Democrats Should Address, Not Ignore or Dismiss, Skepticism of Single-Payer Health Care

The primary purpose of organizing into a political party is the pursuit of unambiguous objectives supported by the vast majority of that party’s members. To that end, political purity tests can be somewhat useful. Conventional wisdom may say otherwise, but I’ve never quite understood the objections to partisan demands for intraparty unity on fundamental issues. After all, what would be the point of a party that refuses to adhere to its own foundational principles? 

There is, however, a world of difference between demanding support for a specific objective and demanding support for a specific strategy designed to achieve that objective. The former is a necessary function of any party that seeks to preserve and fulfill its vision for a better future, whereas the latter indicates an authoritarian point of view that leaves no room for critically important discussions on how to best advance a party’s goals. 

Take, for example, the scornful responses to Democratic presidential candidate John Delaney after he revealed his opposition to a single-payer health care system at the California Democratic Party State Convention on June 2. 

"We should have universal health care, but it shouldn't be the kind of health care that kicks 150 million Americans off their health care," Delaney told the audience, eliciting a chorus of boos in the process. "That's not smart policy. I want everyone to have health care, but it's got to be a plan that works for every American."

So, Delaney agrees that universal coverage is a laudable goal and legislative imperative. He just doesn’t believe that Medicare for All, the single-payer system championed by progressive presidential candidates like Bernie Sanders, is the best way to make that happen. And rather than welcome the opportunity to let Democratic Party voters decide for themselves whether Delaney’s position is the right position for both the party and the country, some progressives, such as Democratic Representative Alexandria Ocasio-Cortez, have made it clear that they will not tolerate any dissent on this subject; Ocasio-Cortez responded to Delaney’s comments not by restating her case for a single-payer system or highlighting the potential pitfalls of Delaney’s own health care plan, but by suggesting that Delaney should just remove himself from the field of Democratic presidential hopefuls if he doesn’t believe that Medicare for All is the only acceptable plan for bringing universal health care to America. 

Over the last several years, rumors regarding the emergence of an authoritarian left have spread like wildfire, and this recent episode involving Delaney lends even more credence to the perception that the American left is becoming increasingly dictatorial. On universal health care specifically, some progressives seem so convinced of their omniscience that they can’t even stomach the mere utterance of an alternative plan, let alone the audacity of a fellow Democrat’s advocacy for said plan. But the truth is that there are viable alternatives to Medicare for All that deserve fair consideration, alternatives which may or may not be better fits for this nation, this culture, and this economy. 

Singapore’s universal health care system, for instance, is a market-driven system in which patients and their employers are largely responsible for the costs of their own medical care. Those costs pale in comparison to what Americans spend annually on health care, but they’re accompanied by astonishingly strict regulations that many Americans would undoubtedly characterize as nothing short of tyrannical. That said, there are facets of the Singaporean model, such as its Medisave program, which could act as critically important components of a future American hybrid system that strives to balance taxpayer-funded universal access with private sector innovation and personal responsibility. 

In Europe, multiple nations have successfully implemented universal health care systems that are sometimes mistaken for single-payer systems. Germany, for instance, has a multi-payer system that’s less expensive than its American counterpart and permits its citizens to enrol in private insurance plans if they so desire.

Switzerland’s system—which, like Obamacare, depends upon an individual health insurance mandate of its own and relies heavily on private sector services—is quite expensive relative to other European nations. But it still costs less than American health care and features impressive flexibility with respect to the types of insurance policies available to Swiss residents. 

Would any of those systems, or perhaps an assemblage of various components from various systems, work better than Medicare for All? If Americans do ultimately settle for single-payer health care, will they be prepared to shoulder the considerable tax burden that will likely come with it? What will happen to the thousands upon thousands of employees who will lose their jobs if private insurance is eliminated entirely? And how can the United States avoid running into the same problems that other single-payer nations have had to grapple with, such as the resource shortages that have pushed Britain’s National Health Service to the brink? These are valid questions that should be debated and discussed. They’re bound to come up during the general election anyway, so Democrats would do well to start figuring out how to explain the ins and outs of Medicare for All—or any other universal health care plan that the eventual Democratic nominee might decide to endorse—to a national audience.

Instead, some on the left have eschewed that discussion, insisting on a my-way-or-the-highway approach to this issue. In their view, any skepticism regarding the feasibility of a single-payer system like Medicare for All is tantamount to treason and must either be met with hubristic dismissiveness or stamped out in short order.

America doesn’t need that sort of dogmatic authoritarianism right now; what it needs is the best possible version of a universal health care system that can affordably meet the demands of the American people without sacrificing innovation or efficiency in the process. It’s not yet certain that Medicare for All fits that bill, or that there isn’t a more politically palatable and effective alternative just waiting to be discovered. With that in mind, Democrats should welcome the opportunity to debate the benefits and drawbacks of every potential health care plan that could finally deliver on the progressive promise of universal access to quality medical care. Considering the stakes, it would be extraordinarily irresponsible to do otherwise.



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