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How Hillary Clinton and Bernie Sanders Can Unite on Health Care

It's the public option, stupid!

Jewel Samad/AFP/Getty Images

In ably explaining why all the passion that drove the public option campaign back in 2009 completely disappeared after Obamacare passed and hasn’t reemerged in this primary, the liberal writer Digby has opened the door further to a possible resolution to the fight Bernie Sanders and Hillary Clinton are waging over single payer.

“The public option was an idea championed by the progressive left during the health care fight,” Digby writes. “And unlike conservatives, when liberals lose a fight like that they walk away instead of doubling down. They accept the defeat as final. But progressives persist in calling for single payer because that’s really a value, not just a policy. … If Democrats were more like Republicans they would have turned the words ‘Public Option’ into a mantra and kept at it the way the conservatives did about ‘death taxes’ and ‘tort reform.’ … I think this one may have been a missed opportunity.”

If you put yourself in the shoes of public option advocates, her explanation makes even more sense. They didn’t interpret that defeat as a matter of insufficient political support, but of betrayal by the White House and the whole class of Democrats who now want Hillary Clinton to be the Democratic nominee. Last time they rallied around a half-loaf health plan because of the promise of the public option, they got swindled. So, fool me once...

But this is why Sanders throwing his weight behind using the public option as a vehicle to migrate toward single payer is probably key to its resurrection. It would also be a political coup for him.

Sanders is going to have a harder time than he thinks picking a fight with Hillary over single payer, despite the concept’s popularity among rank and file Democrats. The difficulty enacting, then implementing Obamacare made a lasting impression on people at all levels of the party. Many of those same people like Obama quite a lot, are proud of Obamacare, and don’t want to devote themselves to a quixotic project of repealing and replacing it, even if it’s with a health system that’s superior to Obamacare in the abstract. 

If Sanders proposes expanding Medicare to everybody (eliminating the private insurance system) without intervening steps, it’ll be perfectly fair for Clinton to point out that when Obamacare led to the cancelation of a tiny percentage of health plans nationwide, it was a political disaster, which the administration was forced to take dubious steps to mitigate. (Chelsea Clinton made an exaggerated and misleading version of this argument this week.) If Sanders instead proposes Medicare-for-all with a private market option, I imagine he’d have to be prepared to spend away a bunch of the savings a straight single-payer system would generate. 

The way for Sanders to avoid these pitfalls is as it was back in 2009: propose a Medicare-powered public insurance option that consumers under 65 can buy into, and that’s robust enough that consumers will flock to it, while the private market adapts or withers on the vine over time. But if Sanders proposed something like that, I don’t think he and Clinton would have much to fight about anymore. The political beauty of the public option was its power to unite the incrementalists and the single-payer people in consensus. I don’t see why that appeal doesn’t still exist.