Bernie Sanders’ single payer plan is here. Think of it as an opening bid.


WASHINGTON POST

Bernie Sanders released his latest single payer health care plan, and while there are some small differences between this one and what he has proposed in the past, the biggest difference is that this time, he’s got lots of company. Fifteen Democratic senators are co-sponsoring his bill, including most of those considering running for president in 2020.

Support for some kind of universal coverage is now the consensus position among Democrats. And Sanders’ single payer plan is the one that has gotten the most attention, so it’s going to be the one against which other plans are measured.

But we have to understand this plan for what it really is: an opening bid. While he won’t say so himself, I doubt even Sanders believes that something in this form could pass through Congress. Even so, it represents an important strategic shift for the Democratic Party.

 here are the basics on what Sanders’ plan would do, based on a summary released by his office:

• It establishes an (almost) true single payer system in which private and employer-based insurance is replaced by an expansion of Medicare to include nearly every American.
• It does so over four years, lowering the Medicare eligibility age to 55 and insuring all children in the first year, then expanding the plan to include all citizens over the following three years.
• It includes areas of coverage not currently offered by traditional Medicare, including dental, vision, and hearing aids.
• It eliminates nearly all co-pays, coinsurance, and deductibles.
• It allows the expanded Medicare system to negotiate drug prices, which Medicare is currently forbidden from doing.
• It does not include nursing home coverage, which would continue to be covered under Medicaid, nor does it eliminate the VA or the Indian Health Service.
• It would pay providers at current Medicare rates, which are lower than private insurance but higher than Medicaid.

This is a maximalist demand. It essentially says, “My plan is: everything. Not just covering everybody, but covering everything, without co-pays or deductibles. Is that realistic? Not really. But that may not be a problem.

One of the complaints people on the left had about both Bill Clinton and Barack Obama — in general, but specifically on health care — is that they gave away too much too quickly, often before negotiations even started. They were too focused on what Republicans or interest groups would never accept, so they moved their opening proposals three steps to the center, leaving the final negotiated solution much more conservative than it had to be. It would have been far better, this critique goes, if they had opened with a much more liberal proposal, then slowly given some ground and eventually arrived at a more liberal compromise.