Jimmy Dore is undeniably good at swearing. A left-wing comedian turned pundit, Dore has earned himself a considerable YouTube following by giving expletive-laden expression to the rage that many American progressives feel when contemplating their nation’s cruel and unusual political economy. But his gifts for political strategy are less clear-cut.
In 2016, Dore informed his audience that it should not “freak out about a Donald Trump presidency,” as the Republican’s election would be “even better for progressives in the short term, meaning in the two-year term, and in four years for sure” than Hillary Clinton’s election would be. No significant constituency on the American left — not trade unions, immigrant-rights groups, Black community institutions, nor health-care justice organizations — shared this assessment. Four years, three Trump-appointed Supreme Court justices, and one Joe Biden presidential nomination later, it is … less than clear that Dore’s judgment was superior to that of every organized left-wing group that is actually accountable to a constituency. And the podcast host’s discernment is further called into question by his promotion of conspiracy theories implicating the DNC in Seth Rich’s death.
Nevertheless, Dore is certain that he has a better sense of how to advance progressive policy goals than Alexandria Ocasio-Cortez does.
Last month, Dore argued that AOC and her progressive allies can best advance the cause of universal health care by denying Nancy Pelosi the support she needs to retain the Speakership — until she agrees to hold a House vote on Medicare for All. Dore considers this course of action so self-evidently optimal that the only possible explanation for why Ocasio-Cortez declined to pursue it is that the congresswoman is a fraud who cares more about her career than the needs of her constituents. “She is standing between you and health care,” Dore told his viewers last week. Responding to Ocasio-Cortez’s argument that it takes years of organizing to lay the groundwork for seemingly spontaneous progressive breakthroughs, Dore exclaimed, “I figured this out in two weeks, AOC! You liar. You coward. You gaslighter.” The comedian’s proposition (if not his condemnation of AOC) was taken up by a gaggle of other left-wing YouTube commentators, among them former MSNBC anchor Krystal Ball; host of Secular Talk, Kyle Kulinski; and ex–Bernie Sanders campaign spokesperson Briahna Joy Gray. Ocasio-Cortez’s decision to respond to their call on Twitter further amplified its reach.
Dore’s proposal was not entirely absurd. AOC and other progressives did center calls for single-payer health care during their primary campaigns. The Democrats’ razor-thin majority in the new Congress does give these lawmakers leverage to extract demands from Pelosi in exchange for their support. We are in the middle of a pandemic in which millions of Americans have lost their employer-provided health care. So why not use one’s leverage to force a national debate over the progressive movement’s signature cause?
It’s important to be clear, however, about what this tactic could and could not have plausibly achieved. There is no rational basis for believing that forcing a House vote on Medicare for All would have led to the nationalization of the health-insurance industry next year. Nor is there much cause for thinking that it would have turned the Democratic base against its party’s moderate lawmakers by exposing their opposition to single-payer health care. In my estimation, the gambit would have, at best, served to direct media attention toward the cruelties of America’s employer-provided health-insurance system at a time when those cruelties are uniquely difficult to paper over. AOC opted to subordinate the pursuit of such a media spectacle to other aims, such as progressive committee appointments and the elimination of the “PAYGO rule.”
The fact that this decision has earned AOC the enmity of some influential progressive commentators reflects a pathological tendency within a small subset of the U.S. left — namely, a habit of mining anti-political cynicism out of its own naïveté.
A political tactic is only as moral as it is effective.
To see what I mean by this, it’s worth examining the most thoughtful case for Dore’s strategy in some detail. Briahna Joy Gray’s case for “forcing a floor vote on Medicare for All” features fewer unprovable allegations about AOC’s crypto-corporatism than Dore’s YouTube rants, but far more lucid reasoning. Her argument can be summarized as follows:
• The pandemic has made Medicare for All more substantively necessary — and politically possible — than ever before. More than “14 million Americans have been kicked off their employer-based health insurance as they lost their jobs to the shutdown,” and support for Medicare for All in public polls has reached new heights, with 88 percent of Democrats backing the policy in one recent survey.
