The Tea Party Helped Build the Bridge to Single-Payer By pushing a draconian repeal of Obamacare, they awakened a giant. Thanks, guys!

March 31, 2017

By Richard Kim

MARCH 29, 2017

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The Tea Party Helped Build

the Bridge to Single-Payer

By pushing a draconian repeal of Obamacare, they awakened a

giant. Thanks, guys!

I n September 2011, a little over two years into its

existence and fresh off some high-profile victories in

the midterm elections, the Tea Party hosted its first

Health-care-justice advocates outside Trump Tower in New York on

January 13, 2016. (Sipa USA via AP)

presidential debate in Tampa, Florida. Late in the

evening, CNN moderator Wolf Blitzer asked

Congressman Ron Paul, a physician by training, what

should happen to a 30-year-old healthy young man who

decides to forgo insurance but then becomes

catastrophically ill. “Who’s going to pay if he goes into a

coma, for example?” Blitzer inquired.

Paul rattled off some libertarian bromides about the evils

of “welfarism and socialism” and how “freedom is all

about taking your own risks.” Unsatisfied, Blitzer drove

home the point: “But Congressman, are you saying that

society should just let him die?” At which point, the

audience burst into applause, as several members roared

out “Yeah!” followed by all-around laughter. It was a

stunning moment, spiked with instant and unfaked

schadenfreude, that caused even Paul to blink back

surprise and that overshadowed anything else on the

stage that night. (The debate’s other newsworthy moment

came when then-front-runner Rick Perry was jeered for

defending the HPV vaccine.)

The GOP’s ignominious withdrawal of the American

Health Care Act, backed by President Trump and House

Speaker Paul Ryan, brought this insurrectionary moment

full circle. Rebranded and purified as the House Freedom

Caucus, the Tea Party’s hard-core members took Ryan’s

already shoddy proposal—including a giant tax cut for the

super-wealthy and the end of coverage for some 24

million Americans—and extracted concessions that would

have made it remarkably worse. The caucus insisted on

gutting the requirement that insurance companies offer

essential benefits, permitting them to sell junk plans. As

the clock wound down on negotiations, it was still holding

out in the hope of repealing Obamacare’s most popular

provisions, which allow young adults to stay on their

parents’ plans and require coverage of patients with

preexisting conditions. The resulting monstrosity would

have simply allowed millions of sick Americans to die.

Moderates bolted, even as the Freedom Caucus refused to

budge. And so ended, at least for now, the Republican

Party’s abiding obsession with abolishing Obamacare.

“A complete disaster!” as Trump might say. But one richly

earned. Since the first year of Obama’s presidency, the

Republican establishment has allowed its extreme rightwingers

to run off the leash. It has amplified their every

outburst, fed every conspiracy theory, nurtured every

grievance, and enabled every act of hostage-taking. Now,

it—and the vandal in chief that the Tea Party helped elect

president—is their hostage. In the battles ahead on

infrastructure spending, taxation, and the debt ceiling,

there’s no reason to believe that the GOP will behave in

any less dysfunctional a manner.

Given this self-inflicted gridlock, Democrats may be

tempted to let the Republicans implode and live with the

status quo. This would be a catastrophic mistake. The

grassroots uprisings that swarmed congressional town

halls with angry constituents were not, at their core, a

defense of Obamacare’s particulars. “Keep your hands off

my Affordable Care Act premium tax credit!” protested

nobody, ever. The 25-year-olds who raged at the prospect

of getting kicked off their parents’ plans, the senior

citizens worried about out-of-control costs, the patients

anxious about preexisting conditions, were expressing a

much more profound belief: that health care is a

fundamental right.

Obamacare falls far short of that mark. The fact that it

has become more popular—49 percent of Americans now

support it—as more people have used and understood it

should come as no surprise. That was always its design.

The more unexpected turn of events is that significant

majorities of Americans—and 41 percent of Republicans

in one poll—now support a single-payer plan. To that end,

in the coming weeks, Senator Bernie Sanders plans to

reintroduce his Medicare for All bill, an idea that has

backers in both expected (Keith Ellison, John Conyers)

and unexpected quarters: Nancy Pelosi, Obama- care’s true

architect, recently told a questioner at a town hall, “I

supported single payer since before you were born.” More

importantly, the citizen coalition to defend Obamacare—

backed by Planned Parenthood, the AARP, MoveOn, Our

Revolution, the chapters of Indivisible, and others—is

amped up to push for its passage. In 2009, the Obama

administration purposefully tamped down that energy,

preferring to run an inside game. But with Trump in the

White House and the Freedom Caucus bullying Congress,

the only game now is on the outside.


Along the way, Democrats must continue to defend the

current law. Trump’s promise to “let Obamacare explode”

was not an empty threat. Already he’s appointed two

leading saboteurs to head key agencies: Tom Price at the

Department of Health and Human Services and Seema

Verma at the Centers for Medicare and Medicaid

Services. Together, they could radically reduce subsidies

to insurance companies, causing more to leave the

exchanges; discourage enrollment and weaken

enforcement of the individual mandate; undermine

Medicaid by allowing states to impose premiums and

work requirements; and reinterpret what qualifies as an

essential benefit, letting insurance companies offer

stingier plans. These changes will come wrapped in a

thick fog of bureaucracy—and it’s up to progressives to

expose and humanize what’s really happening. We also

need to counter each proposed cut with an alternative

plan to expand and improve coverage: to extend

Medicaid, increase subsidies, elevate insurance standards,

and lower the Medicare eligibility age to 50, as Senator

Jeff Merkley has proposed.

Taken together, these steps would grow the public aspects

of Obamacare while reducing its reliance on private

markets. When the bill was first passed, centrist

Democrats placated its critics on the left by claiming that

Obamacare could act as a bridge to a single-payer system.

Wouldn’t it be amazing if that actually came true—and if

the Tea Party helped make it happen? •

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RICHARD KIM Richard Kim is the executive editor of The Nation.

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