Some Experts, Like Krugman, Supported Single Payer Until Bernie Sanders Put It in His Platform

A res ipsa loquitur (“the thing speaks for itself”) post:

Krugman, 2007

In an ideal world, I’d be a single-payer guy. But I see the chance of getting universal care, imperfect but fixable, just a couple of years from now. And I want to grab that chance.

Ezra Klein: The Deceptive Strategy Underlying Obamacare, 2009

I would like to sign the insurance companies out of existence with my pen. It would be sweet. But it’s never going to happen in this country where we have sent a multi-billion dollar industry employing tens of thousands of people in every district in America out in one shot…They have a sneaky strategy, the point of which is to put in place something that over time, the natural incentive in its own market [is] to move it to single payer.

Ezra Klein, 2009, interview with Sanders

[Klein] Lastly, you’re the author of one of my favorite pieces of legislation: The bill to create a prize process for pharmaceuticals. Want to say a word on that?

[Sanders] That makes single payer look like a conservative bill! [Laughs] All that that does is take on the entire pharmaceutical industry and say that everything they’ve been telling the world for many years is simply not true. They’re not using their huge profits into new research for drugs. The best way to get the research we need to address the medical problems we face is to provide a prize to those companies willing to address the most serious problems in the world, and not worry about my baldness or cosmetic me-too drugs, which is what they do.

What we’re saying is okay, you come up with a solution to these very serious health problems which are killing millions of people and you’ll get financial renumeration for it. It changes the whole dynamic. Right now, billion and billions are going into medical research funded by taxpayers into this country. But when the drug is developed, the profits go to the pharmaceutical company. This may be the most radical legislation I’ve ever introduced because it would transform the worldwide pharmaceutical industry.

James Surowecki, 2010

The truth is that we could do just fine without them: an insurance system with community rating and universal access has no need of private insurers. In fact, the U.S. already has such a system: it’s known as Medicare. In most areas, it’s true, private companies do a better job of managing costs and providing services than the government does. But not when it comes to health care: over the past decade, Medicare’s spending has risen more slowly than that of private insurers. A single-payer system also has the advantage of spreading risk across the biggest patient pool possible. So if you want to make health insurance available to everyone, regardless of risk, the most sensible solution would be to expand Medicare to everyone. That’s not going to happen. The fear of government-run health care, the power of vested interests, and the difficulty of completely overhauling the system have made the single-payer solution a bridge too far for Washington, and for much of the public as well. (Support for a single-payer system hovers around fifty per cent.) That’s why the current reform plans rely instead on a mishmash of regulations, national exchanges, and subsidies. Instead of replacing private insurance companies, the proposed reforms would, in theory, turn them into something like public utilities. That’s how it works in the Netherlands and Switzerland, with reasonably good results. One could recoil in disgust at the inefficiency and incoherence of the process—at the fact that private insurers will continue to make billions a year providing services the government has shown, via Medicare, that it can provide on its own. But, messy as the reform plans are, they can still dramatically transform the system for the good. Reform would guarantee that tens of millions of people who don’t have insurance will get it, and that people who have insurance now won’t have to worry about losing it. And, by writing community rating and universal access into law, Congress will effectively be committing itself to the idea that health care, regardless of risk, is a right. If a little incoherence is the price of that deal, it’s worth paying.

Jonathan Chait, 2011

I understand disaffected liberals. I wish Obama had been able to pass a single-payer healthcare bill. I thought the Iraq war sounded like total bullshit when it was being pitched in 2002. I wish we had never gone in, and I wish we had gotten out sooner. I wish the bank reforms had teeth to them, especially considering what we just went through.

Obama, 2003 (with video)

I happen to be a proponent of a single payer universal health care program. [applause I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

Obama, 2007

This is a two trillion dollar part of our economy and it is my belief that it’s not just politically but economically it is better for us to start getting a system in place–a universal healthcare system signed into law by the end of my first term as president and build off that system to further to make it more rational….

By the way, Canada did not start immediately with a single payer system. They had a similar transition step.

Rep. Barney Frank (D – MA), 2009

I think if we get a good public option, it could lead to single payer and that’s the best way to reach single payer.

