Sometimes, everything old becomes new again. The ongoing coronavirus panic has drawn renewed attention to the 1918-19 Spanish flu — both its effects on the economy and society, and whether and how preventive and public health measures used back then can provide lessons in combating the coronavirus.
Another century-old analogy provides comparisons to the current tensions within the Democratic Party on health policy, which have flared up on multiple occasions in recent months. As in the disputes before the Russian Revolution of 1917, Democrats don’t disagree on the ultimate objective of government-run health care. Like the quarrels between the Bolsheviks and the Mensheviks, they merely disagree on the means to obtain their shared ends.
In Russian history, the Mensheviks took a less-radical view than the Bolsheviks. Vladimir Lenin and his Bolsheviks wanted to form a revolutionary cadre to indoctrinate the country towards a workers’ rebellion, whereas the Mensheviks wanted to fortify allegiances and welcome allies outside the core movement to advance their objectives.
In the current climate, Sen. Bernie Sanders (D-Vt.) — who just so happened to spend his honeymoon in the Communist-era Soviet Union — leads the Bolshevik fashion. His movement for “radical transformation” takes many forms, most prominently in advocacy for a complete conversion to single-payer health care.
Sanders and his supporters want to use the coronavirus to accelerate a move towards socialized medicine. Rep. Pramila Jayapal (D-Wash.), a Sanders acolyte, wrote legislation calling for Medicare to pay for all Americans’ out-of-pocket expenses related to the virus. She and her fellow House progressives also demanded that policy’s inclusion in the $3 trillion “stimulus” bill assembled by House Speaker Nancy Pelosi (D-Calif.) this spring.
Outwardly, the Mensheviks continue to maintain the upper hand. The draft Democratic platform said it “welcomes…those who support” a single-payer approach, then proceeded not to endorse that approach. Likewise, Pelosi’s final version of her “stimulus” bill included a subsidy for COBRA continuation coverage provided by employers and a last-minute amendment with new federal dollars to prop up the Obamacare markets via risk corridors.
These attempts at moderation have consistently drawn scorn from the socialist left. Rep. Ro Khanna (D-Calif.) said he would vote against the Democratic Party’s 2020 platform because it did not include an explicit commitment to single-payer health care. His announcement came weeks after 360 delegates also threatened to vote against a platform that failed to endorse socialized medicine.
In Congress this spring, several farther left members objected to Pelosi’s moves, calling them insufficient. Jayapal voted against the bill’s final passage. Other hard leftists, like Khanna and Rep. Alexandria Ocasio-Cortez (D-N.Y.), voted against the rule governing debate on the bill, hoping to extract concessions from Pelosi before its passage. Khanna attacked the legislation for proposing half measures instead of “bold leadership:”
I am voting no on the rule. We have a healthcare crisis yet no expansion of Medicaid or Medicare. FDR didn’t talk about employer retirement accounts. LBJ didn’t talk about voting rights in some precincts. They would have scoffed at Cobra to private companies. Need bold leadership
— Ro Khanna (@RoKhanna) May 15, 2020
The ‘Not-Moderate Mensheviks’
As with the Bolsheviks a century ago, the progressives object because the “moderate” Mensheviks want to work through the current system. Whereas establishment types like Pelosi and Joe Biden want to use COBRA (an extension of employer-provided health insurance) and Obamacare to expand coverage, the farther leftists threatening to vote against them focused on putting everyone into a new government-run system.
But from another perspective, these “establishment” proposals don’t seem moderate in the slightest. Apart from the staggering $3 trillion cost of Pelosi’s legislation, a 100 percent subsidy for COBRA continuation would encourage individuals to remain on one of the most costly forms of insurance — and encourage employers to lay off workers so they can receive “free” coverage, plus enhanced unemployment benefits. These changes would massively expand the number of individuals dependent on government programs — a prime objective of both factions.
Likewise, Biden portrays his proposal for a voluntary government-run plan as less radical than Sanders’s single-payer proposal. But consider what the intellectual godfather of this so-called “public option,” Jacob Hacker, said about the concept in 2008: “Someone once said to me this is a Trojan horse for single-payer. And I said, ‘Well, it’s not a Trojan horse, right? It’s just right there!’”
A Dispute Over Means, Not Ends
The fact that Biden proposed an expansion of Medicare the day after Sanders dropped out of the presidential contest demonstrates Democrats continue to row in the same direction — in favor of government-run health care. Rep. Jan Schakowsky (D-Ill.) said it best in remarks at an April 2009 rally featuring supporters of single-payer health care:
I know that many of you here today are single-payer advocates [loud cheering], and so am I. I’m a co-sponsor of [H.R.] 676 [a single-payer bill]. And those of us who are pushing for a public health insurance option don’t disagree with the goal. This is not a principled fight. This is a fight about strategy for getting there — and I believe we will.
Those who focus on the minor tactical fights like those that have played out in recent weeks mistake the forest for the trees. The left’s ultimate goal remains clear — as does the effect of that goal on the health care system.