Hillary Clinton raised some eyebrows yesterday when she seemed to suggest that single-payer healthcare will “never, ever happen.” Her precise words were as follows:
“I want you to understand why I am fighting so hard for the Affordable Care Act,” she said at Grand View University after hearing from a woman who spoke about her daughter receiving cancer treatment thanks to the health care law. “I don’t want it repealed, I don’t want us to be thrown back into a terrible, terrible national debate. I don’t want us to end up in gridlock. People can’t wait!”
She added, “People who have health emergencies can’t wait for us to have a theoretical debate about some better idea that will never, ever come to pass.”
The argument about the Affordable Care Act is a bit disingenous: regardless of what happens in the presidential election, Democrats are likely to make gains or break even in the Senate. The Affordable Care Act will not be repealed unless Republicans eliminate the filibuster or unless Democrats fail to hold at least 8 senators for the filibuster vote. So the Affordable Care Act is likely safe even in a Trump/Cruz administration. Nor is it entirely clear why Clinton is offering what seems to be a false choice: advocating for single-payer healthcare doesn’t mean that the Affordable Care Act isn’t protected. Presumably, a Sanders administration would fight to protect the Affordable Care Act just as stridently as a Clinton administration would until and unless a superior replacement were passed.
On a larger note, though, Clinton’s argument is reflective of the larger primary debate: is it better to advocate for policies that are completely unlikely to make it through Congress in the hopes of a massive progressive turnout that upends politics as usual (a “political revolution,” as it were), or is it better to advocate for things that are simply highly unlikely to make it through Congress but still fall within the realm of the possible within current constraints? The Clinton argument is that protecting the Affordable Care Act is difficult enough in its own right, and that single-payer healthcare is dead in the water in Congress.
But this argument overlooks the potential power of the presidency in shaping public opinion toward policy goals, and underestimates the degree to which it will be nearly impossible to accomplish anything as long as the GOP holds Congress.
As Brian Beutler noted in The New Republic, the Sanders approach assumes an aggressive negotiating posture that might actually be a better bet toward accomplishing legislative goals in the face of an intransigent Congress than the incrementalist Clinton approach:
But if we’re imagining both of their agendas as opening bids in negotiations with Congress, why fault Sanders for not negotiating with himself? Ask a future Democratic Congress for single payer and a $15 minimum wage and you might get laughed at… but you also might get the public option and a bump to $12. Ask it for the public option and a $12 minimum wage, as Clinton might, and you’ll get a fair hearing from the outset, but you might end up with advancements barely worth fighting for. President Obama, as Sanders is fond of noting, negotiated with himself, and progressives paid an unknowable price as a result.
Center-left liberals will remind us that Obama’s biggest legislative accomplishments were products of hard-nosed dealmaking, rather than mass action. And they’re right. When Clinton makes LBJ-like arguments about the importance of pairing social activism with political leverage, she is telling unlovely truths. But here it’s worth noting that for all the hyperventilating over Sanders’s self-identification as a socialist, he’s been a relatively effective and pragmatic legislator.
This certainly stands to reason. People often forget that Democrats were very close to getting a public option, and that only Joe Lieberman stood in the way of lowering the age of Medicare eligibility to 55. All of these negotiations were predicated on an initial offer from the Obama Administration that closely paralleled Romneycare, and was designed to be the ultimate legislative proposal from the outset. What became the Affordable Care Act was the whittling away of an initial negotiating position that, in retrospect, was far weaker than it should have been (probably in order to allay attacks from the usual suspects in the medical and pharmaceutical industries.) Offer a stronger negotiating position, and the usual centrists who want to weaken bills to please corporate contributors will still slice away their half a loaf, but you’ll be left with more bread to take home when it’s all over.
More likely, however, is that almost nothing will actually be accomplished in the very likely event that the GOP holds the House past 2016. In that case, notching legislative “wins” won’t be nearly as important as communicating the party’s values and sharpening the differences between the parties in order to mount an increase in turnout for 2018. The President’s biggest job in the case of viciously divided government won’t be Compromiser-in-Chief, but pusher of the Overton Window:
The Overton window, also known as the window of discourse, is the range of ideas the public will accept. It is used by media pundits. The term is derived from its originator, Joseph P. Overton (1960-2003), a former vice president of the Mackinac Center for Public Policy, who in his description of his window claimed that an idea’s political viability depends mainly on whether it falls within the window, rather than on politicians’ individual preferences. According to Overton’s description, his window includes a range of policies considered politically acceptable in the current climate of public opinion, which a politician can recommend without being considered too extreme to gain or keep public office.
Single-payer healthcare is popular with the public, and it deserves an advocate at the highest level of American politics because of its obvious superiority to the current system. In an environment where little good can happen legislatively anyway, the best thing a President could do on the healthcare front is make it clear that their party would enact single-payer healthcare if the opposition weren’t standing in the way.
Desire for an improved healthcare system might or might not lead to stronger base turnout in subsequent elections, but in either event the germ of the idea of single-payer healthcare would move from the outside edges of liberal circles to mainstream discourse on the front page of the New York Times. And that in turn means that with enough demographic change and redistricting, single-payer healthcare might actually become a reality by 2030. In other words, just talking about single-payer healthcare from the bully pulpit makes it much likelier to happen over time. Certainly much more so than saying it will “never ever happen.”
Politics isn’t just the art of the possible today. It’s also about shaping the realm of the possible tomorrow. When the opposition is willing to compromise, pushing the envelope might come at the expense of real gains in the moment. But when the opposition is intransigent, advocating for the impossible might just be the most productive thing a president can do to lay the groundwork for gains in the future.