Rep. Jan Schakowsky (D-IL), 2009

And next to me was a guy from the insurance company who then argued against the public health insurance option saying, ‘It wouldn’t let private insurance compete–that a public option will put the private insurance industry out of business and lead to single payer.’ He was right. The man was right.

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  1. Cujo359

    I didn’t pay much attention to the others, but it was sad and funny to watch Krugman’s expectations lower as the ACA worked its way through Congress. I still think “political reality” is the ultimate oxymoron, but these guys all talk about it like it means something.

    1. Benedict@Large

      As someone who spent many of my working years as a professional in health insurance, I have been continually amazed at Krugman’s ability to buffalo his readers into thinking he knows anything about the subject. He really does not. He’s an economist, not an actuary. In fact, he wouldn’t even make a decent underwriter. He certainly is NOT “some expert”, as the title here asserts.

    2. RepubAnon

      I’ll quote Tom Lehrer’s song “Folk Song Army“:

      Remember the war against Franco – that’s the kind where each of us belongs.

      Though he may have won all the battles – we had all the good songs!

      The point is that change is incremental. Other commenters have noted that the Tea Party has had successes in implementing its agenda – but it happened over time.

      As the song in Evita notes: politics is the art of the possible. Congresscritters need to be aware of the current political reality for day-to-day governing. Changing the political reality takes time and consistent effort. It’s taken decades of right-wing screaming to get them this far – it’ll take many decades of the rest of us screaming back to reverse that trend.

      So, enough of the “Obama-bot” and “Hillary-Bot” stuff – and keep pushing for Bernie’s dreams. It won’t happen tomorrow, and Bernie won’t be able to get it done even if he’s elected… but he can start setting the stage for getting it done in the future.

  2. Inverness

    Sure enough, James Surowecki now publishes a piece in the New Yorker as to why Sander’s Medicare is unrealistic. Thank you, Yves, for reminding me of what he “used to” think. I guess Hillbots got to him? Or he wants to stay in their good graces?

    1. NotTimothyGeithner

      Krugthullu went full Obot. Outside of the choir, does anyone read Krugman for any other reason than to see what the elites consider to be the acceptable end of political discourse? I imagine ACA is still popular with the liberal subset with good jobs or have moved onto medicare, the NYT subscribers.

      Without his column, Krugman is a weird professor with a beard, no one cares about. Krugman has lost the less gullible audience, and turning out Obama will only result in the Obots having the vapors. Much like Yves’ aside about Robert Reich yesterday, will you respond well to Krugman seeing the light without contrition for the last 7 years? Krugman recognizes this.

      1. Michael

        That is precisely what I read Krugman for — to find out what the left end of the Overton Window is currently.

        That’s not an evil thing to do, precisely; the left end of the Overton Window is often wrong in a sane fashion, as versus wrong in a deranged fashion. But that’s his job and he does it.

            1. polecat

              It’s the feckless policies of people like him that will likely hasten my death………if i”m not living in a refrigerator box first!

      2. JustAnObserver

        Krugman has, at least, been consistent and relentless in his mockery of the inflation hysterics and Austerian headbangers for a long time. For that he should be thanked … although at times when I see him touting IS/LM for the umteenth time I want to scream.

        Shame he spoils it with outbursts Obotness but hey! we can’t have everything.

    1. hemeantwell

      Somehow this soggy donut brought together leftovers from other breakfast servings to create a turd. What particularly got me was the utterly vacuous political recommendation of compromise, indifferently applied to healthcare, Wall Street regulation, what have you. It really shows how much he is oriented to bargaining between elites and is so worried about any form of unchanneled mass upsurge that he doesn’t bother to analyze what it represents and what its potentials are. Taking that position, or rather acting on that instinct, it’s impossible for him to think in a historically grounded way about what we’re in the midst of, an unprecedented disaffection with both major parties that might congeal into a realignment animated by a relatively clear understanding of how explotative and incompetent current elites are. Instead, PK just makes wise and pretends it’s the same old thing. What a lazy, condescending asshole.