• Although AOC argues that the “opportunity cost” is “too high to waste on a floor vote for a bill that wouldn’t ultimately pass,” the extraordinary circumstances of the COVID pandemic make this the best chance that progressives are going to get to win Medicare for All for the foreseeable future. Now is the time for House progressives to coordinate with activists and social movements and leverage “organized labor and the threat of a general strike” to transform political reality.
• Even if the vote fails, forcing the debate “could spark a referendum on our failing health-care system at a moment when no other issue takes credible priority,” heightening the salience of the left’s signature policy demand — and the contradictions between a corrupt Democratic leadership and its base, thereby abetting progressive primary challenges to moderate incumbents in 2022.
• Ultimately, “the moral case for action requires no strategic justification. As Kyle Kulinski, co-founder of Justice Democrats — the progressive PAC that backed AOC’s historic 2018 run — tweeted, ‘If your politics comes from a place of principle then all the strategy talk is pretty silly anyway. If you believe in something you fight for it & dot every i & cross every t. If you lose ok but the act of doing everything in your power to achieve it is the definition of morality.’”
This last argument is, in some sense, irrefutable: If one posits that the strategic wisdom of a political tactic has no bearing on the morality of pursuing it, then whether Dore’s proposal would achieve what he says it would is immaterial. But that’s a strange thing to stipulate! And I’m not convinced that Gray or Kulinski actually believe it. Like most ardent Sanders supporters, they draw their moral fervor from a consequentialist analysis of public policy. Time and again, Berniecrats have accused opponents of universal health care of complicity in preventable deaths, as such loss of life is a predictable consequence of failing to extend health coverage to all Americans. But if Gray and Kulinski are indeed consequentialists, then they should recognize that “strategic justification” is the only measure of a political tactic’s moral worth. If politics is a tool for minimizing needless suffering — rather than a theater for performing one’s personal convictions — then a tactic is only as morally sound as it is likely to succeed. Kulinski appears to be tacitly aware of this: Even as he argues that “strategy talk” is “silly,” he suggests that the definition of morality is “doing everything in your power” to realize your vision of the good. But whether it is in AOC’s power to effect the outcome Kulinski demands is precisely the object of contention! And that question can only be answered by a debate over strategy.
To further that debate then, let me explain why I find Gray’s arguments about the likely consequences of forcing a Medicare for All vote unconvincing.
Public support for single-payer is broad but fragile.
The core premise of Gray’s column is that single-payer health care enjoys overwhelming popular support. This widespread and intense public backing for Medicare for All is the reason why Gray deems it plausible that House Democrats who do not currently support single-payer may feel compelled to get onboard if put under the spotlight, while Mitch McConnell and/or Joe Manchin could maybe, just maybe, be forced to rubber-stamp the House’s bill (perhaps in deference to a general strike in favor of the legislation).
Lamentably, support for single-payer simply is neither as widespread nor intense as Gray suggests. Medicare for All does poll well — but it polls best when respondents are given few details about what the policy actually entails. And when voters are presented with a choice between single-payer and other alternatives for expanding coverage — rather than a choice between single-payer and the status quo — surveys sometimes find that the Democratic base is more sympathetic to Joe Biden’s views on health-care policy than to Bernie Sanders’s.
The poll Gray cites — in which 88 percent of Democrats voiced approval for Medicare for All — asked respondents, “Would you support or oppose providing Medicare to every American?” This phrasing is highly ambiguous. It is not obvious that “providing Medicare to every American” means mandating that all Americans forfeit private health insurance and enroll in a single-payer plan. And it is almost certain that a majority of the survey’s respondents did not interpret it that way.
