ask, “Where is Bernie’s single payer plan?” Now that he has produced one, the immediate pivot has been to tear it down with an argument that amounts to, “Bernie’s single payer plan is unrealistic because it is a single payer plan.”

There’s a lot that gets packed into these criticisms, but I wanted to take a look at one from a very respected source: Paul Krugman. Paul Krugman’s takedown of Bernie Sanders single payer health care plan contain three main fallacious arguments in my view.

The first is his lede & description of Obamacare: “It more or less achieves a goal — access to health insurance for all Americans — that progressives have been trying to reach for three generations.” That is a re-writing of history. The long standing goal, as Senator Sanders repeatedly pointed out last night in the debate, was universal health care, not access to health insurance. To wit, if the goal had always been the sort of insurance access kludge we got in Obamacare, Obamacare would have been arriving as the clear demand, not the bartered, lobbied, crafted, kludged end-product that we ended up with. Obamacare might be an effective delivery vehicle for “access to health insurance for all Americans” – and its expansion of Medicare are even more effective – but it certainly did not deliver health care as a right. To that end, as much as it was a generational accomplishment for the Democratic Party, it did not leave the health care box permanently checked on the list of goals for the the Party.

The second issue I take with Krugman is that his first two objections to Sanders’ plan are attempts to be pragmatic, yet ignore what Sanders is actually saying. They are, effectively (1) incumbent players have lots of power and (2) it will be hard to convince the public that the tax costs to them are worth it (as rich people will spend lots of money opposing the bigger hit to their wallets).

I don’t doubt that these are accurate descriptions of reality and why passing single payer would be hard. But I think it is incredibly disingenuous to raise these points as reasons that Sanders’ plan is bad, while ignoring that they are fundamentally connected to Sanders’ argument that we need a “political revolution” in America that gets money out of politics and ends the influence of major lobbies like the health insurance, pharmaceutical and financial industries so that we can do the things we need to do like pass single payer healthcare.

Sanders has throughout the campaign presented a coherent argument about how fighting income inequality, passing single payer healthcare, achieving criminal justice reform, and fighting climate change (among many other issues) are all intrinsically linked to the need to reduce the influence of mega corporations, millionaires and billionaires in the political process. Not only is it not news to Sanders that there are major forces aligned against him, it is fundamental to his whole campaign’s argument.

It is dishonest to look at Sanders’ single player healthcare play in the absence of the political analysis that it exists in, then try to discredit the Sanders’ plan as unfeasible on the basis of this exclusion. This is what Krugman’s first two points about Sanders plan being likely to face opposition from powerful lobbies and rich people does. It ignores the fact that Sanders is saying the exact same thing.

Krugman’s third point is that voters wouldn’t stand for this sort of disruption to their insurance plans. Well, today, maybe that could be true. But if we envision a future where we have had our “political revolution,” where money is being forced out of politics, the rich are being made to pay their fair share to help healthcare exist as a human right, then perhaps Americans will be not only willing, but anxiously awaiting the minor disruptions which may come in the process of switching from the kludge of health care and insurance programs we now have to a more unified one that offers them richer benefits.

Sanders’ whole campaign has told the story of how he wants to create a different America, one that is more equitable, that is less corrupt and is built to work for the people, not billionaires. It is no doubt an aspirational story. There are no doubt many pragmatic arguments to be made against such a vision being achieved in the next year or two or four. But focusing into one part of the Sanders vision and trying to discredit it for lacking the very terms found in the rest of that vision is fundamentally dishonest.

Moreover, the highly pragmatic and conveniently disingenuous critique of Sanders is no accidental artifact induced by Sanders’ specific proposals. The likelihood is that there is no single payer plan that could be constructed and presented in such a way so that the political pundit class, establishment Democrats and the entire Republican Party would look at it and say, “Gee, that is a highly pragmatic and achievable plan that we can all see passing within the first four years of a Sanders administration.” None. The response we are seeing now is always the response that we would see from Clinton and centrist self-described wonks.