    2. Benedict@Large

      Ever notice how rich liberals always support your causes, but never want to get there so fast that it disrupts the size of their piece of the pie?

    3. jrs

      “There are still quite a few pundits determined to pretend that America’s two great parties are symmetric — equally unwilling to face reality, equally pushed into extreme positions by special interests”

      well the question really comes down to whether they have the same special interests backing them doesn’t it? Now they don’t exactly, the R’s may have the Koch brother’s, the D’s the bankster money, but that’s both pretty captured by special interests isn’t it? Follow the money and while it may not be exact equivalence there probably will be some symmetry about it.

      “And one of them is the persistent delusion that a hidden majority of American voters either supports or can be persuaded to support radical policies, if only the right person were to make the case with sufficient fervor”

      Radical can mean anything. But isn’t there actual evidence the majority supports a lot of policies we don’t get? Like single payer and like minimum wage increases? And isn’t there actual evidence that they only way the majority supporting a policy has much influence is if the plutocrats also support it?

      “Sorry, but there’s nothing noble about seeing your values defeated because you preferred happy dreams to hard thinking about means and ends.”

      hard thinking is one thing and all very admirable (although questionable how much thinking can really affect policy in this fake democracy, but if we had a real democracy maybe our thinking could actual lead to effective actions). But what has all that to do with pulling the lever for Hillary? How much thought does that really take?

      1. Left in Wisconsin

        Single payer is NOT radical. Canadians are not radical. Nor Germans, Brits, Japanese. The meme that single payer is radical needs to die.

        1. fartherelm

          So ironic, because Krugs frequently writes comedy-rants about “zombie ideas” that won’t die!

        1. Jeff W

          Has there been any New York Times piece criticizing or downplaying one of Bernie Sanders’ positions recently where the commenters haven’t been overwhelmingly negative towards the piece (i.e., supportive of the Sanders position)?

          1. fartherelm

            Perhaps the NYT doesn’t know its readership as well as it thinks it does. Put another way, when oligarchy-approved “Beltway Think” is put forward at the Grey Lady, the mouthpiece of oligarchy, and is being ripped to shreds by its own readers, we may finally be in pre-revolutionary times.

  3. Carolinian

    Thanks. Great stuff. The truth is the Medical/Pharma complex has no power other than their ability to control legislators. You see this in the fact that medical cost inflation goes down every time politicians start talking about reform (the early 90s for example). The clear message is that the prices are not related to fundamentals but rather to what they can get away with. All that is needed to give us a rational system is the political will. What people like Krugman and Hillary Clinton are really saying is that our system is too corrupt to give us real reform. Of course in Hillary’s case that is probably correct.

    1. Banana Breakfast

      While I’m usually all for pointing out the systemic nature of a problem, and our legislative and executive systems are indeed broken, in this case let’s call a spade a spade. What “people like Krugman and Hillary Clinton are really saying” is that they are too corrupt to give us real reform.

      And the conclusion we should draw from this is simply that we shouldn’t expect anyone to “give” us reform – we have to make it ourselves.

  4. PQS

    To everyone who thinks we should just give up the fight for single payer (I am aware there aren’t many of those people here, but you all probably hear this stuff, like from Democratic candidates….):

    The right wing in this country never, ever, ever gives up their fights. Ever.

    Don’t believe me? It is 2016, and the RW has managed to impose their far-out, extreme views about not only abortion but also birth control onto an largely unwilling (and unaware) population via various regulations passed by gerrymandered, nutjub state legislators.


    1. nigelk

      “…Foreign & Domestic.”

      Has the list of enemies of the American working person ever been so heavy on the domestic side?

    2. Gio Bruno

      To congressional district gerrymandering you can add the “Connecticut Compromise” which limits California (38 million citizens) to two Senators while the raving lunatics of Wyoming (<1 million citizens) gets two Senators also.

      In California there many more registered Democrats than registered Republicans, but Repubs have more representation than you would expect. (That has a halo effect on how Republican governors get elected to the Statehouse; that and stupidity— see Schwarzenager.)

