Single-payer health care is not a new idea, not even here in the United States, the only wealthy Western nation without universal coverage. In 1944, President Franklin Roosevelt proposed a Second Bill of Rights that included “the right to adequate medical care and the opportunity to achieve and
enjoy good health.” Roosevelt, of course, spoke at a heady moment, when Democrats were signing up as co-sponsors for sweeping national health-care legislation. After Roosevelt’s death, Harry Truman embraced the cause and agitated for it more aggressively than any president since, only to be blocked by a Red Scare that presaged McCarthyism, as well as a vicious campaign funded by the American Medical Association.
President Lyndon Johnson used his 1964 landslide election to enact Medicare and Medicaid, but the Democratic presidents who came after him have pulled their punches on health care—mostly promoting schemes to better organize the intersection of private and public care that mirrored those once advanced by a dying breed of moderate Republicans.
And here Democrats have paid a political price, not for compromising on any eventual legislation, but for failing from the outset to put forward a clear and simple vision of health care as a fundamental right. In 1993, Bill and Hillary Clinton produced a byzantine and dispiriting plan that blended new regulations, subsidies, mandates, and free-market competition in a stew they called “managed care.” “We have no pride of authorship” over any aspect of the bill, they both conceded during the rollout. Lacking a moral center, the proposal died quickly under a withering attack from the right and the insurance industry. Barack Obama, of course, was considerably more successful in this regard. But he began the negotiations by preemptively taking single-payer off the table, despite having repeatedly stated that such systems make the most sense. With Obama’s punt, there went any room to negotiate even for a public option.
Now Democrats find themselves yet again defending a law that even its eponymous sponsor publicly acknowledges needs significant fixes. Make no mistake, the latest Republican attempt to repeal and replace Obamacare—this time with the Graham-Cassidy bill—is in many ways stupider and crueler than its predecessors. There is no Congressional Budget Office score yet for this hasty, last-ditch effort, but replacing most of the Affordable Care Act with inadequate block grants to states, along with other cuts, will easily leave upwards of 32 million people uninsured. Seemingly as a middle finger, the bill disproportionately targets the blue states that expanded their Medicaid rolls. To this moral obscenity, Democrats have been unified in saying no. But what are they saying yes to?