We Can’t Settle for Less Than Single Payer

25 years ago, ITT’s staff was divided about Clinton’s healthcare plan. This time around there’s no question.

Joel Bleifuss

(Photo by Brooks Kraft / Contributor / Getty Images)

In 1994, America was in the throes of healthcare reform. First Lady Hillary Rodham Clinton was leading the Clinton administration’s grand effort to implement a system of managed competition,” a proposal that would expand healthcare coverage by putting big insurance companies in the driver’s seat but regulate how that care was administered. Her failed proposal, while not perfect, was not that far off from the Obamacare we got 16 years later.

25 years later, we are faced with a field of Democratic primary candidates who run the gamut from Bernie Sanders’ wholehearted push for Medicare for All to Joe Biden’s dismissal of it.

Here at In These Times, the office was divided. Some supported Clinton’s plan on the grounds that it was an improvement, while others thought it folly to settle for less than single payer.

John Judis, a founding editor at In These Times, wrote in March 1994:

I am [not convinced] that a Canadian-style plan could pass Congress … .

As Congress strips away the ungainly features of Clinton’s plan … the real danger is that what remains will more closely resemble the prim [Rep. Jim] Cooper [D-Tenn.] plan [known as Clinton Lite] … . Given that danger, liberals’ priority will probably be defending what the Clinton plan, for all its deficiencies, has in common with the Canadian system: a commitment to universal coverage and control of costs.

What will I do? I’ll have to demonstrate my altruism by defending the Clinton plan against its conservative rivals, even as I anticipate the prospect of my health insurance fees doubling.

Vicente Navarro, a professor of health policy at Johns Hopkins and author of Dangerous to Your Health: Capitalism in Health Care, took the opposite tack in January 1994:

The implementation of the Clinton managed competition” proposal will put large insurance companies in command of the health care system. … The profitability of the insurance industry is based not only on selecting and screening patients, but on favoring those providers who consume the fewest resources, a strategy that frequently interferes with the quality of care. …

And this is why managed competition is favored by large insurance companies. None other than Bill Link, vice president of Prudential Insurance, has indicated that for Prudential, the best-case scenario for reform — preferable even to the status quo — would be enactment of a managed-competition proposal.”

What we need is a single-payer system that, as in Canada, provides comprehensive and universal coverage without co-payments and deductibles, and also allows people to choose their providers. …

There is an urgent need to mobilize support for the single-payer proposal, both to move the debate to the left and to expand and strengthen the single-payer elements in the legislation that Congress may finally approve.

Now, 25 years later, we are faced with a field of Democratic primary candidates who run the gamut from Bernie Sanders’ wholehearted push for Medicare for All to Joe Biden’s dismissal of it. God willing, in another 25 years, we will be having a different discussion. Of course, the nature of that debate will depend on the results of the 2020 election.

Help In These Times Celebrate & Have Your Gift Matched!

In These Times is proud to share that we were recently awarded the 16th Annual Izzy Award from the Park Center for Independent Media at Ithaca College. The Izzy Award goes to an independent outlet, journalist or producer for contributions to culture, politics or journalism created outside traditional corporate structures.

Fellow 2024 Izzy awardees include Trina Reynolds-Tyler and Sarah Conway for their joint investigative series “Missing In Chicago," and journalists Mohammed El-Kurd and Lynzy Billing. The Izzy judges also gave special recognition to Democracy Now! for coverage that documented the destruction wreaked in Gaza and raised Palestinian voices to public awareness.

In These Times is proud to stand alongside our fellow awardees in accepting the 2024 Izzy Award. To help us continue producing award-winning journalism a generous donor has pledged to match any donation, dollar-for-dollar, up to $20,000.

Will you help In These Times celebrate and have your gift matched today? Make a tax-deductible contribution to support independent media.

Joel Bleifuss, a former director of the Peace Studies Program at the University of Missouri-Columbia, is the editor & publisher of In These Times, where he has worked since October 1986.

The War on Protest Cover
Get 10 issues for $19.95

Subscribe to the print magazine.