The long advocacy for universal health-care coverage by Democrats has earned a base of public support, but it has also provided an easy focus for political attacks. Although universal coverage will protect businesses and families from unmanageable costs, it will also increase government spending considerably and increase government involvement in health care.The strategy you have adopted as candidates is the same one that Democrats have used for decades without success (including in 1993, when I was a health policy adviser in the first Clinton administration). You have both designed plans that aim to minimize government costs and to minimize changes for Americans with good health coverage, while still constructing a safety net of coverage for the growing millions without insurance.This approach, however, inevitably increases the complexity of our Rube Goldberg health system. It has made your policies difficult to explain. It has failed to prevent charges that you are promoting “socialized medicine.” And it has cost you the enthusiasm of Americans who want a simpler, tax-based, Medicare-for-all system.
How do you persuade supporters of single-payer health care that your proposals are worth fighting for? And how can you assure the rest of us that the costs and complexities of your plans are actually manageable?
— ATUL GAWANDE, a general surgeon, a staff writer for The New Yorker and the author of “Better: A Surgeon’s Notes on Performance.”
Tonight marks possibly the final debate between the Democratic candidates. As I’ve said all along, health care is the issue I’m voting. That said, I wouldn’t support a candidate only on health care; s/he has to be the whole package. Hillary Clinton has said that a single-payer system would be best, but she doesn’t think it’s politically possible. I don’t know if that’s true, but I do know that her alternative proposal is more ambitious and far-reaching than her opponent’s. But the truth is that we don’t know what either candidates’ plans will look like; we can only go on what policy experts predict.
Ralph Nader’s announcement Sunday morning throws a wrench in the whole election. Nader represents my political views far better than the Dems (I’m not really a Democrat–they’re often the lesser of two evils), and he supports single-payer (Medicare for all) health insurance. I imagine that some of the fervor over the Dems–especially the candidate of empty signification–will ebb over the course of the election, and support will weaken significantly when the Republican attack dogs come out (particularly among youth, who may be tireless, but certainly can’t focus very long on one thing, especially if that one thing becomes difficult and substantive).
So what will those of us who want more than empty promises of change, more than a rock-star-like icon, more than the probable front-runner could deliver do? We won’t have to make that decision until after next Tuesday–there’s still a chance to do the right thing–but if the tide of media hype pushes the celebrity into the position of nomination, there is a choice.