"Affordable" and "access" are words to be refused whenever they appear in these discussions. In January, Bernie quite rightly slapped down Trump's HHS nominee, Tom Price, in this exchange:
Price: I believe that every single American has access to the highest quality care and coverage that is possible.
Sanders. 'Has access to' does not mean that they are guaranteed health care. I have access to buying a $10 million home; I don't have the money to do that.
Well, Bernie, make sure you tell that to Kirsten and Al and all the other Democrats who are crowding into your Medicare-for-All bill to make it the "starting point" for "other strategies" that will give "access" to healthcare--i.e., make it "available to purchase" for those who can afford it.
Of course, there is a final ostensible reason these Democrats who claim to support single-payer insist on promoting "other strategies" like the "public option"--because that is all that's realistic, feasible, politically possible, etc. It's a clinching argument for a lot of people, including some Democratic politicians who sincerely want and are not trying to sabotage single-payer but are honestly persuaded that it's just not feasible. The obverse of this argument is that those who are not so persuaded are incapable of being "pragmatic" or of compromising, and always ruin possibilities of reasonable change by making the perfect the enemy of the good, yada, yada.
To address this requires, first of all, to stop straw-manning. I've never met a leftist, no matter how radical, who rejects the general possibility of either reforms or compromises because they won't achieve the workers' revolution or some other state of perfection.
The question is always about political judgement and the principles that govern it, and how they apply to specific reform proposals. Do the reforms deliver a concrete benefit in a secure and permanent way? Do the reforms change the balance of economic, political, and/or social power in favor of the working-class? Do they at least move in the right direction?
In this regard, we might refer to Andre' Gorz's distinction between "reformist reforms" that stabilize the status quo and "non-reformist reforms" that advance real change. In the U.S. healthcare context, "reformist reforms" are those that seek to stabilize and protect the capitalist market healthcare system as well as the wealth and power of the class that controls it. "Non-reformist reforms" are those that establish new possibilities for a system that's controlled by and for the public, and governed by "human needs and demands" rather than profitability.
Similarly, there are positive and negative compromises. The way to get a radical reform like single-payer is to fight for it, to work to bring people around to it, not to pre-emptively offer something else that you think will be more palatable to those who are resistant. And if, after fighting hard for it, the balance of forces requires you to compromise, you do so in a way that still achieves a net gain for your principles and position. Otherwise, it's not a compromise; it's a loss. In this context, for example, short of universal coverage, increasing the number of people covered by the public program, Medicare, and strengthening it, would be preferable to diverting public resources to subsidizing private health insurance programs and "exchanges" (because markets, it seems, need government support). Which is why Obamacare, which did the opposite, was not a compromise, but a loss, for single-payer.
So let's, by all means, have reforms--even ones that won't end capitalism and imperialism. Let's just not reform the reform away pre-emptively. Medicare-for-all is a reform. As Bernie Sanders keeps pointing out, it's the kind of system that's standard practice in advanced capitalist countries. There's no leftist or marxist who thinks instituting it will overthrow capitalism. We support it because it's one of those "non-reformist reforms" that concretely benefits the lives of the great majority of citizens, and strengthens public control of an essential service, eliminating a needless and predatory capitalist industry. And that is why neoliberal Democrats reject it: they prefer a "public option" because it preserves the "profit option."
It seems that these two kinds of reform, based on two opposing principles, ominously coexist within Bernie Sanders's bill and the political strategy around it. It's King Bernie who has welcomed the Trojan Horse Democrats into his single-payer redoubt. He has let them bury inside his bill whatever poison pill they are going to try to extract and make us swallow: "It turns out that the Sanders bill also has provisions along those ['more limited step'/public option] lines. (NYT)" The duplicity is inscribed within his carefully crafted Schrödinger's bill, which is tamely "reformist" and/or radically "non-reformist reformist," depending on who's looking at it. And Bernie's invited a lot of neo-liberal Democratic Senators to cast their defining gaze. That's raised considerable suspicion about why he didn't coordinate his proposal with the Conyers bill in the House, which has been "considered the gold standard" by the single-payer movement.
I worry, with Margaret Flowers, that: "Sanders has it backwards: Rather than starting from a position of strong legislation and building support for it, he is starting from a position of weak legislation that he considers to be more politically feasible." Beginning with compromise, ending with loss?
Is Bernie again demonstrating his penchant for being an auxiliary Democrat, more eager to show his belly to the Party establishment than to be the leader of his change-hungry pack? Does Sanders think that allying with democratic legislators is more important than allying with a party-independent social movement? As Flower says, Bernie is "trying to walk the line between listening to the concerns of his constituency,"and" his fellow Democrats, whose campaigns are financed by the medical industrial complex". Sanders must decide whom he is working for."
If there's one thing that Bernie has been consistently strong about, in a way that never caused me to doubt his commitment, it's single-payer healthcare. But given the creatures gathering around his bill, it's necessary to ask: Is Bernie shrewdly sheep-dogging the Democrats into supporting single-payer, or is he again sheep-dogging his constituency into supporting another Clintonite market-stabilizing scheme? I wish there were less reason to be suspicious.
Comes the cry: But is anything else possible? (From those who've done so well lately foreseeing what's politically possible.) It depends on how you think about the relation between what is possible and what you can make possible.
Let's, please, be realistic. The "public option" is impossible in this congress. Neither Bernie Sanders's bill nor anything like it is going to pass this congress. Franken's and Gillibrand's "other strategies" are just as impossible as Bernie's full single-payer in this congress, or in any congress that isn't radically different.
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