"My critics will say that Trump, uncharacteristically, puts too much faith in bureaucracy; a single-payer plan would generate a gigantic agency to distribute funds to doctors. I'd point out that by creating one agency we do away with hundreds of smaller ones that are hard to monitor." —Donald Trump, The America We Deserve, 2000
Donald Trump sure has changed a lot. Back in 2000 he wrote a vociferous defense of single-payer health care in his otherwise odious book The America We Deserve.
But as president, Trump is fighting single-payer tooth and nail. In a tweet this week, he called it "a curse on the U.S. and its people."
He wasn't the only one. Much of the Beltway intelligentsia is recoiling in horror after Bernie Sanders introduced a new Medicare-for-all bill, an idea that has gone from zero to 16 sponsors in the Senate in the space of two years.
In the pre-Trump universe, a Medicare-for-all bill would have had no chance of passage. But now that the hated Trump has come out against it, and moreover since Democrats were forced to argue during the Trumpcare debate that leaving people uncovered is morally untenable and even murderous, single-payer suddenly has wheels.
Single-payer doesn't necessarily mean an end to private insurance. It just means the government would be the bureaucratic entity that pays the bills. It would eliminate our current insanely wasteful and inefficient collection system, which leaves too many uninsured and forces medical providers to spend monstrous amounts of time and bureaucratic effort just to get paid.
No other industrialized country has a system as dumb as ours. The unpopularity of Trump provides a unique opportunity for Democrats to organize behind this necessary and instantly popular reform.
The ironies here are myriad: Donald Trump, a onetime single-payer supporter who even as a candidate raged against the obvious stupidity of our health care system and repeatedly bashed the artificial subsidies enjoyed by insurance and pharmaceutical companies, is now the best friend single-payer advocates have got. The more Trump hates on the plan, the more politically realistic it will become.
The best recent evidence of single-payer's new life was the stunning conversion of none other than former Montana Sen. Max Baucus, the chair of the Senate Finance Committee during the original Affordable Care Act debate.
Baucus back then was an obstructionist force, a congressional Dikembe Mutombo blocking any and all attempts to install the donor-despised single-payer system.
As the key senator guiding the Obamacare effort, Baucus had the tough job of passing health care reform while keeping all the major corporate donors at least part of the way inside the Democratic tent.
That meant creating a bill that expanded coverage, but left vast and unnecessary bureaucratic inefficiencies in place to be gorged upon by the clients of lobbying orgs like AHIP, Amgen and PhRMA, who held then (and still hold) considerable sway with both parties. Many of those lobbying firms hired former Baucus staffers to act as liaisons during the Obamacare debate.
Baucus was seen as a kind of unofficial sounding board for the corporate side of health care reform. He was considered so totally in the bag that when asked if he thought Baucus would be open to single-payer, Bernie Sanders back then said, "Not in a million years."
That makes the news that Baucus has now come out in support of single-payer shocking. "We've got to start looking at single-payer," Baucus told local reporters in Montana last week. "We're getting there. It's going to happen."
For people who were forced to follow the agonizing ACA madness, the Baucus news feels like an unthinkable conversion, like hearing Ralph Reed had gone into porn. It has both sides of the Beltway punditocracy freaked out.
In Politico, Bill Scher, a writer who's made a career cranking out pieces like "The Liberal Case for High-Tech NSA Surveillance" and "The Resistance Will Be ... Underwritten by Corporations," penned the definitive Dem-side freakout on the Sanders bill.
Scher's "The Single-Payer Insanity" argues... something, but it's not clear what. He seems to be saying that single-payer is a "quick fix" panacea, more slogan than policy, and something that sounds easy but isn't. Apparently there are other issues are more important, so, also, why bother?
"Democrats: we'll back reforms, but only if they're easy, and high enough on our arbitrarily sliding scale of importance," does not sound like a winning platform in this day and age.
Ed Rogers wrote the Republican take. The former Bush and Reagan staffer turned lobbyist is a dependable source of tendentious right-wing bilge in the Washington Post, so humorless and forgettable that he makes George Will seem like Mick Jagger.
His version of a single-payer scare piece, "A 2020 Democratic Agenda Is Emerging," was meant to read like a hide-the-children warning about a coming wave of left-wing radicalism in the opposition party.
Rogers imagines the next Democratic administration as a kind of Stalinist hell. Antifa types man the gates of the White House like the old Public Enemy S1Ws, and there is no "moderating counterforce" in the Oval Office to raise necessary doubts about horrors like gay rights, or to remind the next president that global warming is a hoax. Note the amusing parenthetical about Rogers' lobbying clients:
"Economic polices will consist of government giveaways and anti-business crusades. Social causes will give no quarter to moderate positions, and LGBT special interests, labor unions, global warming fanatics and factions such as Black Lives Matter, along with other grievance industry groups, will face no moderating counterforce. (Disclosure: My firm represents interests in the fossil fuel industry.)"
Where the Rogers piece got really interesting was when he talked about what he believed will be the litmus tests for the next Democratic nominee:
"Any Democrat who wants to be taken seriously must support a single-payer health-care system, a $15 minimum wage, free college tuition, affirmative support for sanctuary cities along with minimal immigration controls and, finally, a contender must completely embrace Black Lives Matter and engage in a probing courtship with the radical pseudo-group the 'antifa.'"
Rogers spends a lot of time worrying about antifa without really defining what it is. Excluding that fixation, the rest of the Rogers scare story seems like a simple list of asks by a generation that has decided it actually wants something concrete from its government, beyond speculative bailouts and expensive colonial wars.
Even the briefest visit on social media these days will reveal a Democratic electorate that is bitterly divided. Twitter slugfests between Berners and Hillbots are depressingly common, with flame wars breaking out over everything from donut emojis to Game of Thrones quotes to the unintentional comedy of the new pro-Clinton Verrit news site.
But if you strip away the vitriol, you see widespread agreement among Democrats on a lot of the issues Rogers references. The next generation of Democratic voters wants most of the same things people in other Western democracies take for granted. They want health care, a decent wage, free higher education, an end to abusive policing, and a few other things. No matter what people like Scher says, these aren't huge asks.
If you're looking for a silver lining to the Trump phenomenon, this might be it. Our crazy president, if nothing else, has had a clarifying effect on American politics. He may make the Democratic Party desperate enough to return to power that it will actually have to start picking voters over donors when it comes time to choose which policy approaches to endorse. Which might mean embracing policies that would actually excite people for a change.
A candidate who ran on a platform of universal health care, free higher education and a fair minimum wage, and didn't act like these ideas were something to be embarrassed about, would probably breeze to the nomination. It would also make our future less depressing to think about.
If there's one thing the election of Trump has accomplished, it's clearing away the myths about the sanctity of our political system. The notion that we neither can nor should reform the old Beltway machinery, which was basically a vast network of corporate subsidies kept in place by an indefensible system of legalized bribery – who believes that anymore?
That system we had served citizens so poorly that it actually made Donald Trump look like a sensible option to a not-insignificant number of people. What a relief, that politicians are finally trying something new.