Consider the polling of the Kaiser Family Foundation. KFF routinely surveys voters on whether they support “a national health-care plan, sometimes called Medicare for All, in which all Americans would get their health insurance from a single government plan.” Large majorities of Democrats consistently endorse this proposition. And yet, despite the specificity of the question’s phrasing, most voters who answer it in the affirmative also say that they believe they would be able to keep their current health insurance under Medicare for All.
Which is to say: Even when pollsters spell out the meaning of single-payer in explicit terms, voters still have a tendency to interpret the proposal as a strong public option. This misimpression is surely more pervasive in more vaguely worded surveys like the one that Gray cites. For this reason, such polls are not reliable gauges of whether voters support single-payer over a public option or other approaches to expanding health-insurance coverage.
This point is made plain by a KFF survey from September 2019, which found a majority of Democrats voicing approval for single-payer — but also favoring “building on the Affordable Care Act” over “replacing the Affordable Care Act with Medicare for All.”
It is possible that the pandemic has changed the Democratic electorate’s mind on this question. And it is possible that a national debate over the issue, in the present context, would help bring more Democratic voters into the left’s corner. Personally, I believe that if American voters were given a clear-eyed understanding of the relative merits of Medicare for All and Biden’s health-care plan, a large majority would recognize their interest in the former.
But providing Americans with such an understanding is no easy task.
Big money can corrupt Democratic politicians. But it can also buy off public opinion.
Democratic voters were treated to a nationally televised debate over Medicare for All about a dozen times during the 2020 primary — and they proceeded to vote for the candidate with the least progressive health-care policy in the field. The left did not need to “expose” Biden’s opposition to Medicare for All; he proudly advertised it for the bulk of the past two years. And, as of this writing, Biden enjoys a 93 percent approval rating among Democratic voters.
Progressives may argue that the primary debates over Medicare for All were distorted by the biases of corporate media (I would argue this). But where do we think most voters are going to get their information about a House vote on Medicare for All if not from corporate-media entities?
This gets at a conspicuous tension in progressive electoral analysis. Some left-wing pundits posit that (1) big money exerts a profound influence on American politics, (2) corporate media influences how voters see the world, (3) big money and corporate media are profoundly hostile to left-wing policies, and yet (4) Democrats have no electoral incentive to spurn left-wing policies, and only do so because they are personally reactionary or corrupt.
These premises are not entirely irreconcilable. The power of well-heeled interest groups and corporate media to shape public opinion isn’t unlimited. Many left-wing policies have retained their popularity in the face of reactionary coverage. And Democrats have long derived a political benefit from their identity as the party less beholden to the rich and corporations. Nevertheless, the left’s critique of corporate media implies that it is not necessarily irrational for Democrats to believe that antagonizing powerful interest groups might cost them elections. These interest groups can influence Democratic politicians through the mechanism of campaign donations — but they can also influence voter behavior through propaganda campaigns. And on Medicare for All specifically, the health-care industry has demonstrated success in turning voters against the policy.
In Colorado four years ago, progressives and health-care lobbies did battle over a ballot referendum that would have brought a single-payer health-care system to the Rocky Mountain State. The referendum went down by a margin of 79 to 21 percent. To be sure, that ballot measure was riddled with flaws that earned it the opposition of pro-choice groups, among other potential constituencies for single-payer. And it is true that single-payer is a much more challenging proposition at the state level than it is at the national one. But the fact that the proposal went down by 58 points nevertheless suggests that the health-care industry has considerable power to reduce support for single-payer through paid and earned media. And the collapse of Vermont’s attempt to establish single-payer through legislative action – and the subsequent election of a Republican to its governorship –lends further credence to this notion.
