Seven-Minute Abs, Medicare For All, and the Case for Being Bold in 2020

Bernie - Medicare for All.jpg
Sen. Bernie Sanders unveiling his Medicare for All bill. Photo courtesy of Andrew Harrer of Bloomberg.

I’ve made it pretty clear in previous posts that I’m not the biggest fan of Hillary Clinton, or specifically, her last two attempts (hopefully) running for the presidency. To some degree, I felt sorry for the many brazenly-sexist attacks she faced during the 2016 election, and thought that in some cases, her position as First Lady during the Clinton administration made her an unfair target of her husband’s own legislation. But during her second attempt at the White House, she illustrated some pretty stunning moments of indifference to the real sense of change that American voters were screaming out for. Days before the Iowa Caucus, she dismissed the possibility of pursuing a single-payer healthcare plan:

Just a few days before the Iowa caucuses, Democratic candidate Hillary Clinton stressed to voters in Des Moines just how unfeasible she considers her opponent Bernie Sanders’ plan to pursue a single-payer health care system. ‘People who have health emergencies can’t wait for us to have a theoretical debate about some better idea that will never, ever come to pass.’

Post-defeat, in her memoir What Happened, she bemoaned what she considered as Sanders’ “everyone gets a pony” approach to policy promises, comparing his bold promises to the “six-minute abs” scene from the comedy There’s Something About Mary (1998). She argued:

A deranged hitchhiker says he’s come up with a brilliant plan. Instead of the famous ‘eight-minute abs’ exercise routine, he’s going to market ‘seven-minute abs.’ It’s the same, just quicker. Then the driver, played by Ben Stiller, says, ‘Well, why not six-minute abs?’ That’s what it was like in policy debates with Bernie. We would propose a bold infrastructure investment plan or an ambitious new apprenticeship program for young people, and then Bernie would announce basically the same thing, but bigger. On issue after issue, it was like he kept proposing four-minute abs, or even no-minute abs. Magic abs!”

While of course there is a mastery to balancing important policy promises with calculating whether they’ll even get close to being implemented in practice, Clinton’s dismissal of Sanders’ campaign promises does little to warm her to an increasingly bold Democratic Party membership, and epitomises the failure of being guided entirely by a “pragmatic politics” approach when voters are making it clear they are increasingly desperate for bolder solutions. Her treatment of Sanders’ ideological position reflected larger failures that her campaign struggled to answer during the 2016 election. As noted in Amie Parnes and Jonathan Allen’s Shattered and their outstanding expose of the major deficits of the 2016 Clinton campaign, her inability to articulate why she was running for president, beyond that of her own personal ambitions, haunted the campaign until election night. Their failure to do this ensured that the campaign was continually on the back foot against a negative public narrative of Clinton that ultimately doomed the campaign. While stimulating, attainable policies may have helped overcome this, it wasn’t something the Clinton campaign had much interest in pursuing.

Furthermore, I don’t believe that this element of political campaigning, i.e. why a candidate is running for office, is particularly esoteric; in the final months of the 2016 election, Trump’s campaign seemed imbued with all manner of meaning and symbolism for his voters, and one centered on challenging establishmentarian values and bringing real change through substantive policies. Likewise, Sen. Bernie Sanders didn’t have to try very hard to enunciate what his campaign stood for either, seeming to almost effortlessly tap into broad American anxieties around healthcare, education and jobs with nowhere near the same campaign infrastructure as Clinton. For Clinton, these forms of policy seemed absolutely untenable, and as a result her own policy promises seemed piecemeal and uninspiring to American voters. For many, setting a roadmap towards substantial change, however long it may take in practice, was far more enticing than promising little, or nothing at all.

As Democratic Party pollster Stanley Greenberg argues in his incisive essay, “How She Lost”, the necessity for Clinton to be bolder in her denunciations and remedies of the widely-felt inequities of American life were communicated to her campaign on numerous occasions. He argued that Clinton’s optimistic, “America is Already Great” platitudes reinforced the tone-deaf nature of her message to a nation in desperate need for change, and did little to address the “pocketbook pain” felt by so many in economic trouble. As a casual speechwriter to the campaign, he recommended injecting more populist segments into her campaign speeches that focused more on delivering a critical economic message that decried the increasingly unfair playing field of American opportunity, and more closely aligned her message with working class Americans. Greenberg noted the significantly positive reaction that these amended speeches received from respondents, but unfortunately this message didn’t continue in future drafts. As Greenberg notes, “that was the last America heard from Hillary Clinton on the economy.” Unable to cash a cheque of this nature, Clinton’s timidity ended up in her defeat, partly as a result of her pursuing a bizarre political centrism that was wholly unsuited to the extremely inequitable conditions of much of modern American life.

