I’ve come to be pretty tired of the Clinton and Sanders camps sniping at each other — especially over healthcare reform. It’s hard for me to be objective, of course, because I am a Bernie Sanders supporter. But I do think more sniping comes from the Clinton camp. It isn’t a question of total sniping. But there is a whole lot more institutional sniping by Clinton supporters. And I understand it: she’s the establishment candidate for a reason: she’s the safe choice. And as a Sanders supporter, I have to admit: I don’t see much in the way of policy differences between the two once they are in office. We live in a democracy, not a autocracy. So I wish everyone would just cut it out.
But there are substantive differences between the candidates that are worth talking about. Healthcare reform is the big one: the “fix Obamacare” approach and the “replace Obamacare with single payer” approach. What I don’t understand is why these have to be different. As you all know, I’m very happy with Obamacare, Covered California: I Died and Woke Up in Canada. I certainly would prefer a universal, single-payer system. Obamacare is a complicated mess. And I don’t really see why I had to decide between the bronze and silver plans. Like I’m in any way qualified to know what is best for me! But that’s the way our neoliberal system works.
Still, it seems to me that Obamacare is single-payer just waiting to happen. For this discussion, forget people who get their insurance through their employers. For one thing, it makes this all easier to think about. But more important, I think that now that we have Obamacare, employer provided health insurance will (Quite rightly!) become a thing of the past. It will probably take twenty years, but eventually, healthcare just won’t be provided in that way. It’s existence is a fluke of history anyway.
So we have a system now in three parts: Medicaid for the poor, Medicare for the old, and the Exchanges for everyone else. Currently, Medicaid provides free healthcare to those making up to 133% of the poverty level. (Because of John Roberts, this isn’t true in most red states, but that will change over time.) What I want to know is why we can’t change the Medicaid level. Why not increase it to 150%? Or 400% (the level where government subsidies end on the exchanges)? Or why can’t we lower the age for Medicare? How about 60 years old as a cutoff? For people like me who want “Medicare for all,” this seems obvious. Whenever the Democrats get control of the government, they can increase the number of people who qualify for Medicare and Medicare. And eventually, you end up with a universal, single-payer healthcare system.
As far as I can tell, there is only one objection to this healthcare reform plan: it isn’t realistic. But it is more realistic than simply jumping to a full out single-payer healthcare system. And it has the advantages of being a gradual process — one where the insurance companies can gradually move into other areas. But even more than that, our healthcare problems are a lot bigger than our fragmented private insurance market.
Dean Baker recently wrote, Paul Krugman, Bernie Sanders, and Medicare for All. He noted, “Getting universal Medicare would require overcoming opposition not only from insurers and drug companies, but doctors and hospital administrators, both of whom are paid at levels two to three times higher than their counterparts in other wealthy countries.” And that’s important. The country needs to get used to the fact that our idiosyncrasies have distorted our system such that healthcare reform is complicated. And it is going to take time on a lot of fronts to deal with this. There is no quick fix.
So in a sense, I agree more with Hillary Clinton about healthcare reform. But I know a little bit about negotiation. And if Clinton is talking about the very reasonable idea of making Obamacare work better and having it cover more people, the most likely result will be that nothing will change. But Sanders’ unreasonable push for single-payer healthcare right now is much more likely to result in good changes to Obamacare. Let’s not forget that Obama ran in 2008 on the unreasonable idea that we didn’t need an individual mandate. We didn’t get his more liberal plan, but we did get a plan that is providing me with healthcare and dental insurance at negligible costs.
None of this means that Clinton is bad. But similarly, none of this means that Sanders is unrealistic. I’ll proudly support either of them.