With momentum building for single-payer healthcare among Democratic voters and a growing number of 2020 hopefuls, Sen. Bernie Sanders unveiled a "Medicare for All" bill last week. Immediately, a number of pundits denounced the legislation as an "unrealistic" "bloated" "disaster" full of "magic math."
Some of the naysayers are conservatives who simply abhor "big government." Some have perfectly valid reasons to question the merits of single payer in general or Sanders' methods in particular. Yet others claim they support universal healthcare in theory (one day, perhaps) but cannot do so now because of a "concern." They are "concern trolls" — broadly defined as "a person who disingenuously expresses concern about an issue with the intention of undermining or derailing genuine discussion."
The nuance troll: ‘We need more details!’
Less than 24 hours after the bill's introduction, New York Magazine's Jonathan Chait lamented that the bill gets America "zero percent" closer to single payer. While saying he agrees with single payer in theory, he insisted that the 155 million Americans who already have healthcare represent an insuperable barrier, and that the issue of how to move them all to a government-run system "is not a detail to be worked out. It is the entire problem." As he noted, Lyndon Johnson failed and Hillary Clinton failed and Barack Obama failed to undo the private system. So why bother? It's too hard; everyone go home.
Nuance trolling is argument by way of tautology, an attempt to pass off power-serving defeatism as savvy pragmatism. Nuance trolls simply cannot envision a bold legislative movement to alter the system.
Even if Sanders did lay out how a single-payer transition would work in a technical sense, nuance trolls would find other nits to pick. Where would the money come from? How would you manage all the corporations disturbed? There's always some essential detail that needs solving before Senate Democrats earn the right to support a bold policy.
And if the demand for nuance seems reasonable enough, consider that pundits rarely require it when it comes to military interventions — Chait and others set this issue aside when it came to invading Iraq in 2003, for instance. The idea at the time was: This is an urgent threat, we will rush to solve it and sort out the details later. With an estimated 45,000 people dying a year because of a lack of healthcare and almost half of the money raised on GoFundMe used to pay medical bills, we must ask: How is this crisis any less urgent?
The deficit troll: ‘How do you pay for it?’
Of all the water-muddying tactics, this one is the easiest to set aside. As I've noted in these pages before, deficit scare-mongering is used, almost exclusively, as a bludgeon to smear progressive policy proposals. When it comes to launching wars or bailing out banks, these fears vanish.
Articles in the Washington Post, Vox and Think Progress all asked how Sanders' single-payer bill would be "paid for," yet not a single one of those outlets asked the same question the day after the Senate signed a $700-billion military spending bill, an increase of roughly 13% from 2017. (That $80 billion increase alone could cover 2017-2018 tuition for every student at a 4-year state university in the country.) Money for war is magically always there; money for healthcare must be counted bean by bean.
The feasibility troll: ‘What about the GOP?’
Many pundits seem to believe that leftist politicians must preemptively agree internally to some assumed compromise that is "practical" even before attempting to change the conversation, much less the law. Thus feasibility trolls argue that GOP opposition to government-run health insurance renders futile any such proposal.
That's ahistorical. Maximalist demands aren't all or nothing, they're about establishing broad moral goals that people can rally around.
Indeed, the Tea Party movement provided a clear counterexample to conventional wisdom. It routinely held "unrealistic" positions such as shutting down the entire U.S. government and establishing a 14.5% flat tax, but nonetheless went on to help the GOP net 900 seats nationwide as well as the White House and both houses of Congress.
To have seen this play out and still conclude that maximalism can't work is perplexing. Progressives lose nothing by setting bold targets right out of the gate. Why not make every Republican lawmaker go back to his or her constituents in 2018 and explain opposition to free healthcare? Force the issue, shift the debate, just as the far right has been doing for years.
President Eisenhower — an early practitioner of concern trolling — told the New York Times in 1957 that he supported integration "in principle" but said activists in the South risked going "too far, too fast." Give it more time. We need more details. Who will pay for it? All meaningful changes to society have been met with these types of objections. But the game of politics isn't won by waiting for the ideal. Its most successful actors establish a moral goal and fight for it until reality catches up to them.
Adam H. Johnson is a media analyst for Fairness and Accuracy in Reporting.