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.