On the Hyde Amendment, Single-Payer, Bernie Sanders, and Socialism

Hillary Clinton recently called for repealing the Hyde Amendment, the federal law which prohibits federal funds from being spent on abortion. That is, among other things, surprisingly radical for a candidate most known for her cautious, calculating, pragmatic manner. It's also interesting because Bernie Sanders, the generally more radical candidate opposing her, has not, to the best of anyone's knowledge, come out in favor of repealing the Hyde Amendment. Which is funny, when you think about it, because Sanders is thoroughly pro-choice, and of course is most notorious these days for his proposed single-payer health care system. In which the federal government would pay for all the health care.

But if the Hyde Amendment is still around, then that won't include abortion.

At best this would lead to a market for supplemental abortion insurance, or just to women paying for abortion out of pocket. That's the at-best scenario, and it's pretty much a nightmare from a reproductive rights perspective. The worst-case scenario would be if private insurance, and maybe even private out-of-pocket purchase of medical treatment, were actually outlawed, which would effectively outlaw abortion itself. (That would almost certainly be unconstitutional under current doctrine, certainly as to abortion and maybe more generally.)

So, the first thing to say about all this is that someone needs to ask Bernie Sanders about the Hyde Amendment. Like, yesterday. But that's not really the crux of the issue: he'll almost certainly say he supports repealing it. He assuredly does support it on the merits, and there's no great political loss to admitting it.

The deeper issue, I think, is what it says about him that he didn't think of this when he was drafting his proposal. Because, it's a big issue. In a single-payer system, every aspect of medical treatment is subject to intense politicization, and this is a country where that could get seriously problematic, very fast. This is actually one of the virtues of the liberal-capitalist order: it's very good at letting people decide what they want for themselves, and having there be people willing to give it to them (so long as they can afford it--aye, there's the rub), even if other people aren't too happy about that. Single-payer, even if it allowed private insurance around the margins, would complicate that happy "live and let live (if you're not poor)" picture a lot. That doesn't mean it wouldn't be worth doing; that "if you're not poor" part is a really big problem. But it's not just a fantasy issue. It's a genuine cost to achieving an awful lot of good, and Sanders shows no sign of recognizing that it must be paid. This is for me the big issue with the fact that, at certain points in the past, he wanted to let the states administer the new single-payer system. Really, Bernie Sanders? An awful lot of states would make decisions about what should and should not be covered that you would really not like. He's backed off that position for now, but the lack of attention to the analogous issues at the federal level, e.g. the Hyde Amendment, doesn't give me a ton of confidence that he understands the real problem here, or has good ideas for what to do about it.

And then of course there's just the fact that the politicization of medicine would add an entirely different dimension to the fight. Paul Krugman has been talking a bunch lately about how it's tough to get a single-payer system from where we are because it really would impose losses on a bunch of important stakeholders. Well, once you remember that the Hyde Amendment exists we've got a whole other fight on our hands. There's been controversy in recent years about requiring employers to provide insurance that covers contraceptives. Imagine the explosion that would ensue if we proposed to have the federal government cover the full cost of abortions for everyone. Which is not to say that we shouldn't do it! We should, in an ideal world. This is a fight that deserves to be won. That's slightly different, though, from saying that it would be won, or even that the victory would be worth the fight.* 

More to the point, perhaps, is that Sanders does not seem to anticipate that fight, or the others like it that would surely come. And this has me thinking about a recent Ta-Nehesi Coates article and its discussion of the view that Sanders and his ideological comrades have toward racial justice issues:

"[Sanders sees] black people not so much as a class specifically injured by white supremacy, but rather, as a group which magically suffers from disproportionate poverty.

This is the “class first” approach, originating in the myth that racism and socialism are necessarily incompatible."

My feeling about this is that it's almost the other way around. It's not that adopting socialism would make racism and its effects disappear. It's that racism itself, as a separate and distinct ideology, is a big part of what's stopping us from being more socialistic. There was some research, which I could probably dig up if I wanted to spend a bit of time on it, trying to figure out why, descriptively, causally, why the United States has such a meager welfare system. Ultimately the study concluded that it's all about race, or more specifically racism: American whites don't have solidarity with black people, and therefore resent having their wealth redistributed to black people in a way that middle-class Germans don't resent having their wealth given to poorer Germans. (Interestingly we can see a related phenomenon playing out in the European Union right now; it turns out the Germans and the French don't have that much solidarity with the Greeks after all, and therefore experience a similar resentment and a reluctance to support the much-poorer people of Greece.)

And similarly with issues of sex and gender. There's a lot about the social democratic agenda that is deeply threatening to the patriarchy, there really is. Just as there is with white supremacy. Someone like Sanders is right about that. But he seems to assume that this means we should focus our energy on attacking Capital (capitalized for sinister emphasis, of course), and that when we defeat it, all those identity-politics fights will take care of themselves. But I feel like if you don't appreciate the independent power of the patriarchy, of white supremacy, in American political life, then you won't appreciate the true nature of the struggle to make America better. And you'll lose. Because you'll rush headlong at the one enemy you're focused on and let yourself be surrounded by the other armies in their coalition. Better to attack each of those allies--whose support Capital needs but to whose defense Capital cannot necessarily come--in turn, and then leave the main enemy weakened and alone. But defeating white supremacy, defeating the patriarchy, that's a massive undertaking. It'll take years, decades really. Maybe generations. And it's not a fight that Bernie Sanders seems to see himself as fighting. Hillary Clinton does, if in an incremental way (though her opposition to the Hyde Amendment is impressively bold).

And that, I guess, is the socialist case for voting Hillary.



*Perhaps my favorite part of that fight would be the inevitable court case arguing that covering abortion in the single-payer system violated religious freedom. Because the logic there is damn near identical to the similar claims being made about mandated private insurance in a case like Hobby Lobby, but if we move it to the context of a government program then it becomes obviously absurd. There's no right to have the government not spend its money on things you disapprove of for religious reasons; that's absurd. We can tax you, and once we tax you it's not your money anymore. (The one exception is that we can't spend it actually supporting religious institutions you don't support, per the Establishment Clause.)