In my middle-class family (of origin), we were raised to acknowledge and appreciate our good fortune, like good health and the freedom middle-class Americans had to pursue their dreams, but also to knock wood when acknowledging it, which was insurance against jinxing said good fortune. (The wood-knocking tradition apparently had pagan roots.) In my family, if no wood was handy, you could knock yourself on the noggin.
In that spirit, I gratefully acknowledge my good fortune that since birth I have had mostly good health, and have also always been covered by health insurance, first provided by my parents, then via various jobs. And now I qualify for the program that we call Medicare (so we don’t have to call it socialized medicine for seniors).
Lucky me. I’ve had many advantages in life: brave grandparents who emigrated here from a much worse place, parents who worked hard and sacrificed so their kids could have a shot at the good life in America, a healthy body, and now a wonderful wife and kids who were born with healthy bodies and access to health care. I know a lot of people have been less fortunate.
I don’t know how central any of the above is to my basically liberal leanings (probably a lot). But, personally, perhaps based on what is sometimes mockingly called liberal guilt, I have long been ready to support social democratic programs, like, for example, single-payer health care. (I know, I’m supposed to say “Medicare for All” now. Fine. Either way, I’m for it. Having never had to worry about access to health care, I want that peace of mind for everyone.)
Despite the self-mockery above, I don’t know how to morally justify the status quo in U.S. health policy in which our nation, one of the most affluent in the world, has one of the highest (or is it the highest, among the wealthy nations?) share of its population who are uninsured. Health care policy and economics – especially in the USA – can be maddeningly complex, and the policy discussion is fraught with political peril.
The Affordable Care Act (Obamacare) was ridiculously complicated, made too many concessions to the medical/pharmaceutical/health insurance megaplex, and didn’t do enough to reduce the uninsured portion of the U.S. population. But, considering how difficult it was to get it passed, it was probably the biggest step toward reducing the ranks of the uninsured that could have passed. And it has – significantly – helped formerly uninsured people get covered.
The ACA’s enemies are determined to repeal it, or at least continue to weaken it. This graph from the Kaiser Family Foundation demonstrates two things at a glance.
From 2011 – the year the ACA began to be implemented, to 2016, the uninsured portion of the non-elderly U.S. population was reduced from 17.8 percent,to 10.0 percent. Not quite cut in half, but almost. It dropped every year, although the decline certainly was stalling. The closest the United States has ever been to having universal coverage was 2016.
Also in 2016, Hillary Clinton ran for president promising some smallish improvements in the program. Bernie Sanders ran advocating movement toward “Medicare for All,” which was another, presumably less politically scary name for single-payer government subsidized health care. And Donald Trump ran on repealing the Affordable Care Act and replacing it with something that he couldn’t describe intelligibly, perhaps because the replacement program didn’t exist.
In case you’re just waking up from a long nap, Trump won the election. But, despite Republican control of all branches, the dream of “repeal and replace” failed.
The Trump administration continues to try to hamper the ACA in small ways. In 2017, for the first time in seven years, according to Kaiser, the portion of non-elderly Americans who are covered by health insurance declined, but only slightly. Efforts on many fronts across all three branches of the federal government continue to starve or poison the ACA program continue. Nothing very big has happened.
And now that Democrats have retaken control of the U.S. House, talk of ACA repeal is mostly over. Democrats oppose repeal, but are divided between those (like Sanders and many of the fiery lefties who were just elected) continue to push for something much closer to single payer/Medicare for all.
Which brings me to this week’s New York Times column by the great Thomas Edsall, which is what set me off in this small diatribe, or ode to my late parents. As usual, Edsall corresponded with scholars and other smarties seeking their insights into political and policy questions, in this case about the future of health care policy.
Edsall wasn’t fundamentally exploring ACA repeal. He was asking his correspondents more about the coming clash within the Democratic Party between its left and its centrist (or center-left) branches.
Before 2016, even the leftmost tended not to use the word “socialism” (as in “socialized medicine”). They were pretty shy about what might be called far-left liberalism.
Sanders, who has called himself a “democratic socialist” for decades (and still doesn’t call himself a member of the Democratic Party, even though he sought its presidential nomination in 2016 and may do so again in 2020), took many positions that were outside the boundaries of conventional Democratic Party liberalism, made a strong run for the Democratic nomination and may try again in 2020. Meanwhile, a substantial cadre of new young Democrats emerged who don’t shy away from the S-word and advocate for policies that used to be considered nut-left positions, like single-payer health care.
That has changed. Many young Democrats call for unambiguously single-payer health care (although some prefer “Medicare for All”).
Freshman Democratic superstar U.S. Rep. Alexandria Ocasio-Cortez of New York calls herself a Democratic Socialist and says health care is a basic human right. And she’s not the only one among young Democrats.
This is precisely the phenomenon Edsall is exploring in his column, but he notes an obvious tension. Ocasio-Cortez represents a powerful new left in the party, but the same party includes moderate liberals who certainly are not comfortable with the S-word.
Some Democrats, though a shrinking share, call themselves moderates and a few even call themselves conservatives. But the furthest left group are the most active Democrats and the most likely to, for example, vote in primaries, which raises the possibility that the moderate Democrats may find themselves uncomfortable with some of the party’s nominees.
Edsall quotes David Graham of The Atlantic, who wrote:
There’s clear leftward movement among Democratic voters on a range of issues, and there are more progressive candidates running than ever. But this doesn’t amount, at least yet, to the socialist groundswell that advocates pine for and critics fear. The actual policy positions, and number of leftist officeholders, will remain limited — at least for now. What happens in 2020 could be more telling.
The Democratic Party is moving left, but it might not be clear quite how far left for two or even six years. The revolution is coming more slowly than its champions hope and its critics fear.
It’s clear the Dems will have a huge primary field for the 2020 presidential nomination, ranging from socialists to moderates. To read the full Edsall column, follow this link.