Democratic Senator and 2020 presidential candidate Elizabeth Warren greeting supporters. Photo courtesyy Travis Dove for The New York Times.

In contrast, two years after her defeat, the Democratic Party is becoming more and more determined to pursue substantive, progressive economic and medical policies such as an increased federal minimum wage, wholesale rejection of Super-PAC funding and a commitment to single-payer healthcare via Sander’s “Medicare for All” bill. The New York Times’ Jonathan Martin and Abby Goodnough picked the latter issue up in their Saturday piece, “Medicare for All Emerges as Early Policy Test for 2020 Democrats, arguing that so far, there is a lack of coherency among Democratic presidential candidates over what Medicare for All actually entails, namely on the role of private coverage under a single-payer system. They note:

The concept of Medicare for all has become popular with Democrats: 81 percent support it, according to a recent Kaiser poll. Yet voter opposition to surrendering the insurance they are used to led to a backlash over President Barack Obama’s repeated promise that “if you like your plan, you can keep your plan” after it proved false for several million people under his health law. Many Democrats are keenly aware of that backlash, and the 2020 presidential race will be the first where many of the party’s leading candidates will have to explain and defend the meaning of Medicare for all.

For now, as Ms. [Elizabeth] Warren demonstrated, many candidates do not want to wrestle publicly with the details. After Ms. [Kamala] Harris’s comment [saying she would support terminating private health insurance], her aides hastened to add that she would also support less sweeping changes to health care; like most other candidates, Ms. Harris declined an interview request. And by Friday, Mr. Booker, hours after announcing his presidential bid, sought to curtail the matter by offering a brisk “no” when asked if he supported eliminating private coverage.”

Vox’s Sarah Kliff and Dylan Scott report that the umbrella term of Medicare for All in reality covers eight different bills from Democratic representatives, all of which fluctuate in their emphasis on taxation, employer-sponsored insurance, and regulating premiums and healthcare prices. For many on the left, candidates such as Sen. Cory Booker and Kamala Harris’ inconsistencies on Medicare for All will be seen as a sign of their insincerity, but I think it’s as much a sign of a party currently in flux over how best to propose these forms of major policy without being seen as overly ambitious or contrastingly, timid, or whether to pursue them at all. I see this kind of coverage as a form of healthy challenge to the likes of Sen. Booker, Sen. Elizabeth Warren, and Sen. Harris’ own positions on Medicare for All. Even Sen. Sanders should be held to account over the viability of this bill, especially considering the complex conclusions from his own state of Vermont’s failure to maintain single-payer healthcare. As we know, a lot can change in two years, and if the party is to continue down this path, it will need to unite behind a coherent plan for healthcare reform.

It goes without saying that the Democratic Party is in an interesting period of change, and it is vital to ask the hard questions about implementing a single-payer healthcare plan. For many, the inevitable tax increases may be too difficult to digest, and that’s a major risk that the party takes in endorsing it. Democratic efforts regarding Medicare for All seem to suggest implementing it incrementally to avoid shocking private healthcare markets, but it’s at least on the right path towards addressing the need for substantial policy interventions. If the party goes down this path, the bill will be inevitably endorsed and rejected by certain caucuses and candidates, rifts will open between more progressive and centrist voices, and the party is going to have to work out exactly how to answer pressing issues on taxation and what will happen to existing private healthcare plans. Any purist ideas of a European-style proposal may fall short, but I do think the benefits of moving forwards with these forms of healthcare will prove a major boon in answering the palpable sense among many Americans that things have to change. Getting 70% towards implementing a full-scale single-payer option in the short-term is still better than offering meager trimmings around the Affordable Care Act.

As we’re currently seeing with President Trump’s border wall negotiations, there is of course a real danger in making substantial promises that may not be possible to keep. But even if Trump doesn’t get his wall, he will almost certainly get major concessions on border funding / infrastructure. Getting only some of what he wants may be a difficult pill for his supporters to swallow, as we’re currently seeing take place with Ann Coulter’s anger over Trump ending the shutdown, but it does demonstrate that in some cases, pushing for bolder policies may reap worthwhile rewards even if the original aim falls somewhat short. Likewise, the goal of a purist single-payer healthcare plan, turned moderate during negotiations, would still provide enormous benefits to tens of millions of Americans. Stating outright that there is no point even attempting to address major inequalities through bold legislation because, well it’s extremely difficult, is no message at all, and to suggest focusing entirely on keeping existing policies does very little to deal with existing inequalities. The temptation to follow a Clintonian message again in 2020 is still very much there, but hopefully the Democratic Party acknowledges both the need for aspirational policy-positions as well as the complex political, public and the legislative arithmetic needed to implement these same positions.

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