When Bernie Sanders talks about how to get to universal health care, the biggest barrier is people (namely, Democrats like Clinton) who don’t want a better policy badly enough: “What this is really about is not the rational way to go forward—it’s Medicare for all—it is whether we have the guts to stand up to the private insurance companies and all of their money, and the pharmaceutical industry.”
For her part, Hillary Clinton, whose campaign has distanced liberal supporters in recent days by criticizing Sanders’s stance on single payer, differed sharply, pointing to the same political forces that scuttled her 1993 health care reform and is pushing to repeal Obamacare today: “Well, as someone who—as someone who has a little bit of experience standing up to the health insurance industry, that spent, you know many, many millions of dollars attacking me, and probably will so again, I think it’s important to point out that there are a lot of reasons we have the health care system we have today.”
All of this recalls the best piece I know of about the political mechanics of universal health care, written by Atul Gawande on the eve of Obama’s inauguration in 2009.
Every industrialized nation in the world except the United States has a national system that guarantees affordable health care for all its citizens. Nearly all have been popular and successful. But each has taken a drastically different form, and the reason has rarely been ideology. Rather, each country has built on its own history, however imperfect, unusual, and untidy.
The way forward may be what Sanders wants, but history says the path will look a lot like the one Clinton’s described.