    1. NotTimothyGeithner

      “Why don’t we try a more Romanized slavery system? Certain slaves might get a stipend and have a system for buying their freedom which would be available on the Internet for the computers they don’t own. If they bought computers It would be stimulate. ” -NAACP Chairman Krugthullu

    2. Tom Allen

      You didn’t get the memo? This is the week Democrats honor Dr. King by advocating half-measures, telling activists to pipe down, and mocking socialism.

  5. RL

    Krugman talked about a public option in that article you linked saying “The public-private competition in the Demoplan is crucial”. If you’re trying to point out a flip-flop from these people, I don’t think you’ve achieved that.

  6. jcc2455

    Krugman really does know very little about health care.

    My favorite panicked liberal soundbite is “what about the public option?????” Let’s get Hillary to pass that!

    As if it ever meant anything other than a pacifier for progressives. As if it has any natural constituency — nobody gives a shit about it except for pants-wetting liberal columnists faced with a leftist revolt in the Democratic Party.

    And as if it has any more chance in hell of becoming law than single payer. As if the insurance industry would permit its existence for a second.

    1. John

      But that’s just it, in a nutshell really. Who’s in charge here, the Gov’t or the Corps? There is one candidtate out there who talks about this every day. It’s like ya’ll here are talking about John Lennon’s Imagine dream, rather than something we can do. Nike’s got the slogan gov’t should be using: just do it.

      1. rex visigothis

        The coda was Obama’s signature on the omnibus bill that contained Rubio’s (by his self-important account) torpedo of the risk corridors (obamacare bailout!) that doomed the few coops that actually got off the ground.

  7. Paul Tioxon

    In 1974, Keynesian economics was considered just economics. Today, it is regarded across the political spectrum from neo-liberals to libertarian kooks as voodoo economics. I have a hard time believing how easily it was to lead intellectuals, well read university grads and actual experts with MBAs and PhDs in econ have jumped ship in large numbers. I am not talking so much about people who had little to no exposure to the wide spread acceptance of Keynes and the almost non-existence of right wing think tanks that blanket op-ed sections of papers and fielded battalions of talking head mouth pieces from august sounding “Institute”s or “Foundation”s.

    I have read about the sea change from men who in their youth, worked for the New Deal or Great Society and saw the cause and effect of nation building as public spending by the federal government created demand by giving people jobs, money in their pocket with Social Security and underwrote the expansion of health care with Medicare and Medicaid. Later in life, these same men mostly bought into the whole supply side crap and the DLC Clintonista reinventing government by outsourcing it to beltway bandits scam. Going along to get along is a valid political tactic some of the time but if you do not stand for something, at least one thing all of the time, such as social security and Medicare For All, then you have nothing to offer. And people will know that you are just an empty suit with nothing to offer other than the current party line. So much anger stems from having nothing to offer all of the people some of the time. We have reached the political equation of offering nothing to all, all of the time.

    The fact that the state of Vermont can’t make its way to Single Payer should not be compared to Canada. We have a national program in Medicare. It has an economy of scale far greater than Vermont could ever approach. We are way past the states being the lab for democracy for health care in the US, because we have demonstrated a national program for a huge number of people across state lines. Instead of looking to a state with so few people to lead the way for the most expensive sector of our economy, the federal government can take the next step towards single payer by consolidating Tri-Care/VA, CHIP and Medicaid into Medicare. A single payer system at the federal level for these 4 government funded programs, although not universal single payer, would be ready to scale up to universal when the time is right i.e. politically doable. Aetna and Humana are merging, Cigna and Anthem are merging, as well as others. Isn’t it time for Medicare to also do what every one from the Chamber of Commerce crowd has begged for, for government to be run like a business by merging into one nationally managed organization?

    The VA has been a total disaster for vets, Medicaid expansion under the ACA is held up depending on the state and if there is a republican governor in charge and regular Medicaid varies in eligibility and benefits from state to state creating a separate and unequal 2nd class citizenship for the poor. CHIP seems to be a widely supported, successful program for children, covering anyone under 18 with free or almost free healthcare if they do not have it from their parents. Medicare operates on the federal level automatically enrolling you upon the age of 65. No shady racist Southern governor or neo-liberal crackpot, cheapskate Michigan governor can interfere. These are all federally funded programs under existing law that can be placed under Medicare’s management structure and renamed Medicare. All military personnel and dependents, all under 18 can be automatically enrolled, just like the 65 year olds. The poverty applications for medicaid can be handled at the federal level with just 1 national standard, not 50, which is more expensive to administrate. I’m thinking bold Presidential Executive Order to do this one. Fortune Favors the Brave.