The reality that big money can thwart progressive aims — even when Democratic officials are supportive — was made plain by some of this year’s ballot measures. In Illinois, Democratic governor J.B. Pritzker backed a referendum that would have lifted the state’s constitutional prohibition on progressive taxation. Specifically, the measure would have enabled the state to raise taxes on residents who earn over $250,000 so as to limit budget cuts in the midst of a fiscal crisis. Opponents spent over $100 million propagandizing against the policy. Supporters spent roughly as much, but the combination of well-funded propaganda and the public’s aversion to higher taxes led to 53 percent of the deep-blue state’s voters opting to make it impossible for their representatives to tax the rich at a higher rate than the poor. That same night in California, Uber’s agitprop succeeded in persuading voters to overturn the Democratic legislature’s extension of labor rights to gig workers.
The case for pessimism of the intellect.
To see the implications that all this has for Gray’s argument, let’s quickly review what we’ve established:
• As recently as late 2019, a majority of Democratic voters favored “building on the ACA” over replacing it with Medicare for All. And right now, virtually all Democratic voters approve of a president-elect who has vowed to veto that policy should it somehow come to his desk.
• In the Kaiser Family Foundation’s polling, a majority of voters who say they support Medicare for All believe that Medicare for All is some kind of public option. (And when voters are asked to choose between a single-payer plan and a public option, they typically favor the latter).
• When progressives attempted to implement single-payer by referendum in a blue state, interest-group opposition (among other things) turned the policy so toxic that it lost by 58 points.
• In November, big money proved capable of turning voters against the concept of progressive taxation in a deep-blue state, in defiance of a Democratic governor’s wishes.
Given these realities, is it reasonable to suppose that, by forcing a House vote over Medicare for All, progressives will be able to muster public support for their policy that is widespread enough to make moderate Democrats in purple districts change their hearts and intense enough to survive both a narrowly divided Senate and the opposition of every major health-care-industry group in America, including organizations that represent doctors, the widely hailed heroes of the present crisis? Or is that a conclusion that one could only reach by ignoring all relevant evidence except for the top-line findings of polls of Medicare for All that do not define what the policy entails?
The notion that a vote would usefully expose Democratic politicians to their primary voters is nearly as far-fetched. House Democrats who have not yet co-sponsored Medicare for All just proved their ability to win primary and general elections while opposing the policy. If we do not presume that a House debate over a messaging bill will proceed as it would in an Aaron Sorkin drama — with truth and reason winning out over mendacity and spin, as tens of millions of Americans look on, their noses glued to C-SPAN — then there is little reason to believe a floor vote will make it significantly easier to primary these Democrats in 2022 than it was in 2020. Meanwhile, House Democrats who have co-sponsored Medicare for All could vote for the bill irrespective of whether they actually support it because they have no reason to believe that the legislation will make it into law. (Stray references to general strikes are not a substitute for a coherent legislative strategy. There hasn’t been a major citywide general strike in the United States in 74 years. There hasn’t been a nationwide general strike in U.S. history. The American labor movement is weaker today than at any time since World War II. And a significant minority of actually existing unions opposes Medicare for All.)
This is not an apology for the Democratic Party or an endorsement of despair.
To acknowledge that public support for Medicare for All is currently fickle — and that Democrats have a rational basis for fearing the policy’s electoral viability — is not to excuse Democratic opposition to universal health care or to embrace “doomerism.” Passing the Affordable Care Act instead of single-payer in 2009 did not spare the Democratic Party short-term political backlash. The ACA was deeply unpopular at the time it was passed, and Democrats suffered historically large losses in the ensuing midterm. The party could have used its brief lease on power to deliver genuinely affordable health care to all Americans. And there is reason to believe that — had it done so — it would have reaped long-term political benefit, even if the immediate backlash cost it congressional control. Instead, the party left tens of millions of Americans bereft of insurance and the power of the heath-care industry undiminished.
