Paul Krugman has entered the healthcare reform fray on behalf of Hillary Clinton, a fact which will no doubt disappoint many progressives. In a op-ed titled “Health Reform Realities,” Krugman argues that though Obamacare is “a kludge: a somewhat awkward, clumsy device with lots of moving parts,” it works:
Health reform is the signature achievement of the Obama presidency. It was the biggest expansion of the social safety net since Medicare was established in the 1960s. It more or less achieves a goal — access to health insurance for all Americans — that progressives have been trying to reach for three generations. And it is already producing dramatic results, with the percentage of uninsured Americans falling to record lows.
In other words, the Affordable Care Act was a big win for us against Republicans, who fought any reform at all. Most will remember the failed Bill Clinton attempt to get healthcare reform done during his administration. As Krugman puts it,
The question for progressives — a question that is now central to the Democratic primary — is whether these failings mean that they should re-litigate their own biggest political success in almost half a century, and try for something better.
Most Democrats probably agree that single payer is better than what we have. It is what most of us wanted to begin with, after all. But how practical is it as a goal? Krugman reminds us that we barely got Obamacare even with a Democratic controlled Senate. If single payer had been a possibility, we would already have it.
But we don’t.
This is a big bone of contention now between Sanders and Clinton. Jason Easley wrote here regarding the Democratic debate:
Former Sec. of State Clinton’s argument is that the country should not tear up with Affordable Care Act and start over again with a new debate would set the country back. Bernie Sanders argued that his Medicare for all plan would cover the 29 million people who still don’t have healthcare.
Sanders said what this debate is really about is whether “we have the guts to stand up to the health insurance industry and the pharmaceutical companies. Clinton pointed out that during the ACA debate Democrats could not get support for the public option. Clinton clearly has been shaped by her experience in the 1990s of trying to pass healthcare reform. The debate within the Democratic Party comes down to whether Democrats should stay on ACA path or take a shot at Medicare for all.
In Krugman’s opinion, the candidates should “focus their main efforts on other issues.” You know, those we haven’t already won, even if the victory was not all we had hoped for. Krugman lists the many problems with pushing for single payer, including the massive influence of the insurance companies, the necessity of raising taxes to pay for it – not only the rich but the middle class – and the disruption to people who already have insurance they are satisfied with.
Krugman makes a powerful argument when he says “progressives must set some priorities,” and calls Sander’s goal of single payer “a quixotic attempt at a do-over, not of a political failure, but of health reform — their biggest victory in many years.” Any president only has so much political capital. There are battles we haven’t fought and won – to any degree whatsoever – that it might make more reasonable objectives for an incoming president.