By PAUL STARR – – – –
I have a strange idea about presidential primaries and elections: The purpose is to elect a president.
And I have a strange thought about primary voters: They have a choice between sending the country a message and sending it a president. That is a choice Democratic voters in Iowa and New Hampshire ought especially to be weighing with the first caucuses and primary only days away.
The desire of many Democrats to send a message is understandable. As the co-editor of a liberal magazine, The American Prospect, I know that impulse. There’s a lot of anger and frustration among Democrats about entrenched institutions resistant to change. The bankers and other financiers responsible for the 2008 crisis have largely gone unpunished, and the big banks are now bigger than they were then. Although the economy has substantially recovered from the crisis, the gains in income and wealth continue to go mainly to people at the top. Despite the passage of the Affordable Care Act, the prices of drugs and health-care services are exorbitant, and even many of the insured are not well protected against those costs.
Racism, climate change, the campaign-finance system—it’s easy to come up with a list of problems that do not seem amenable to incremental reform. So when Bernie Sanders calls for mobilizing millions of people to bring about a revolution, a lot of progressives cheer him on.
But as appealing as Sanders may be, he is not credible as president. Elizabeth Warren would have been a credible candidate, but Sanders isn’t. The campaign he has been waging is a symbolic one. For example, the proposals he has made for free college tuition and free, single-payer health care suggest what might be done if the United States underwent radical change. Those ideas would be excellent grist for a seminar. But they are not the proposals of a candidate who is serious about getting things done as president—or one who is serious about getting elected in the country we actually live in.
If he were elected, Sanders would be 75 years old on assuming office, the oldest person to become president in American history by more than five years. (Ronald Reagan was 69.) Some of his supporters were outraged by David Brock’s recent demand that he release his medical records—did they think no one was going to notice how old Sanders is? The presidency is an enormously taxing job, physically and mentally. His age is a legitimate issue, and if he were the Democratic nominee, even many people sympathetic to his views would have reservations about putting him in office.
Two other obstacles, however, would be so decisive that the question of Sanders’ age might hardly come up. Sanders’ self-identification as a “socialist” is all that many voters would need to know to reject him. A recent Pew poll found negative reactions to the word “socialist” outpacing positive reactions by two to one—59 percent to 29 percent.
In June 2015, Gallup asked people whether they would vote for a “well-qualified person for president” who had various possible characteristics, and “socialist” was a deal-breaker for more Americans than any other attribute, including gay, Muslim or atheist.
“Socialism” is the label Republicans have been trying to pin on Democrats; it is not the flag Democrats want to be waving. Not only would Sanders find it difficult to get elected, Democratic candidates up and down the ticket would disassociate themselves from him.
The other decisive problem for many voters would be that Sanders is not credible as commander-in-chief. When foreign policy issues have come up in the debates, he seems out of his depth. He sometimes mentions his role in veterans’ legislation, retreating to the nearest social-welfare aspect of national defense.
Some advocates of Sanders point to national polls showing that he would do well against Donald Trump and other Republican candidates. But the public hasn’t yet been bombarded with the adverse publicity and negative advertising against Sanders that would be sure to follow if he became the Democratic nominee. Republicans and conservative media have been outdoing each other in their denunciations of Hillary Clinton. They will hardly believe their good fortune if Sanders turns out to be the Democratic candidate. A campaign against a 74-year-old socialist senator from Vermont writes itself. For a change, the right-wing media would not have to make anything up.
The tax implications of Sanders’ proposals provide a particularly rich target. I haven’t yet seen anyone add up the cost of all of Sanders’ proposals, but he is clearly talking about tax increases that have no historical precedent in peacetime. As Harold Pollack points out, the cost of Sanders’ health-care proposal alone is nearly equal to the entire amount now generated by federal income and estate taxes. Yes, Sanders says people would save money because they wouldn’t be paying for health insurance or co-pays. But he is asking Americans to have a level of trust in the efficiency of government that they do not have.
In fact, voters would have reason to be skeptical. High-costs have been built into the health-care system; they can’t be taken out overnight. If the United States had enacted national health insurance in the late 1940s when Harry Truman proposed it, Americans might be spending substantially less on health care than they do today. But, instead, private insurance expanded and then was supplemented by Medicare and other public programs that also promoted high-cost, specialized care. Decades of skewed incentives have created the system we have.
Beginning in the 1980s, reforms to Medicare began holding down its payment rates, so it now pays only about 80 percent of providers’ costs, while private insurance rates pay more to make up for the shortfall. Switching to single-payer—“Medicare for all”—implies withdrawing an enormous amount of the revenue that hospitals and other institutions are counting on (for example, to meet bond payments). The likely effect of switching to single payer under Sanders’ plan would be to destabilize the health-care industry.
Not only would Americans need to trust government to be more efficient; they would also need to trust government to take over one-sixth of the economy and make good decisions about nearly every aspect of health care. Single-payer, after all, means concentrating power as well as payment.
Sanders tells us that the political system is rotten and corrupt. But anyone who believes that government is rotten and corrupt has to be worried about making it more powerful, especially in a way that has such personal effects as health care does. This is the contradiction at the root of Sanders’ rhetoric.
As bad as the campaign-finance system is, I don’t share the view that government is so corrupt that it can’t do many things better than the private sector. We do need to go beyond the Affordable Care Act, and one step might involve extending Medicare incrementally (for example, allowing 55-to-64 year olds to buy into the program). But, unless the Republicans succeed in repealing the ACA, that legislation will have to provide the framework for further reform.
The passage of the ACA illustrates just how difficult it is to bring about institutional change in the United States. These difficulties are not just the devious work of Wall Street and other big business interests; they’re the result of the checks and balances in our constitutional system, the reservations many Americans have about grand schemes for change and the deep racial and class divisions in American society. You can’t blame everything on Wall Street, as emotionally satisfying as that may be.
In 2016, Republicans have the chance to consolidate control of all three branches of the federal government and to carry out changes they have been talking about for a long time. An America under Donald Trump or Ted Cruz would be a very different place.
With that prospect in view, I expect Democrats will eventually decide to treat the election as a matter not of symbolism but of real consequence. They do have a real candidate for president in Hillary Clinton. The support for Sanders has already sent a message. Now the primary voters have to choose a president.
Paul Starr, a winner of the Pulitzer Prize for nonfiction, is co-founder and co-editor of The American Prospect and professor of sociology and public affairs at Princeton University. Among his books is Freedom’s Power: The History and Promise of Liberalism