Friday, June 24, 2016

Packaging medicare-for-all as a defense measure

Despite Hillary Clinton’s claim that single-payer medical insurance is politically impossible,  it might get enacted if shown to be necessary for our national defense.  There are precedents.

Before the Eisenhower administration,  highways were mostly state responsibilities.  But Eisenhower admired the German autobahns he saw after World War II.  His 1919 military convoy across the U.S. had convinced him that good highways would be invaluable during wartime.

Eisenhower’s National Interstate and Defense Highways Act of 1956 produced our present freeway system.  Conservative enthusiasm for this major legislation was surely enhanced because it was a defense measure.

In 1957 the U.S.S.R. launched the first artificial satellite. The U.S. had not managed to launch any satellites yet, so Sputnik hit us like a psychological Pearl Harbor.     

The Sputnik scare led to the National Defense Education Act of 1958  funding improved science classes in American schools.  The NDEA also established federal graduate fellowships from which I personally benefited. After I graduated from Willamette University in 1961 an NDEA fellowship financed my Ph.D. studies at Johns Hopkins University.

Before 1958 most education had been considered a state responsibility, and again a major federal expansion was justified by the need to strengthen national defense.

During World War I President Woodrow Wilson backed off from earlier opposition to the proposed Nineteenth Amendment, and he did it in the name of national defense. He said, “I regard the concurrence of the Senate in the constitutional amendment proposing the extension of the suffrage to women as vitally essential to the successful prosecution of the great war of humanity in which we are engaged." 

 Bernie Sanders has put single-payer insurance squarely on the national discussion agenda and many consider Medicare For All an excellent idea.  Hillary Clinton’s argument that single-payer is politically impossible seems reasonable, given Republican hostility to Obamacare, since without some Republican support  no such legislation can be enacted.   But Clinton neglects a historical fact:  “packaging” can have a major influence on getting legislation passed. 

The only program Republican leaders do not want to cut is national defense.  They want to increase defense spending while whacking everything else.  Therefore to encourage Republican support for single-payer, we must bill it as a national defense measure.

The National Defense Medical Insurance Reform Act of 2017 would gradually reduce the percentage of GDP devoted to medical care, thus reducing the danger that medical costs will gobble up resources otherwise available for the military,   research, and education.  It would help fight viruses like Zika or attacks by contagious biological weapons, since protecting anyone requires protecting everyone.  And a healthier population would include more people physically capable of military service, which could be especially important as young people become a smaller part of our population.

Expansion of federal involvement in highways and education as defense measures took place under President Eisenhower,  a Republican. A Republican president might be the ideal person to propose Medicare For All legislation.  Perhaps Ted Cruz would be unlikely to propose any such thing,  but Donald Trump or John Kasich might find it an interesting way to replace deeply flawed Obamacare with broad bipartisan support. 

Woodrow Wilson, who backed women suffrage as a defense measure,  was a Democrat.  As president Bernie Sanders would also be well advised to present insurance reform as a military defense measure.  Hillary Clinton could do likewise if her opposition to single-payer is actually based on its perceived political impossibility rather than being her opinion on the merits.

True leaders of either party can sometimes turn political impossibility into political reality.

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