The Other Main Obstacle to Single Payer

Last week, Nancy LeTourneau accurately observed:

There’s been some chatter lately among liberals that the 2020 Democratic presidential nominee will likely run on a platform that includes a commitment to single payer health insurance. While that would be appealing to a lot of people for a whole host of reasons, it doesn’t take into consideration the ongoing challenge of actually putting forth a reasonable plan.

It wouldn’t be a surprise if the 2020 Democratic platform eschews talk of single payer: Democrats and the larger progressive movement are, unfortunately, nowhere near ready to win the fight for single payer (we will leave aside, for now, the question of whether single payer should even be the appropriate terminology).

Health care reform advocate Jacki Schechner suggested last week that federal single payer is doomed unless the country embraces the separation of billionaire and state:

Until we get money out of politics, it’s not gonna happen. Because we have too much money that’s tied up in our political system. I love the momentum [behind single payer]. I love that more and more Democrats are on board. I love that we can get some momentum [among Democrats] in the House, and if we can take over the House and the Senate, then we’ll be well-poised to pitch something like that, but, having seen how the sausage is made, and seeing how money impacts the way people vote, both in the House and the Senate, I’m afraid of that wholesale change [not] being an actual, tenable goal…

Schechner called for a renewed push for a federal public option, viewing this as a more achievable goal. As for why single payer might not be achievable, she noted:

I’m hesitant, because [single payer advocates are] in the realm of people who pay attention to politics and who know how these things work. And I think about the everyday Americans who aren’t focused on the details of this, who are just worried about [things like] getting food on the table and getting their kids to school and making it to work on time, and they hear something like “single payer” and they think nationalized health care, national health care system, bureaucracy, waiting in line. I mean, it’s one of the reasons why people didn’t understand [that] the Affordable Care Act and Obamacare are the same thing, because they heard “Obamacare” and automatically had this idea of a big giant government bureaucracy and decided they hated it, and then when they found out that it was the same thing as the Affordable Care Act, now the Affordable Care Act is more popular than it’s ever been…I don’t think the messaging can overcome [right-wing attacks on single payer]. I just don’t think that you can convince people who don’t understand how health care works [about the benefits of single payer]…they don’t understand that it’s a single-payer [system], not a single-provider [system]. I don’t think people get that nuance, and I think it’s harder to explain that to people than you’d think. The status quo is very powerful. One attack ad can derail an entire plan.

Schechner’s line about “one attack ad” hints at another reason why the prospects of federal single payer are bleak: Democrats and progressives cannot, at this point, win the media war over health care policy, as they simply do not have enough of a presence on cable news to make the case for single payer, and to push back against right-wing attacks on the concept.

Next month marks the tenth anniversary of the release of Michael Moore’s Sicko, a brilliant, horrifying documentary about the savage inequalities of the American health care system. You may remember that just a few weeks after Sicko was released, CNN’s Sanjay Gupta opened fire on the film. In his response, Moore famously observed:

[T]hat report was so biased. I can’t imagine what pharmaceutical company ad’s coming up right after our break here.

Why don’t you tell the truth to the American people? I mean, I wish that CNN and the other mainstream media would just for once tell the truth about what’s going on in this country, whether it’s with healthcare — I don’t care what it is. I mean, you guys have such a poor track record.

And for me to come on here and have to listen to that kind of crap. I mean, seriously, I haven’t been on your show now for three years. The last time I was on, you ran a similar piece about Fahrenheit 9/11 saying oh, this can’t be true what he’s saying about the war, how it’s going to be a quagmire, the weapons of mass destruction…

Why don’t you start off, actually, with my first appearance back here on your show in three years and maybe apologize to me for saying that three years ago, because it turned out everything I said in Fahrenheit was true. Everything has come to happen.

Everything I said. I mean, I was — I took you in that film to Walter Reed Hospital and it took three years before you or any of the rest of the mainstream media would go to Walter Reed Hospital and see what was happening to our troops. So for me to have to sit here and listen again to more crap about socialized medicine or how the Canadians have it worse than us and all this, all the statistics show that we have far worse healthcare than these other industrialized countries.

We’re the only ones that don’t have it free and universal. And, you know, you said that Germany was the only one that was better than us in terms of wait times. The Commonwealth Fund last year showed of the top six countries, we were second to last, next to Canada. It showed that Britain, for instance, 71 percent of the British public, when they call to see a doctor, get to see the doctor that day or the next day. It’s 69 percent in Germany. It’s 66 percent in Australia. And you’re the ones who are fudging the facts. You fudged the facts to the American people now for I don’t know how long about this issue, about the war…

If Democrats were to go all-in on single payer at this point, “fudging the facts” would be the order of the day on cable news, with opponents of single payer outnumbering and drowning out the voices of advocates–all in the interest of “fairness,” of course. (Don’t think that MSNBC, whose coverage of health-care inequalities was of incalculable importance during the run-up to the passage of the Affordable Care Act, would provide any relief in the Andrew Lack era.) Fox in particular would weaponize race and gender as never before in the attack on single payer, running daily segments raising the prospect of “illegal aliens” and “gangbangers” having “free health care” funded by middle-class white taxpayers and “transgender surgeries” and “abortion on demand” subsidized by evangelical Christians. Support for single payer would be squashed thanks to this media onslaught.

I’ve previously noted the unforced error, from a climate standpoint, of Al Gore selling Current TV nearly five years ago. Had Current survived, perhaps it could have played a role in combating right-wing disinformation about single payer, clarifying the benefits of such a system, going beyond where even Sicko went in terms of highlighting the dangers of the status quo. As it stands now, with no cable-news platform actually controlled by progressives (not hosts, but executives) to provide a forum for single-payer advocates to make their case to viewers who aren’t health-care policy wonks, those advocates would be going into a political war unarmed.

We may bear witness to an early casualty of such a war in California, where, as George Skelton notes, the effort to push for statewide single payer may already be DOA. The merits of federal single payer are not in dispute. The ability to win the fight to implement such a policy is.