Matthew Yglesias touches on something that has bothered me for a long time on the left-ish side of the healthcare debate (boldface mine):
If progressive activists want to make a push for single-payer health care, then a push is going to be made. If competent technocrats don’t help, then the push will end up being for something unworkable and will likely end in tears. It’s time for Democratic health wonks to stop refighting old wars and start working on the health care system of the future….
Sanders’s 2016 campaign started as, essentially, a protest movement that didn’t particularly seek expert policy advice in crafting its proposals and certainly didn’t receive it, given fear of retaliation by presumed victor Hillary Clinton against anyone who worked for her opponent…
What they need are some concrete policy options that would let them begin to seriously weigh the pros and cons of different possible approaches. How much revenue would be needed, and what taxes could raise it? Can disruption be usefully minimized by phasing in the new program over time? Can both disruption and tax increases be minimized by structuring payments as “premiums” or something that employers “buy in” to? What happens to private insurers’ participation in selling of Medicare Advantage and Medigap insurance plans? How can we help ensure that the money employers save actually does pass through to workers as wages?
These are the kinds of details that voters don’t really care about right up until something is about to become law. But if you want to pass a law, you need to address them. And as the ultimate collapse of Republicans’ ACA repeal efforts shows, it’s not good enough to simply assume that good solutions will emerge in the future. Nothing at all is politically feasible from a progressive point of view right now. But in truth, nobody knows what 2019 or 2021 will hold or what avenues for action may open up in state government. Right now, though, the left wing of the Democratic Party has a big idea on health care but no plan. It’s time for the wonks to step up.
One issue is that Yglesias assumes most Democratic-aligned wonks want a good, universal system. It’s not clear to me that those ensconced within the party-aligned think tanks actually want to do this (plenty of them were cool with the Clinton line of opposing ‘free’ public college education, even though we could rearrange current subsidies to cover this–though that might affect said wonks personally). Ideologically, many of them are neo-liberals sensu Sawicky.
Single-payer advocates, the hardcore socialists aside, want what other countries have: portable, affordable healthcare that is easy to use (and gain access to in the first place) and that isn’t contingent on your job. Personally, I don’t care if it’s a hybrid system or more like Medicaid-for-all (that’s not a typo), or flat-out Canadian-style healthcare (AAAIIIEEE!!!!). But such a system, whatever the details are, is not like trying to make cold fusion work or going to Mars. Other countries have already done this, so this is not impossible, by a long shot.