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Michael A. Cohen

Single-payer snake oil

Bernie Sanders at an event announcing the “Medicare for All Act of 2017.”EPA/MICHAEL REYNOLDS

Senator Bernie Sanders introduced legislation Wednesday that would create a single-payer health care system in America. While the bill has zero chance of becoming law in a Republican-controlled Congress, it has the political backing of several of the leading Democratic contenders for the party’s presidential nomination in 2020 — Senators Kamala Harris, Cory Booker, Kristen Gillibrand, and Elizabeth Warren.

It’s a telling indication of how far the Democratic Party has shifted to the left since last year’s electoral catastrophe. It’s also a reminder of the Democratic Party’s remarkable capability for self-sabotage. Single payer is the wrong idea at the wrong time and has as much potential to hurt the party going into crucial midterm elections as it is likely to help.


The great irony of the push for single payer is that it ignores the lesson from the GOP’s recent failure to repeal Obamacare — don’t rock the boat. When scrapping Obamacare was an abstract notion it had majority support. But once voters realized the costs of repeal and the disruption caused by the Republicans replacement plan the bottom fell out of the GOP’s plans. This is not a new development. From Bill Clinton’s efforts at reform in the 1990s to the Obamacare debate, health care has long been a political minefield.

So why get behind an even bigger disruption to the US health care system? Unlike Obamacare, which in reality affected few Americans, single payer would change how nearly every American receives health care coverage. It would get rid of employer-based health care, practically do away with the private insurance system, and would lead to major new taxes to pay for the program.

Single-payer supporters will argue that higher taxes will be paid for by lower health care costs. A five-decade decline in confidence in government to solve national problems suggests that few Americans are going to believe that promise. No matter what the polling may show today, once Americans come to understand the costs of single payer, support will likely disappear.


For years Republicans dishonestly claimed that Obamcare was a government takeover of health care and that it created new taxes. Now Democrats are making it possible for Republicans to run ads in the fall of 2018 accusing Democrats of doing both . . . and they’d be telling the truth.

Why Democrats, who already have the political wind at their backs, would want to hand Republicans a stick with which to beat them over the head is hard to figure. For all the help single payer may provide Democrats in rallying the party rank-and-file, there are plenty of other ways to do that — like reminding Democrats who sleeps in the White House.

But there’s also the question of why after eight years of bruising health care fights in which a largely incremental and not overly intrusive health care reform measure became a policy flashpoint in American politics — and contributed to Democrats losing the House of Representatives in 2010 — the party would want to go through this fight again. Democrats spent the last 8 months successfully defending Obamacare from GOP attacks. Now they want to argue that it was all for naught because single payer is so much better?

Why not focus instead on the Obamacare fix-it-bill currently making its way through Congress? Why not propose extending and expanding the Children’s Health Insurance Program? Why not propose a more modest proposal like extending Medicare buy-in to those aged 55 and over? These ideas might not be as sexy as single-payer, but they are more legislatively viable, have less political downside, and would actually help millions of Americans. If the goal is to get America to universal coverage there are plenty of ways — other than single payer — to achieve that goal.


Right now in the Democratic Party there is a desire for bold policy initiatives. In some cases it is politically astute and for a party, long afraid of its own shadow on domestic policy, it’s a welcome change.

But not on health care. Not after what’s happened the past several years, not with the success of Obamacare and not with a proposal that can be so easily demagogued.

I get why Bernie Sanders is so jazzed about single payer. He’s not a Democrat and has never shown much interest in the political health of the party. He’s an ideologue who sees it as his job to expand political possibilities. Good for him. But Democrats should be focused on protecting Obamacare from the Trump administration’s efforts to undermine it. They need to steel themselves for the major fight coming on tax reform. Above all, they need to be doing everything possible to win the 2018 midterms and minimizing their political exposure. Pushing a single payer health care plan won’t fatally undermine that effort, but it won’t help it either.


Michael A. Cohen’s column appears regularly in the Globe. Follow him on Twitter @speechboy71.