In today's NYT (1/18/16), Paul Krugman has a piece in opposition to pursuing Bernie's single-payer system: "The question for progressives--a question that is now central to the Democratic primary--is whether [the failings of Obamacare] mean that they should re-litigate their own biggest political success in almost half a century, and try for something better...[T]hey shouldn't...they should seek incremental change on health care (Bring back the public option!) and focus their main efforts on other issues--that is, that Bernie Sanders is wrong about this and Hillary Clinton is right."
Krugman argues that "single-payer wasn't a politically feasible goal in America," for three reasons: 1. The power of incumbent players (i.e., health insurance companies) won't allow it; 2. It would require a tax increase; 3. It would disrupt existing employer-based health insurance.
1. The power of incumbent players (the insurance companies) would kill single-payer. Given the current Republican control of Congress, he is undoubtedly correct. However, Krugman fails to account for the political reality that existed in the early days of the health care debate. Both houses of the Congress were controlled by the Democrats, and as Tom Harkin reported, the votes were there to pass single-payer health insurance. It was a decision of the White House to go with a Republican/Heritage Foundation concocted plan because of its view that single-payer was not politically feasible--despite knowledge that they had the votes in Congress to pass single-payer! Once that decision was reached, the game was over. The reading of "political reality" was suddenly, and willfully, discounted, or ignored, by the White House rather than exploited.
In addition, Krugman's reading of current political realities in effect, discounts the significance of Bernie's "political revolution." If Bernie is successful in mobilizing an expanded Democratic electorate, and there is survey data providing evidence that the potential is there, it could be sufficient to turn the Senate and make Democratic gains in the House, thus altering one of the the parameters of Krugman's constricted view of "political reality."
2. It would require a tax increase, "and we would be talking about taxes on the middle class, not just the wealthy. Krugman recognizes that the increase would be offset by significant savings in cash payouts for current health insurance premiums, that Bernie's recently released health care proposal pegs at $5,000 annually per family. (Robin pays $7200 annually for her private health insurance from the exchange.) But, Krugman avers, "it would be difficult to make that case to the broad public, especially given the chorus of misiinformation you know would dominate the airwaves." First, he is assuming the outcome in advance, based on his reading of political reality. Of course, the insurance industry and its allies would throw up misinformation. But one must assume that there is no adequate answer to misinformation to concede success without a fight. Once again, Krugman's "realism" obscures any conception of the possible. His position seems to be that any debate over taxes is a loser for Democrats (e.g., would he object to a debate over increasing marginal tax rates for high income groups?) For example, while what he foresees is certainly probably accurate, it would be a substantive debate worth having and one which, I think, we could win. [BTW, I think Bernie made a mistake during the debate in not pointing out that the middle class tax increase he is talking about is 2.2% and the potential savings is $5,000 per family. By characterizing the increase as "small," without defining it as 2.2%, with more progressive rates for higher income brackets, all the audience heard was "tax increase." (The Clinton campaign is capitalizing on this issue, pointing out that he would indeed increase middle class taxes.) He missed an opportunity to define the issue as a 2.2% tax increase versus a $5,000 benefit.]
3. It would disrupt existing employer-based health insurance. It is interesting that Krugman doesn't specify just how Bernie's proposal would "disrupt" existing employer based insurance. He merely asserts that "switching to single-payer would impose a lot of disruption on tens of millions of families who currntly have good coverage through their employers." He concedes that an argument could be made that such people could benefit, "But getting voters to believe that would be a very steep climb." First, he is assuming that single-payer and employer-based insurance are incompatible, yet there is no reason to make that assumption. One can imagine a hybrid system where the two co-exist. However, the reality is that a single-payer system would give employers a reason to drop that benefit in the interests of saving costs. Health insurance was initially installed as an incentive in the competition for employees. With a single-payer system, everyone would be covered, so the original rationale would no longer apply. (Unless the employer system offered benefits superior to the single-payer program as an added incentive.) But the employees would, at a minimum, be no worse off, and the employer would be able to benefit from the cost-savings.
What Krugman seems to be saying is that the debate would be "a very steep climb" and, by implication, either not worth the effort, or futile. Once again, he offers no reasons other than what he mentions in the first point above for such a judgment.
Indeed, as he puts it: "a simple, straightforward single-payer system just isn't going to happen. Even if you imagine a political earthquake that eliminated the power of the insurance industry and objections to higher taxes, you'd still have to protect the interrests of workers with better-than-average coverage so that in practice single-payer...would be almost as kludgy as Obamacare." So he is aguing that the debate would be fraught and not worth the effort.
"There are many items on the progressive agenda [e.g., tuition-free public higher education, climate change, "restoring some of the lost bargaining power of workers"]. Making progress on any of these items is going to be a hard slog, even if Democrats hold the White House and, less likely, retake the Senate. Indeed, room for maneuver will be limited even if a post-Trump Republican Party moves away from the scorched-earth oppoisition it offered President Obama."
What Democrats should do is set priorities. "So it's really hard to see...why it makes any sense to spend political capital on a quixotic attempt at a do-over, not of a political failure, but of health reform--their biggest victory in many years."
Once again, Krugman's "realism" fails to offer a rationale for not choosing health care as a priority on which to expend political capital, given that 30 million people are still without health insurance, at least in part, because they can't afford the premiums (even with subsidies), high deductibles and/or co-pays. In addition, the high and increasing costs of prescription drugs is an added financial burden that would be addressed by a single-payer system, not adequately addressed by Medicare Part D. As he notes, all of the items on the progressive agenda are "going to be a hard slog." Why not take the next logical step, not an incremental one, and complete the reform of the health care system, an issue which is on the list of important issues according to public opinion surveys. Given the nationwide magnitude of the potential public benefit, in terms of cost and coverage, it seems to me that it is an issue worth pursuing, rather than settling for incremental change, which, as Krugman admits, would itself be a "hard slog."