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.

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