Biden’s comments to O’Donnell are being taken out of context to make him look even more hostile to Medicare-for-all than he actually may be; he basically said he would veto a bill he thought was unworkable, and repeated his well-worn criticism of single-payer.
But here’s the problem. Asking Biden whether he’ll veto single-payer in 2021 is like asking him whether he’ll flap his wings and fly to the moon, then attacking him for the kind of jumpsuit he’ll be wearing while doing it.
I say this as someone who believes a single-payer system would be the most effective at solving our many health-care problems. But single-payer health care will not be passing Congress in 2021. It won’t happen if Biden is president, and it won’t happen if Bernie Sanders is president. It won’t happen if Democrats take back the Senate, and it won’t happen if they get rid of the filibuster. It not only couldn’t get 50 votes for passage there, it probably couldn’t get 30 votes.
That doesn’t mean people should stop making the case for it! We should keep talking about the predations of the insurance industry, and how overpriced our system is, and how immoral it is to leave millions without coverage, and how unconscionable it is that, unlike every other industrialized country, we have things called “deductibles” and “medical debt,” and how much more secure and less anxious universal coverage could make all of our lives.
But when it comes to arguing about procedures and hypothetical scenarios, we’re asking Biden — who right now has the best chance to be the Democratic nominee, and could have the nomination nearly locked up after Tuesday — the wrong set of questions.
The right questions have to do with Biden’s public option plan: how committed he is to it, how quickly he’s going to push it, what he’s willing and unwilling to compromise on, and how he plans to wage the fight it will take to pass it.
As far as I can tell, Biden hasn’t been asked about any of that.
And it’s incredibly important. People have convinced themselves that the public option is some kind of pathetic husk of a reform, the kind of thing that is so meaningless you could tack it on as an amendment to a bill renaming a post office.
But the truth is that it would be more significant than the Affordable Care Act, maybe even more significant than the creation of Medicare.
You know who understands that? The insurance industry, and the hospital industry, and the medical device industry, and all the other well-funded actors who like the current system just fine. Which is why they’re ready to fight like hell to keep a public option from ever happening, and why they lump it in with Medicare-for-all in their propaganda.
“The politicians may call it Medicare-for-all, Medicare buy-in, or the public option,” the industry says in its ads. “But they mean the same thing: Higher taxes or higher premiums. Lower quality care.”
Biden’s health-care plan is surprisingly liberal. It goes way beyond the ACA and enrolls millions of people in government health care, including everyone who was denied Medicaid because they live in a Republican hold-out state that refused the ACA’s Medicaid expansion. It auto-enrolls low-income people whenever they have an interaction with the government. It allows anyone, even those with employer-provided insurance, to join a government plan.
If Biden becomes president, there will be no point in asking, “Why isn’t this as expansive as Bernie Sanders’s version of single payer?” The question will be whether Biden can actually make what he promised happen.
And there’s reason to be skeptical. Biden was certainly part of the legislative effort to pass the ACA when he was vice president, but he was never known as an advocate for going beyond the compromise the administration settled on. And compromise is his thing — he obviously can’t wait to get back to negotiating with members of Congress and making deals.
While he’ll certainly defend his plan if you ask him to, he has spent much more time in this campaign criticizing Medicare-for-all, which suggests that for him health care has been less a subject of passionate commitment than a way to make a clear differentiation between himself and some of his more liberal opponents.
That doesn’t mean Biden, if elected president, won’t pursue reform. But it does mean that making that reform as comprehensive as possible will require getting him to make firm commitments now and keeping him under pressure when he’s president.
If Biden wins, a lot of Sanders supporters will be disillusioned, feeling that because their preferred solution is no longer on the table, there’s no point in staying involved. Many of them appear convinced that if we don’t get Bernie’s Medicare-for-all, any other reform is useless.
These Sanders supporters should know that if they drop out of that fight, the insurance companies will send them a thank-you text as they clink their champagne glasses to toast victory over health-care reform. If we’re going to get anywhere, we need to keep pressure on even incrementalists such as Biden. If you think that isn’t important, you’ve already surrendered.