But seeking to explain the behavior of political actors — in a non-polemical, cognitively empathetic way — is not to justify that behavior. Progressives are keen to emphasize this point in certain contexts. We insist that scrutinizing how America’s imperial presence in the Middle East helped inspire a given terrorist action is not to justify the slaughter of innocents, but to seek an understanding of what produces such horror so as to prevent it. Attributing an attack to the metaphysical evil of its perpetrators may be politically useful, but it is analytically bankrupt. Something similar can be said of attributing moderate Democrats’ opposition to single-payer to their personal corruption while ignoring the real electoral disincentives of endorsing the policy in a context where (1) most Democratic primary voters are equally supportive of more incremental reforms, and (2) well-heeled interest groups have demonstrated their capacity to turn general electorates against single-payer by instigating anti-tax panics.
In the context of Sanders’s primary campaign, exaggerating the level of public support for Medicare for All — and insisting that the policy came with no plausible political downsides — may have made political sense. But as single-payer advocate Jon Walker has argued, for broader strategic purposes, progressives must grapple with the fragility of public support for the policy. What precisely progressives should do in light of that fragility is not obvious. Walker believes that the movement can make Medicare for All more robustly popular by developing a detailed plan for financing the policy — one that reduces the taxes necessary to implement it (without spurring high inflation) by slashing the exorbitant payment rates of many U.S. hospitals, drug companies, and physicians. Others might argue that the movement should avoid antagonizing providers, as cultivating the radicalism of the rising generation of doctors — who are more disposed to left politics, and more alienated by the banal evils of the system they work in, than any of their predecessors — is vital to building up the movement’s institutional strength and cultural power. Another faction might counsel creative thinking about how to incrementally expand coverage in a manner that makes single-payer more winnable in the future (e.g., Medicare for Kids). Which is to say: A clear-eyed view of the political obstacles to single-payer is compatible with a wide array of strategic judgments. What it is not compatible with, however, is the judgment that anyone who does not push for Medicare for All’s passage right now is a lying, careerist shill with no commitment to the cause.
Dore justifies casting such aspersions by appealing to the moral horror of America’s status-quo health-care system: Given the consequences of delaying the achievement of universal coverage, he argues that acquiescing to political reality — instead of mounting an effort to change it (however improbable that effort may be, and whatever other opportunities for building power that Hail Mary may foreclose) — is unacceptable. Yet there are countless other moral atrocities that the U.S. government has the power to ameliorate. There are 26 million refugees in the world whom the United States could welcome to its shores. There are myriad nations beset by a history of colonial subjugation — and a future of ecological decline — that deserve climate reparations from the United States and transfers of green technology to abet their sustainable development. Medicare for All would not reduce suffering as much as the resettlement of tens of millions of displaced people or trillions of dollars in transfer payments from the U.S. to the Global South. In calling on House progressives to force a vote on the former but not the latter, Dore & Co. tacitly concede that, when setting legislative priorities, the moral righteousness of a given policy must be weighed against its political viability. Their disagreement with AOC is therefore not one of principle; they too believe that some morally urgent causes are too improbable to be worth prioritizing over imminently winnable fights. They just have a different judgment of how winnable the fight over Medicare for All is at the present moment.
Which is fine. I’m not convinced by Gray’s case for forcing a floor vote on single-payer and find its characterization of public opinion highly misleading. But I admit that, in the course of human history, political reality sometimes changes in a hurry. We are in an exceptional political moment (see how much social spending McConnell just sanctioned). So I can’t say with 100 percent certainty that she is wrong. But I am certain that it is intellectually dishonest and politically counterproductive for Dore and his kin to demand others bow to the certain truth of their punditry or reveal themselves to be traitors.
Ignoring the structural obstacles to single-payer’s passage, the fragility of public support for the policy, and the simple fact that people can share political values while earnestly disagreeing about the best way to advance them — all for the sake of declaring Alexandria Ocasio-Cortez an enemy of America’s uninsured — is a sound strategy for ginning up interest in your rant-based YouTube show. But it is also a recipe for converting your politically naïve viewers into anti-political cynics and making the U.S. left as self-deluded and internally divided as corporate America wishes for it to be.