This diary will be relatively short. I am writing it in response to several diaries discussing single payer supporters. Some attempt to convince single payer advocates to not forcefully push for a single payer system. Others seek to try to convince single payer advocates to agree to some version of the public option. I believe many public option people miss the value of having single payer advocates as a part of the debate. I will discuss their value below.
Let me start off, before going forward, by saying substantively I support the public option approaches. I will not go into details other than to say that, at one point, I supported a state based approach, but am now on board with a national Medicare for all approach. However, my main focus in this diary is not on which policy I support, but which strategy will aid us in achieving substantively my hoped for outcome.
Single payer supporters as a part of the debate change the calculus of what is right and left. By changing this calculus of what is right and left such that the left is further left than the public option, we have a better chance of shaping the details of the debates.
One of my issue when people choose to discuss issues is that it is often framed as the politics of lowered expectations. "Well, this is the best we can get. Therefore, let's just go for the best that I believe we can get"is the normal frame of far too many comments and diaries. The danger of lowered expectations is that you are may undercut your own bid for reform. I had a similar thesis about the stimulus.
If you want to obtain the best proposals on healthcare reform, you need to include further left positions so that the middle position triangulated for or against will see the public option as the middle ground. Maybe even a further left leaning public option than sees possible at first.
For example, the result maybe that we will have a public option, but with some subsidization by the federal government rather than one which has none after startup costs.
I am a pragmatist about this. I will take whatever I can get , and I am willing over the next few years to support something better. However, this being said, I am also clear that the best time to obtain the best policy is when you start rather than after the system is created. Is this always true? No. Does this seem likely given the nature of healthcare politics? It took 60 years to get to this point of even considering a public option. I am not convinced it would not take another 60 to obtain a partially subsidized one.
Why do I want some subsidization? Well, it comes down to cost. I believe that subsidies will allow some wiggle room regarding negotiating for better prices that over the long haul will decrease costs. I maybe wrong, but I feel that it is a move that eventually pays for itself regarding aggressive market pricing.
But, this is an aside. The main point is that single payers need to be part of the debate because they can help us shape the debate about the form of public option we eventually see.