    “… National Labor Relations Board officials finished tallying ballots, 516 nurses had voted to join the Pennsylvania Association of Staff Nurses and Allied Professionals, marking the nation’s largest pro-union vote in the last year, according to data from the NLRB.”

    Hahnemann University Hospital Nurses unionize in Philadelphia this Wednesday following a Saturday unionization of Nurses in next county over Delaware County Memorial Hospital. A 3rd hospital, St Christopher’s Hospital for Children, also in Philly, is scheduled to vote next month for its nurses to unionize. The pressure to squeeze the productivity out of staff is so grueling that medical institutions in this area being easily organized by unions, preparing a wave applications for union representation in unprecedented numbers. The power base for single payer has been growing out among the people that have to deal with BS paperwork and begging for approvals and payments of claims from employer insurance plans. It is getting a shot at national political policy status by Bernie proving to be so earnest about pursuing this policy
    so vigorously. Good for him and all of us.

  8. John

    Two things, a little small but not insignificant, never, hardly ever mentioned in these discussions. (I loved the comment above, “shorter Krugman: let them eat Bronze plans.” It hits the mark.) Even Medicare won’t get you there though, huh. That’s what my friends and neighbors don’t seem to understand. It always amazes me how little the average American knows about our social programs. First of all, the US Gov’t at some point in history last century, gave Medicare profits to private insurance companies. Has no one under 65 out there ever heard of Medicare Advantage Plans, and Gap Policies? On the contrary then, Insurance companies abolished? I don’t think so. And even in England, the private market is alive and well (Sorry I have no first hand knowledge of France, etc.) When I lived/worked in Japan (and was allowed to opt out of the socialized medicine program for certain reasons) there was no shortage of private insurance available. Offshore? In Hong Kong for example, I went with a Dutch company, and was treated very fairly by them until I moved back to the United States (that’s another story).

    1. Gio Bruno


      Not certain what your point is, but your knowledge of Medicare doesn’t seem complete. Medicare covers 75% of approved medical expenses. Those expenses for medical procedures are strictly controlled by Medicare (some say the doctor/hospital compensation is too generous; doctors/hospitals say it’s too low).

      Only wealthy (or foolish) Medicare participants would enroll in an Advantage Plan. There are 9 Gap Plans (to cover the complementary 25% of medical expenses) that are offered by private insurers (Anthem/Blue Cross. etc.). The provisions of these 9 Gap Plans are strictly controlled by Medicare; that allows participants to select a gap plan that best suits their needs without being bamboozled by fuzzy insurance plan lingo.

      I have been on both a state funded (employer) plan and Medicare. I can attest that Medicare beats the pants off of Anthem/Blue Cross.

  9. TG

    It’s been obvious for years that Krugman’s job has been to defend Obama’s left flank. I mean, if he was really on our side the NYT would have slandered him as a populist demagogue (or something) and taken away his soapbox a long time ago…

  10. cripes

    Yes to all.
    If there is any unifying principle that joins “pwogwessive” democrats and their followers; Obama, Krugman, Clinton, Gore, Deblasio, etc. it is this: to defend pwogwessive values against an implacable, vicious and uncompromising enemy that will use any means to destroy the remaining rights of workers–by refusing to defend those rights on the premise that its too hard to win. And bashing anyone who tries as a quixotic fool socialist.

    Then they turn around and help them pass all manner of plutocrat-friendly legislation, economic exploitation, promote foreign wars and compete for corporate cash.

    These clowns make Neville Chamberlin look like a real stand-up guy.

    Despite his painful position in international and military policy, Bernie Sanders actually is walking the talk on most of these issues. Demanding single payer and bank breakups alone is bold and revolutionary in the American political context, if soft stuff elsewhere in the world.

