Single Payer Today, Tomorrow The World
By Seth Sanders
There is a bewildering plot device in some movies known as the “unreliable narrator.” The small-town sheriff of Jim Thompson’s Killer Inside Me earnestly narrates his own attempts to solve horrible crimes—until we finally realize he is committing them himself. The effect can be insanely dark but it can also be just daffy: the blessed life of Forrest Gump hinges on him being completely and totally oblivious to any of the great historical events he helps cause. Unreliable narrator movies share a key fact: they’re driven by the storyteller’s own misunderstanding of the very story they are telling about themselves.
But unreliable narrators are real, and nowhere do their stories have more impact than in politics. Liberals find it easy to see through Trump’s doltishly jumbo story of ABSOLUTELY NOTHING BUT WINNING, but remain deeply unnerved by the fact that it worked: the GOP still controls most of the country. Meanwhile Democratic leaders tell a more subtly perverse story that is, in its own way, just as big a problem. This story is not only at odds with their original values but with the political reality of the past decade, and so it prevents them from acting effectively and envisioning a future in the current environment.
Call it the Democratic Plot Twist: In it, the Democrats reject their brash youth as party of everyday working people, recognize reality and grow up, becoming pragmatic adults who compromise to win. They’re too wise to offer bold visions because the real world doesn’t work that way—it’s grey. But—the story goes—that’s exactly why we ought to trust them! Grey is the color of victory! The very fact that they’re tough-minded enough to shoot down pipe dreams about bringing back jobs, debt-free education, or universal healthcare should convince us they’re realists who know how to “get shit done” (though in the absence of jobs, school, or health free of crippling debt you can forgive voters for not really caring if shit gets done or not).
This is why we should be grateful that latest Democratic Plot Twist is being told by two narrators so bad they have clearly been sent by God to discredit it—past-the-expiration-date advice for Democratic victory by people literally invested in the Democratic party’s defeat. Indeed if there were a call for stock footage of “corrupt political failure” you might pair a New York pol who dated Ann Coulter, got busted for tax evasion, then endorsed Trump with a union-busting, conflict-of-interest-ridden consultant responsible for Clinton’s catastrophic “inevitability” campaign against Obama. If you wanted to paint a Democratic Picture of Dorian Gray to close off an era, you’d commission Andrew Stein and Mark Penn to suggest that the only possible solution to a move that’s been failing for 20 years is to do it again but harder.
The glory days of Democratic compromise—when Penn helped Bill Clinton hold onto power by enacting a Republican agenda of austerity, layoffs and mass incarceration—are now two decades old, and they paved the way for the party’s present day failures. It goes back at least as far as Bill Clinton’s backroom deals with Newt Gingrich, and Barack Obama’s search for consensus with a GOP minority Congress. We kept hearing it as income inequality and black incarceration jumped under Clinton, and as Democrats lost the House, Senate, and the majority of state legislatures and governorships under Obama. Emblematic of this approach was Obama’s signature—and very real—achievement, the ACA, a concept created by a conservative think-tank and first implemented by a Republican governor.
But as Democratic leaders intoned this monotonous if comforting story, more and more holes opened up in it. They went down in election after election. Deeply knowledgeable and experienced, Hillary Clinton presented oddly complex charts without big promises. Democrats staked an early comeback on John Ossoff, a smart young candidate who texted that he would “cut wasteful spending” (who wouldn’t?). They crowdsourced increasingly bland bumper stickers.
Here is where we should have realized that this Democratic narrative isn’t just incorrect but actually making things worse, that the story they’re telling is actually key to the increasingly insane plot we’re stuck in. Because it turns out that simply “being pragmatic” isn’t a vision, and just being less bad than the other guys—a motto they literally suggested this week—won’t get one more voter out of bed. The story just doesn’t motivate people anymore.
It turns out that the Democratic line—be smart, don’t ask for much—is just playing a part in a bigger political story, that goes: the less you ask for, the less you get.
But it’s not the only political story you can tell, and a far cry from the old Democratic story like FDR’s Democratic “New Deal,” the recent one of Corbyn’s Labor Manifesto, or even Newt Gingrich’s 90’s “Contract with America.”
In California, Democrats have the chance to ask for everything. Universal healthcare—the hottest issue in national politics—is on the table in the richest state in the country and one of the only with a Democratic supermajority.
The nation looks to California for leadership, and to provide a proof of concept—and a bold vision for healthcare is our first real shot at it.
Analysis after analysis shows Single Payer would make healthcare not just universal but cheaper. Its power comes from three simple factors everybody understands: bargaining power, cutting out the middleman, and good incentives. As America’s biggest buyer of medical goods and services, Medicare’s bargaining power already gets its members the best healthcare prices in the country—to such an extent that all insurance bases its cost on how much more expensive than Medicare it is. Single payer would be an even bigger Medicare with even more bargaining power—a sort of health-service Amazon—so it would get even better rates. Cutting out the middleman follows from the first: normal insurance’s business model is to cost more than Medicare and pass that extra cost on to the customer. But in fact it’s worse. Because this is where bad incentives come in. The only way insurance companies truly profit is by taking more money than your insurance really costs them, and the best way to do that is to not pay for things you need. Insurance companies literally define any benefit to you as a “loss” to them (in their technical business term: “medical loss ratio”). As the cliché goes, the role of insurance companies is to collect premiums and deny claims. That’s why, left unchecked, they will move heaven and earth to deny your family and friends’ pre-existing conditions, from being a childhood cancer survivor to having had depression to just being pregnant.
As a result of this massive efficiency, Single-Payer gives states and taxpayers more money at the end of the day because it makes medical care cost them so much less: it’s an investment with big immediate returns. It only “costs” extra money in the same way that investing in a good mutual fund would “cost” more than keeping the money under your mattress for 30 years. Just as sensible investors from Warren Buffet to the Dilbert Guy get rich from the same solid strategy countries from Norway to Canada have all gotten the same great results: you have to actually use the money to make it do something good for you.
Single Payer, in other words, is a good thing that most people—and especially most Californians—really want. It’s also something most California Senators want, passing it with a strong majority on June 1 after okays from senate appropriations committee and the assembly health committee, and speaker Rendon’s health policy specialist. Then on Friday at 5pm—the time you make news you don’t want anyone to notice—the same speaker Rendon quashed it without possibility of debate.
Why do California Democratic leaders want to quietly kill Single-Payer in the face of the most inspiring grassroots movement we’ve seen in years? None of them will say, meaning it’s for a reason too embarrassing to say in public. Whatever the answer, what we can be sure of is it’s internal political calculation to protect political careers, whether a ballot measure tactic for 2018 to prevent a Brown veto or providing cover for the sort of conservative Democrats who aren’t willing to risk a controversial vote. But can we afford another story of Democratic compromise over vision?
Excuses are running out: a sometimes laughably-sourced piece in the Intercept portraying conservative Democrats as victims of bullying by the physically terrifying RoseAnn DeMoro and death threats (citing one tweet from a Texas DJ that had received no response at all at press time), the article made a series of peculiar claims: the bill’s organizers were only doing it for the money and fame (none of the activists I’ve met expect much more than saved lives out of it—a calculation too crass for Dayen to consider); the bill can’t become law without money upfront (it explicitly states that it can, becoming “operative” when funding completes). At most it exemplified the contortions defenders of the status quo now have to go to defend delay.
The grassroots offer a way forward. They have no position to defend and aren’t getting paid to say what they do. And the message is beginning to resonate, from the progressive vanguard of the Democratic Socialists to some of the smartest people at the top. As the great Social theorist Wayne Gretzky said, you miss 100% of the shots you don’t take. Let’s take this one.