Democrats want their party to make bold healthcare reform its top priority. Could that be a fatal error for our warming planet?

Democrats want their party to make bold healthcare reform its top priority. Could that be a fatal error for our warming planet?
January 19, 2019 San Francisco / CA / USA - Participants to the Women's March event carry "Healthcare for all" sign while marching on Market street in downtown San Francisco

To my knowledge, every poll that has asked voters about their top priorities has found that Democrats rate healthcare number one, and by wide margins. They don't want to see the system patched; most Dems--and a majority of Americans--now see healthcare as a human right that should be guaranteed by the government. They want universality and an end to people going bankrupt or dying because they can't afford their insulin.


Most of the political class rightly sees healthcare as a winning issue for Democrats to run on. It was central to the midterm shellacking they delivered to the GOP, and Trump and his party have made themselves vulnerable with their relentless attempts to strip away public insurance and kill protections for people with pre-existing conditions. Surveys show that the American people have little confidence in Republicans to offer anything worthwhile on this issue.

With their base demanding bold reforms and the pundits agreeing that the politics are in their favor, the 2020 presidential candidates have put it at the top of their agenda. The issue got more time in the first two debates than any other. And as a group, the candidates are going big. As I pointed out in my rundown of the leading Dems' healthcare proposals, even Joe Biden's approach is much more ambitious than one would have expected even a few years ago from a candidate positioning himself as a safe, moderate choice.

Contrary to popular belief, politicians do not tend to say whatever voters want to hear to get elected and then go back on their word once in office. They may not be successful in delivering on their campaign promises--they're never able to fulfill all of them--but historically they have tried. So if Democrats win big in 2020, and end up with unified control, there will be widespread expectations that they pursue major healthcare reform legislation as their top priority and a lot of pressure to do so.

But in this case, voters and the conventional wisdom may be painting the party into a dangerous corner. And that's because the reality of climate change could clash headlong with that of both the legislative calendar and extreme partisanship.

The calendar is a problem because while in a perfect world lawmakers might be able to pursue more than one major agenda item at the same time, the simple fact is that juggling major pieces of legislation--the kind that both structural healthcare reform and a serious Green New Deal-like climate policy would be--require a lot of committee time and staff resources and eat up an enormous amount of the calendar. The Affordable Care Act's (ACA) sausage-making took 15 months to complete. It's possible to juggle multiple small-bore bills, but by the time you finish a major legislative effort--if you're able to at all--it's midterm campaign season.

That's where negative partisanship comes into play. As Michigan State University political scientist Matt Grossman wrote last year, voters tend to punish parties for enacting their agenda, and it doesn't seem to matter what that agenda is. It's a manifestation of our highly polarized and closely divided polity. When one party achieves some of its goals, it fires up the other side's base. It might make that party's own voters more complacent. In any event, regardless of their success or failure, the party that doesn't hold the White House has gained seats in every midterm election since 1946.

All of this means that in all likelihood, even if the Democrats do exceptionally well next year, they'll only get one bite at the apple in terms of big, transformational legislation. And as RL Miller wrote for AlterNet 2020 a couple of weeks ago, the planet is at a turning-point. The scientific consensus, she wrote, has "been popularized as 'we have 12 years to turn this around.' But a better way to think of 2030 is this: If the United States elects a Democratic president in 2020 and reelects her in 2024, almost all of the decarbonization work that we must do to avert a global catastrophe will occur on her watch."

Healthcare reform is incredibly important but it should go without saying that if civilization collapses due to catastrophic climate change there will be no healthcare. It should be voters'--and Democrats'--top priority. And the dynamic of this election may make it politically impossible to treat it as such.

That raises another question: If they win big, should Democrats pursue a small-bore fix for our dysfunctional healthcare system and then move onto climate? There are bills currently languishing in Congress that would shore up the ACA's exchanges and bring down premiums and prescription drug costs to a degree. They could pursue something along those lines relatively quickly, possibly even with some bipartisan support. The benefit of this approach is that it would help real people struggling to afford vital care. The drawback is that it might blunt momentum toward the kind of deeper, structural reforms we really need at some point.

I lean toward the view that they'd be better off pocketing whatever gains they could get on healthcare and then pivoting to climate. You never know how long you'll have a governing majority--in our closely divided country, they tend to be fleeting.

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