    It;s enough to bring me back to the ballot box for the first time in a dozen years.

    1. fartherelm

      Liberal, progressive, social democrat, democratic socialist, socialist, leftist don’t seem to have fixed meanings, and now “pwogwessive”?

  11. freedomny

    I seem to be getting in a lot of arguments these days from people who keep reminding me that I am part of the 1-10% when I tell them I’m a Bernie fan. As I speak to people, on the sly, in my financial institution (we are a private bank) it is truly surprising how he has resonated with so many people. Because if I am part of the 1-10%, own my own home, have no mortgage, and still question if I could retire in NY State without having to work until I am 70….

    What about those that aren’t as “lucky” as me?

    That being said…for all you in the track of the Jonas storm….Bernie Sanders is having a Volunteer Orientation and Recruitment Conference Call….Sat….EST at 12:30. Hey, sign up….

    1. LAS


      You expressed my concerns well. Every month there’s a big bill for simply existing status quo (property taxes, insurance, sewer taxes, monthly bills or something). Although quite frugal in living style expenses are still quite high because of fixed costs.

      With age, the only concession I’ve made toward retirement is switching to a job with a more palatable mission, less over-time/late hours and less salary. Sometimes I wonder if this is the right decision, but at least I do feel happier/healthier. To not work at all is simply unthinkable though.

  12. Ancaeus

    I am sorry Yves, but I just don’t agree with you, particularly with respect to Paul Krugman. He is clearly in favor of single payer, but does not think that Bernie Sanders’ plan is realistic. And, I think that Krugman has been very, very clear about this.

    It is OK for Paul Ryan to put out a budget with magic asterisks. We expect better from Bernie!

    If Bernie Sanders is serious about single payer, then he should be up-front about how much it will cost, and what the program will be like. Those of us (like me) who favor single payer will only applaud.

    1. fartherelm

      Sanders tried to make this point in the last debate. THE US SPENDS TWICE AS MUCH OF GDP ON HEALTHCARE AS THE CIVILIZED NATIONS. Therefore, doubts about costs are absurd, as a rational plan would obviously cut costs by around 50%. Sure, there are questions like, “The new system might not cut costs even if it is universal.” Yes, it MIGHT not if we let oligarchy/corporations continue to buy Congress. Of course it will take rational legislation, not the usual DC BS.
      Where do the savings come from? This is the fun part that’s not mentioned often. There are many people and entities making fortunes off of the health care industry who never lift a finger to provide any actual care. CEO’s and such, armies of drug salespersons, investors, insurance salesmen, medical coders, billers, attorneys specializing in insurance disputes, on and on. When these people are moved into productive jobs, it will help society and they will feel better about themselves. If not, anti-depressants will be free!
      The next progressive (or leftist, whatever) assignment: shrink the financial sector until it is small enough to drown in its little-bitty baby bath!

  13. LAS

    Even if there were Medicare for all, insurance companies would remain, to offer medigap policies.

    I’ve stopped worrying about the insurance companies anyway. To me, our biggest drivers of costly and unsafe health care is the US health care system itself.

  14. cripes


    That’s true to the extent that ACA insurers are losing money and bailing out of the marketplace at an alarming rate. Plus actuarial death spiral. Pharmaceutical companies are on a monopoly price-gouging rampage, and doctor practices are being gobbled up by hospital corporations chasing quarterly returns.

  15. Tomtom

    I don’t get it. Most of the arguments Yves quotes are persuasive. They argue single-payer can’t come at once, it has to come incrementally. And that is what is happening Bernie Sanders is only able to powerfully push single-payer for all because Obamacare is already here! If Bernie Sanders is elected I doubt he’ll be able to adapt single-payer unless a revolution happens and both houses of Congress turn democratic. But at the end of his 8 years single-payer will likely be closer than it is now and closer then it would be had Obamacare failed. I’ve several times noticed Yves is very critical of Obamacare. I haven’t read her so long enough that I know why, and I don’t really understand it. We don’t have a parliamentary system. Change is incremental and slow.

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