The hot new thing to get angry about on the progressive wing of the Democratic Party is single-payer. That's the bold idea that the government should give health insurance to every American—a fundamental transformation of a huge part of the economy that advocates say would make healthcare more efficient, and which more cautious liberals warn would be disruptive not to mention politically impossible, since you'd have to raise a lot of taxes to pay for it. The debate has gotten heated at times, with single-payer skeptics accusing single-payer campaigners of having ideas that are both overly ambitious and half-baked, and single-payer fans arguing that any other healthcare reform would fail to fix the system's problems.
But whatever you think about single-payer as a policy, let's agree on something: "Single-payer," the phrase, needs to be rolled up in a carpet, shot, taken out to the middle of some remote lake, and tossed into the watery depths.
"Terms matter a great deal" in politics, says Stephen J. Farnsworth, the director of the Leadership and Media Studies at the University of Mary Washington. That's why Republicans often refer to the "estate tax," which only affects fortunes of over $5.45 million, as the "death tax"—if something is called the death tax, as in the government is coming for your money even after you die, wouldn't you want to eliminate it?
"You want to avoid anything that speaks to pain if you can," is Farnsworth's advice for politicians naming policies they want to see made reality. "This is why people like to use 'revenue enhancement' instead of 'tax.'" It's also why the most effective political slogans of the past decade—Barack Obama's "Hope and Change," Donald Trump's "Make America Great Again"—were both pithy and positive, not to mention vague. What sort of change? What kind of greatness? Who cares?
Arguably one mistake Obama and the Democrats made during the last round of the healthcare wars was to more or less accept the Republican attempt to dub the Affordable Care Act "Obamacare." With a name like that, Farnsworth notes, how you feel about the policy will inevitably be wrapped up with how you feel about Obama. The rebranding had long-term effects: A poll from this February found that a third of Americans either didn't know or weren't sure if Obamacare and the Affordable Care Act are the same thing.
Today progressives face many obstacles in their efforts to further reform America's broken healthcare system. Adopting single-payer would probably mean switching millions over from employer-provided insurance to government plans, a big tax increase, and a transformation of the insurance industry. That sort of sweeping change naturally makes voters and many politicians wary. Republicans and the health insurance lobby will attack single-payer proposals as "socialism" and decry the necessary tax increases. With all that to worry about, why burden yourself with an ugly monicker?
"Single-payer" is a good term to use if you are having a technical debate about health insurance. (There are multiple care providers but a single-payer, the government, under that sort of system.) Most people, however, are not having that debate. I find the term to be a bit of opaque wonkery, a phrase that's meaningless to those who aren't already steeped in healthcare politics, and I don't think I'm alone. Farnsworth calls it "clunky" and notes that "it doesn't give people the sense of comfort that terms sometimes offer… It's the perfect example of a big-government terms that calls attention to its big-government origins"
By way of comparison, Farnsworth offered the example of Social Security, a massive expansion of the government's responsibilities that is also extremely popular. "Security sounds good," says Farnsworth. "How can I get me some?"
Occasionally, government programs and agencies change names for rebranding reasons, as when "Food Stamps" became the "Supplemental Nutrition Program." Once the United States had such a thing as the Department of War, which became the Department of the Army and was placed under the new Defense Department umbrella in 1947—"defense spending" sounds a lot nicer than "war spending."
So what should replace "single-payer"? A Kaiser poll from 2016 indicated that people's support for the policy varied not just on which arguments were emphasized by the pollster but which term was used, with "single-payer" and "socialized medicine" being the least popular. At the top of the list was "Medicare for all," which Farnsworth notes is something people can "intuitively grasp." Most people know (at least vaguely) what Medicare is, so expanding it seems like a good idea.
Farnsworth suggests the term "health security," which sounds comforting but vague. In the Nation, Trudy Lieberman recently suggested "guaranteed lifetime coverage for all," which is positive if wordy. Neither seems likely to catch on, but both are more welcoming than "single-payer"—or for that matter, the "public option," the healthcare reform alternative embraced by single-payer skeptics, which is also stuck with a lousy name.
Unfortunately, "single-payer" remains stubbornly dominant in this debate, though Medicare for all has been bandied about by some advocates, including Bernie Sanders. But there are plenty of alternatives that speak to the policy goals of progressives: "health access for all," "universal coverage," "universal healthcare," "healthcare for all."
These terms are squishy, yes—single-payer advocates are pushing for a specific system, while "universal coverage" could be arrived at several ways, by an expansion of Medicare or Medicaid for instance. But as Farnsworth says, vague terms give politicians "wiggle room," which can be important.
At the moment, Democrats have no power to pass major legislation, no matter what they call it, until 2021 at the earliest. Wonky debates over policy are important, but so is how you define your party's position to the non-wonk population. Single-payer, as a goal, is extremely controversial. "Single-payer," as a phrase, is lousy. Progressives looking for a message in the 2018 midterms and belong should start by picking a message that everyone can understand. Details can come later.
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