That is what it is. It does not mean Sanders should not be campaigning for single payer nor that he made a mistake by articulate a plan. Presenting a vision, grounded in a wider analysis of the political process, for how we can deliver health care as a right in America is a critically important step that Sanders has taken. It pushes the envelope on what has been presented by American presidential candidates. We are having a debate about single payer health care in America – that is a good thing! This is a necessary step for us ever actually getting single payer. It isn’t going to happen absent a politician running on it, building a movement of support for it, and having that movement force it forward over loud, monied opposition.

Bernie Sanders knows this would be a dogfight. He’s told us so for a long time. And as of January 2016, he’s the only candidate pushing forward into the fray.

Krugman vs Vouchercare

Paul Krugman has been steadfast in his commitment to calling out the Republican plan to destroy Medicare in the Ryan budget for what it is: a plan to destroy Medicare and replace it with vouchers. The GOP has been pitching quite a hissy-fit since Krugman and many Democrats have started to correctly label their Vouchercare plan for what it is. But Krugman doesn’t back down and today’s column is a good look at exactly why the Ryan budget destroys Medicare and how calling the GOP Vouchercare plan Medicare is nonsense.

Towards the end of his column, Krugman turns towards Canada’s universal healthcare system (also called Medicare) as an example of what a genuinely improved version of our Medicare could look like by reducing waste and increasing efficiency. Krugman writes:

Canadian Medicare, then, looks sustainable; why can’t we do the same thing here? Well, you know the answer in the case of the Republicans: They don’t want to make Medicare sustainable, they want to destroy it under the guise of saving it.

One thing that could emerge (at least an a sane, alternative reality version of America) from the current fight over the Ryan budget’s destruction of Medicare and the wholesale voting of House Republicans in favor of this destruction is a debate about why Medicare works and why it needs to be expanded, not destroyed with vouchers. This, in turn, could actually open up the door for a policy debate that says, “Well if Medicare is this great for seniors, why don’t we expand Medicare to cover all Americans?” Of course there is no cohort of Democrats in federal elected office with any power who support this or would argue for it. But I’d love to hear the anti-Vouchercare crusading Democrats make a convincing argument against Medicare for All that doesn’t use the words “political capital,” though I doubt that’s possible.

A Vulnerable Plan

What Digby said:

The plan is vulnerable on a number of fronts (not the least of which is the funding for the Medicaid expansion) and all we heard for months was “don’t worry, once you pass an ‘entitlement’ they’ll never be able to take it away.” And that was nonsense. With the plan taking years to implement, the right having packed the courts for decades and the Republican Party being batshit insane, there was always a very good chance that some element of the plan was going to be struck down. And because it was such a Rube Goldberg mess by the end of it, the result was likely to be the whole thing falling apart. Having something like an optional Medicare buy-in would have been a good back-up just in case. (After all, if they start invalidating Medicare, they know there will be hell to pay.)

All the Very Serious People also told us that the plan would be immediately “improved” and all the problems would be fixed once it was passed, so I suppose they could still add on a Public Option. I was just a teensy bit skeptical that they would even be able to defend the plan as it was, much less “fix” it, and I’m even more skeptical now. But who knows, maybe a miracle will happen.

The Modern Republican Party

Former Bush speechwriter David Frum:

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

Enter newly hatched CNN contributor, Erick “Son of Erick” Erickson:

The Republican leadership remains accommodationist and fearful of being labeled the ‘party of no.’

Let me be blunt: any Republican who says we will repeal and replace will themselves be replaced. We want repeal period.

This is not to say we will not offer up our own ideas, of which there are many. This is to say that right now there is no consensus on what to replace this monstrosity with, so instead of nuancing just promise to repeal it. We don’t need cute and clever politicians right now, we need a commitment to repeal Obamacare.

It looks like Erickson and his piece of the Republican Party want to double-down on the radicalism. Good luck with that!

If I had to guess, though, Frum is going to continue to be marginalized by increasingly establishment voices like Erickson. I don’t think the GOP will be able to tear themselves away from the Party of No and in fact will only increase their blind oppositionism to any and all things proposed by President Obama and the Democratic Party.

What Progressives Won

This post by Chris Bowers is really worth a read, especially as the wheels of “Rahm was right to shit on progressives” get going in the Beltway. The main point by Bowers:

It is factually untrue that progressives won no concessions in this bill. People are free to debate over whether the concessions are enough either to support the bill or to demonstrate increased influence, but it is simply untrue that they won nothing in return for their support.