Purity vs. Pragmatism, Environment vs. Health

https://www.nytimes.com/2019/04/11/opinion/green-new-deal-medicare-for-all.html

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Right now there are two big progressive ideas out there: the Green New Deal on climate change and “Medicare for all” on health reform. Both would move U.S. policy significantly to the left. Each is sponsored by a self-proclaimed socialist: the Green New Deal by Alexandria Ocasio-Cortez and Medicare for all by Bernie Sanders. (Of course, neither of them is a socialist in the traditional sense.) Both ideas horrify not just conservatives but also many self-proclaimed centrists.

Yet while they may seem similar if you think of everything as left versus right, they’re very different on another dimension, which you might call purity versus pragmatism. And that difference is why I believe progressives should enthusiastically embrace the G.N.D. while being much more cautious about M4A.

You see, for all its sweeping ambition, the Green New Deal is arguably an exercise in pragmatism — in the proposition that the perfect is the enemy of the good.

What’s the perfect in this case? Climate-policy purists are focused on the notion of a carbon tax to discourage greenhouse gas emissions, and they look down on any proposal that doesn’t put such a tax front and center.

What’s wrong with a carbon tax as the centerpiece of climate policy? There are some narrow economic arguments for a broader range of public policies — for example, government support can be crucial for the development of new energy technologies.

Even more important, however, is the political economy. A carbon tax would hurt significant groups of people — and not just fossil-fuel billionaires like the Koch brothers. As a result, a carbon tax on its own is the kind of eat-your-spinach policy that technocrats love but many ordinary citizens hate, as illustrated by what just happened in France, where a planned fuel tax increase was withdrawn in the face of furious “Yellow Vest” protests.

So how do you make climate action politically feasible? The G.N.D. answer is to bundle measures to reduce emissions with a lot of other stuff people want, like big public investment even in areas with only weak direct relationships to climate change.

You could call the G.N.D. a proposal for economic transformation that includes climate action. But you could also call it a “Christmas tree,” the traditional term for legislation festooned with lots of riders unrelated to the ostensible purpose in order to win political support.

The point is that climate action probably won’t happen unless it’s a Christmas tree — and the G.N.D.’s advocates are O.K. with that. In that sense, they’re pragmatists despite their big ambitions.

Medicare for all, by contrast, is an exercise in the proposition that we must not settle for anything less than the ideal.

Indeed, Sanders has explicitly refused to support Nancy Pelosi’s proposal to enhance Obamacare, even though her proposal would expand health insurance coverage to millions of Americans and make it more affordable for millions more. His reasoning seems to be that making things better, even as an interim step, would undermine support for a more radical transformation.

To be fair, the simplicity of the pure single-payer, government insurance system Sanders advocates would have some advantages over the hybrid public-private systems that have been proposed by other progressives — for example, letting people keep private insurance if they want, but offering the option of Medicare buy-in.

You might say that single-payer is the system technocrats would choose if they had a free hand, with few political constraints. In fact, that’s pretty much what happened in Taiwan, which asked a panel of experts to design its health care system, and ended up with single-payer.

On the other hand, international experience shows that universal coverage and high quality health care can be achieved in a variety of ways; technocrats may prefer single-payer, but it’s not essential.

And the political obstacles to a Sanders-type plan are formidable. Almost 180 million Americans are covered by private health insurance, and many of them are satisfied with their coverage. Polling suggests that while the public reacts favorably to the slogan “Medicare for all,” that support drops precipitously when people are informed that it would eliminate private insurance and require substantial tax increases.

The Sanders view, however, is that a sufficiently determined leader can overcome these doubts and persuade many voters who are currently doing O.K. that radical change is nonetheless in their interests. I don’t know of anything in recent history to justify this belief, but there it is.

My guess is that if Sanders does make it to the White House, he’ll quickly find that he can’t deliver on his grand vision, and will eventually try for a less purist alternative. And let’s be clear: A lot more Americans will have affordable health care if any Democrat is elected than they will if Donald Trump retains the White House.

Still, it’s important to realize that among Democrats, purity versus pragmatism is as important an axis as left versus right. And the two big progressive ideas are on opposite ends of that axis.

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