Making It Worse: Campaign for America's Future vs. Single-Payer

By David Swanson

In a far better than usual, and very encouraging, conference, held by the Campaign for America’s Future last week, the low point was the complete white-out of single-payer healthcare.  Rather than apologizing, which even Max Baucus has done sort of, CAF decided to put forth a bunch of insultingly false reasons why single-payer is a terrible idea.  These are not reasons why it was shut out of the panels and plenaries and press conferences.  In fact, if it was such a terrible idea, it ought to have been openly discussed so that we could all be thus enlightened.

Here’s Bernie Horn:

Single-payer is the cheapest and simplest approach. So why aren’t Obama and the Democrats pushing it?

Some say it’s because the Democrats don’t want to offend the for-profit health care industry—that Democrats in Congress have taken too many campaign contributions from insurers. As Marcia Angell, former editor of the New England Journal of Medicine, argues:

Single-payer is simply considered not realistic for a politician. The medical industrial complex just won’t permit it.

Well, it’s certainly true that health care executives, lobbyists, and their hundreds of thousands of employees don’t want to be put out of work. They would all fight their hardest against single-payer. But that’s really not the main reason why Democrats are avoiding such legislation.


Whoa there, Bernie!  Numerous members of Congress, including Senator Max Baucus are on record admitting openly to the explanation you’ve just dismissed.  And you’ve done worse than dismiss it.  You’ve tried to turn health insurance into an economic stimilus program.  This is what weapons makers do with their destructive proposals, and I’m sorry to see your poor attempt to imitate them.  The fact is that switching to single-payer would NET us 2.6 million jobs.  I know that you actually care about jobs and wouldn’t have used this crazy excuse if you had known the facts.  But that shows the value of knowing the facts as well as the value of being honest rather than searching for justifications of a predetermined outcome (I mean unless you work for a private health insurance company).

Some say it’s because we can’t convince moderate members of Congress to vote for single-payer legislation within the next few months. Darcy Burner, executive director of the Progressive Caucus Foundation, published an important diary on Daily Kos urging progressives to stop “attacking progressives [who are] fighting for a public option” because:

There are not 218 votes for single payer in the House. Single-payer cannot happen in this environment right now, regardless of how passionately its advocates want it.

Darcy, the Progressive Caucus, and everyone on Capitol Hill know this is so. But again, that’s really not the main reason why Democrats focused on a hybrid plan a few years ago.

"We don’t have the votes"?  "We don’t have the votes?"  You’re going to stand behind that, Bernie?  We never have the votes for anything until we win them.  Activist groups that try to change Congress operate differently from astroturf groups that try to change activists.  We push for what we want, and then we compromise when we have to.  Go ask your union buddies how many negotiating sessions they’ve opened by demanding the least they would settle for.  It doesn’t work.  If you think a public option could be created in a way that did more good than harm, you ought to be pushing for single-payer with that fall-back position available.  And if you wanted to show your good will, you would be insisting that any final compromise include provisions to free states to create single-payer at the state level if they choose.  

The main reason is—American voters are scared to death of single-payer.

Even though I’m sitting in a quiet room writing this, I can hear some of you objecting loudly! Friends, we are on the same side. We all know that health care should be recognized as a human right. We all know it is a national shame that more than 50 million Americans are uninsured, and 25 million more are underinsured. We all know that even Americans with insurance are struggling with soaring health care costs, and that insurance and drug companies are putting profits before people. We all know that we need to change the system.

But we progressives are not the ones who need to be convinced. In any great national political debate, there are partisans on our side and partisans against us. To achieve victory, we have to persuade people in the middle—and they don’t know what we know about health care.

Consider three central facts:


Oh, here we go. Here’s where Bernie disputes the fact that polls consistently show a majority of Americans favoring single-payer. … What? Wait a minute! The central facts don’t even mention any polls. Check this out:


  • Nearly all persuadable voters—those who don’t automatically side with or against us—have health insurance. (In fact, about 94 percent of voters are insured. The uninsured, unfortunately, don’t tend to vote.)
  • About 3/4ths of insured Americans are satisfied with their health insurance.
  • When Americans hear about a health care proposal, they immediately think “how is it going to affect me and my family.” That’s their overarching, overwhelming concern.

That means when average American voters consider a new health care policy, their paramount concern is that the policy allows them to keep the health insurance they have. Union members—who usually can be counted on to support progressive policy—are among the most adamant that they be permitted to keep their health insurance. Why? Because unions tend to negotiate better insurance for their members than the rest of us have!

No matter how good a single-payer system might be in theory, these voters are easily turned against any plan that they think might force them off their current health insurance. That’s what the 1994 “Harry and Louise” ads were all about—claiming that the Clinton plan would force Americans to “pick from a few health care plans designed by government bureaucrats.” The Harry and Louise ads thoroughly scared voters—and that’s why they were so effective.

How do we know this? Over the past two years, progressive groups have conducted an unprecedented amount of public opinion research about universal health care. Usually it’s the conservatives who have all the polling data. This time, our side has the upper hand. In fact, I believe progressive advocates have more polling, focus group, and “dial group” research on this than on any issue in history. That research shows that, even if a single-payer proposal starts out with a majority of Americans in support, it won’t hold majority support after the insurance industry clobbers it with ads.


Wow, Bernie. Your polls find what everybody else’s polls find? That a majority of Americans want single-payer? AND on top of that they predict the future? They predict that if the private insurance companies spread a bunch of lies, people will believe them? And will that happen in a vacuum, Bernie? Or will it happen in one of two situations: (1) progressive astroturf groups stick their hands under their fat asses and whimper, (2) groups representing majority opinion push back hard with our own aggressive talking points on behalf of single-payer with the advantage of honesty, simplicity, and the "obvious facts" you yourself noted at the very top of your article? Did you poll into the future on both of these scenarios? And did you notice that the health insurance companies are hammering you with lies even though you pre-compromised? Didn’t see that one coming, huh?

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