1/ I'm curious about the theory of change under which Sanders supporters operate when it comes to Medicare 4 All. And I ask this as someone who philosophically supports single payer, even if I have questions about some specifics. I support the idea and figure it could work...
2/ But politically, I'm curious as to how they see it coming about if Bernie wins. Obviously, Senate will likely remain GOP, or barely Dem but w/several more conservative Dems unlikely to support M4A. House too: many more conservative Dems who may not feel they can support yet..
3/ So, is the theory that Bernie's bully pulpit alone will push all Dems to support M4A? If so, how long will that take? And why would Dems in places w/more center-right voters feel pressured to support it? Are their constituents gonna flip views bc of Bernie's soaring rhetoric?
4/ If not, why would they care that there could be 1m people marching in DC for M4A (theoretically?) Marches and demos alone don't push votes unless officials feel the heat in THEIR districts/states. So, best case, it would take many years to build the movement in such places...
5/ Not saying it wouldn't happen. It might, and that would be great. But it's not gonna happen in a year or two, or maybe even four. So then the question is: would Bernie or his supporters be on board for a short term stopgap health reform to shore up ACA? And this is important..
6/ ...bc right now there are millions in states that refused to expand Medicaid under ACA, leaving the poorest & often sickest in private pay pools, thereby discouraging insurers from entering markets there. This kept costs high and services low relative to the goal of ACA...
7/ That kind of shit is one reason we need M4A, no doubt. But meanwhile, lots of folks can't even get the improvements ACA offered, bc right wingers sought to undermine it. So would Bernie push for a stopgap to help these folk? Or hold out bc anything short of M4A is evil?...
8/ I worry he would be reluctant to accept a stopgap for fear it would sap political will to go further. Better perhaps to him & his movement to hold out and accept no compromise in the hopes people will "see the light." Meanwhile people suffer who could be offered relief...
9/ Yet there is a simple reform he could push as a first step, which would alleviate some of that suffering AND build political support for M4A, if he and his movement are prepared to accept a type of incrementalism (a big if)...
10/ Namely, we could offer people in states that blocked Medicaid expansion (thus undermining ACA), immediate access to a public option. This would push back against the monopoly insurers currently in those states, bring down costs and provide better care...
11/ It would also build political support for getting rid of private profit-driven health care, by showing people in more conservative states (who would benefit from this measure) that things are better when you take profit out, and offer guaranteed care...
12/ Politically, this would be crucial on three levels: 1) by targeting people in "red states" for this new benefit, you eliminate the typical right wing nonsense grievance that the left "forgets about them" or only cares about coastal cities, blah blah blah...
13/ then, 2) you remind them by doing this that the people who screwed them in the first place by refusing to fully implement ACA were conservative republicans, who were willing to leave them hanging and paying more, and then 3) by building support for public care...
14/ You end up providing political cover to more conservative Dem lawmakers in more conservative areas , to ultimately move to M4A, since the voters will now be more likely to see the benefits of taking profit out of the equation. THEN, you might actually get M4A..
15/ But unless you do a short term measure that can build support in such places (and provide real relief to millions who need it), you may never get M4A support to be high enough to pass. And doing short term measures like this requires a willingness to trust incrementalism..
16/ My fear is that Bernie (and certainly his hard core supporters) are not OK with incrementalism. They want justice now and nothing less. While philosophically valid, That is not rooted in a real theory of change, nor history...
17/ And if you would spurn short term relief so as to hold out for the full prize, not only will you be implicated in ongoing suffering you could relieve right now, you will ultimately probably not get the full prize anyway. You'll feel very righteous, but that's about it..
18/ If I'm too pessimistic about Bernie's willingness to do something like this, so be it. I hope I am. But it just seems like talk of anything short of total M4A is met with head shakes and "no, no, no..." and reminders of the evils of the profit system. That's not sufficient.
