Practical Law-Making -4, Virtue-Signalling +4

At the New Yorker Jonathan Chait castigates Sen. Bernie Sanders’s single-payer legislation as hand-waving and posturing:

In reality, single payer has always been, and remains, a political dilemma that nobody has been able to resolve, and there is no evidence the resolution has grown any easier. What looks like a large step forward is actually a party edging closer to a cliff it has no intention of going over.

The barrier to single payer is that the American health-care system has been built, by accident, around employer-based insurance. The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

That is not a detail to be worked out. It is the entire problem. The impossibility of this barrier is why Lyndon Johnson gave up on trying to pass a universal health-care bill and instead confined his legislation to the elderly (who mostly did not get insurance through employers), and why Barack Obama left the employer-based system intact and created alternate coverage for non-elderly people outside it.

The basic problem, no minor detail, is that as in the old joke, you can’t get there from here.

The most generous possible interpretation of the bill is that Sen. Sanders is attempting to move the Overton Window. Somewhat less generous is that he’s trying to establish a litmus test for Democratic candidates for the 2018 and 2020 elections. That would be disastrous. However vocal and visible they may be, progressives are still a minority of the Democratic Party. Moderates and conservatives hold a narrow majority.

And they account for only about 15% of voters. Appealing more strongly to progressives is the key to becoming a clique rather than a functioning political party.

By far the greatest likelihood is that Sen. Sanders and his cosponsors are merely trying to tell us that their hearts are in the right place.

9 comments… add one
  • Ben Wolf

    Chah-It’s history is wrong: the intent behind Medicare was to begin with the elderly and gradually extend the program downward until all Americans were covered. This didn’t happen because Johnson decided it was more important to set Southeast Asia on fire than expend influence on expanding the Great Society programs he abandoned almost immediately after enacting.

    The Sanders bill also rolls out in stages. Over a four year period the program will expand until all Americans are covered, an approach that appears to have come from Kirsten Gillibrand and her staff.

  • TastyBits

    Why should leftist progressives sit down, shut up, and submit to their ‘betters’? If I were a leftist progressive, I would want to know what I am getting for not being ‘uppity’.

  • jan

    A calculated guess, at what Sander’s bill would cost through 2026, is something like $35 trillion. That’s not chump change! And, the sentiment, behind this raw estimate, is that it could cost more — an avenue of debt that most big social programs tend to go.

  • Modulo Myself

    Chait is a banal middle-manager telling his owners what they want to hear, which is that altering the social arrangements in force in America (and from which they absorb all of the profits) is as impossible as exceeding the speed of light. “Yes, master they all love their shit insurance that ties them to their shit jobs. And if that doesn’t work Just show them a picture of a poor person and they’ll give you a nice handjob in the middle manager white fashion, just like their daddies told them to.”

  • Andy


    Considering the success of the Obamacare rollout four years is stupidly idealistic.

    Point being is that progressives and Democrats still are not active supporters of good governance which is something I still don’t understand. If we decide to operationalize this thing and pit our present sclerotic federal bureaucracy against the idealistic intentions of this bill, I know who will win that contest and it won’t be the American people.

    That said I agree with the general gist. I’ve long thought it would be best to get employers out of the health insurance business. But I’m also a guy that focuses on the operational details – a hard lesson learned from trying to implement plans that sprang forth from good idea fairies in the DoD who had big ideas but little experience. Congress is worse.

    Also, we’re talking trillions of dollars here – the contracting for all that and the required support systems should be a lot of fun! Given the stakes and the competition, we might get some of the contracts finalized in four years – after all the protests are adjudicated – but maybe not.

  • mike shupp

    Chait is an idiot. I assume he spends half an hour a day hitting himself in the head with a large hammer to prepare himself for work.

    We have this thing called Obamacare, which is a health insurance scheme run by the government which is deliberately engineered to keep non-governmentally-owned insurance companies functioning. Since this is clearly an important issue, I’m willing to bet the US can create a health insurance scheme with some elements of choice, so everybody in the nation gets some kind of health care, and privately owned insurance companies — through the miracles of Free Enterprise and Competition and Entrepreneurism — make out like bandits. Somehow, the wealthy will survive our leftward lurch into socialism. We can do this.

    So the economics and machinery of providing Health Care For All is not really the issue. There’s a political problem, in that half the people in the country have health care through their employers. and think of their health care as something they earned through their labor, and will be resentful of F$%^&^g Bums Who Want Health Care But Won’t Work To Earn It. The FBWWHCBWWTEI may inherit the rest of the earth, but it’s going to be good long while before they get their hands on the American part of it!

    The public’s not into socialism, in other words. And, hell, sitting here mumbling to myself, I’m not sure I am either.

  • Ben Wolf

    A calculated guess, at what Sander’s bill would cost through 2026, is something like $35 trillion.

    Without the bill spending over the same period is currently projected to be $48 trillion. And let’s keep in mind the $32 trillion price tag was deployed by allies of the Clinton’s to hit Sanders during the primary.

  • Janis Gore

    If they’d do the damned actuarial studies first we might get somewhere.

  • sam

    “There’s a political problem, in that half the people in the country have health care through their employers. ”

    We have seen subsidization and they is a very large proportion of us.

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