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Right now there are two big progressive ideas out there: the Green New Deal on climate change and Medicare-for-all on health reform.

Both would move U.S. policy significantly to the left. Each is sponsored by a self-proclaimed socialist: the Green New Deal by Alexandria Ocasio-Cortez and Medicare for all by Bernie Sanders. (Neither of them is a socialist in the traditional sense.) Both ideas horrify not just conservatives but also many self-proclaimed centrists.

While they may seem similar, if you think of everything as left versus right, they're very different on another dimension, which you might call purity versus pragmatism. And that difference is why I believe progressives should enthusiastically embrace the GND while being much more cautious about M4A.

For all its sweeping ambition, the Green New Deal is arguably an exercise in pragmatism--in the proposition that the perfect is the enemy of the good.

What's the perfect in this case? Climate-policy purists are focused on the notion of a carbon tax to discourage greenhouse gas emissions, and they look down on any proposal that doesn't put such a tax front and center.

What's wrong with a carbon tax as the centerpiece of climate policy? There are some narrow economic arguments for a broader range of public policies--for example, government support can be crucial for the development of new energy technologies.

Even more important, however, is the political economy. A carbon tax would hurt significant groups of people, and not just fossil-fuel billionaires like the Koch brothers. As a result, a carbon tax on its own is the kind of eat-your-spinach policy that technocrats love but many ordinary citizens hate, as illustrated by what just happened in France, where a planned fuel tax increase was withdrawn in the face of furious Yellow Vest protests.

So how do you make climate action politically feasible? The GND answer is to bundle measures to reduce emissions with a lot of other stuff people want, like big public investment in areas with only weak direct relationships to climate change.

You could call the GND a proposal for economic transformation that includes climate action. But you could also call it a Christmas tree, the traditional term for legislation festooned with lots of riders unrelated to the ostensible purpose in order to win political support.

The point is that climate action probably won't happen unless it's a Christmas tree--and the GND's advocates are OK with that. In that sense, they're pragmatists despite their big ambitions.

Medicare for all, by contrast, is an exercise in the proposition that we must not settle for anything less than the ideal.

Indeed, Sanders has explicitly refused to support Nancy Pelosi's proposal to enhance Obamacare, even though her proposal would expand health insurance coverage to millions of Americans and make it more affordable for millions more. His reasoning seems to be that making things better, even as an interim step, would undermine support for a more radical transformation.

To be fair, the simplicity of the pure single-payer, government insurance system Sanders advocates would have some advantages over the hybrid public-private systems that have been proposed by other progressives--for example, letting people keep private insurance if they want, but offering the option of Medicare buy-in.

You might say that single-payer is the system technocrats would choose if they had a free hand, with few political constraints. In fact, that's pretty much what happened in Taiwan, which asked a panel of experts to design its health-care system and ended up with single-payer. On the other hand, international experience shows that universal coverage and high-quality health care can be achieved in a variety of ways; technocrats may prefer single-payer, but it's not essential.

The political obstacles to a Sanders-type plan are formidable. Almost 180 million Americans are covered by private health insurance, and many of them are satisfied with their coverage. Polling suggests that while the public reacts favorably to the slogan "Medicare for all," that support drops precipitously when people are informed that it would eliminate private insurance and require tax increases.

The Sanders view, however, is that a sufficiently determined leader can overcome these doubts and persuade many voters who are currently doing OK that radical change is nonetheless in their interests. I don't know of anything in recent history to justify this belief, but there it is.

My guess is that if Sanders does make it to the White House, he'll quickly find that he can't deliver on his grand vision, and will eventually try for a less purist alternative. And let's be clear: A lot more Americans will have affordable health care if any Democrat is elected than they will if Donald Trump retains the White House.

Still, it's important to realize that among Democrats, purity versus pragmatism is as important an axis as left versus right. And the two big progressive ideas are on opposite ends of that axis.


Paul Krugman, who won the 2008 Nobel Prize in economics, writes for the New York Times.

Editorial on 04/13/2019

Print Headline: Purity vs. pragmatism


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  • mozarky2
    April 13, 2019 at 6:46 a.m.

    Used by permission of PJ MEDIA:
    Do not be alarmed, comrades, that I, V. I. Lenin, here again so soon from mausoleum after first time to address you. Once you back from what people's author Raymond Chandler call "Big Sleep," it become difficult to stop self-commenting affair of day.
    And we have extreme serious counter-revolutionary problem, tovariches -- almost as bad Stalin rescind my New Economic Policy for idiot Five-Year Plan, doomed to failure before start. He was dumb as AOC.
    But never mind. Real danger today come from skillionaire -- almost as rich Elton John -- libertarian (although he hide from public) graduate of London School Economic (feh!) Sir Mick Jagger! He have heart valve problem and go to New York for replacement with private doctor instead of waiting turn British National Health like good people's artist. It would only have been few month. Or years. What betrayal of working class!
    Worse yet -- operation success... Okay, don't tell capitalist friend. Everyone supposed to wish well sick person. So just say, I wish well. But what do you expect Jagger? His lyric always hidden capitalist message -- like "Jumpin' Jack Flash is a gas gas gas" secret propaganda to use Americansky natural gas instead Russian pipeline to our dear East German comrade Angela. May she be buried with other revolutionary hero by Kremlin Wall!

  • joebub61yahoocom
    April 13, 2019 at 7:45 a.m.

    GND, like Christmas tree! More like a Grinch. Bernie, I’m a Democratic Socialist. He is a Grifter and a putz. AOC, a shining example of our failed uducational institutions. A moron. Paul Krugman, a useless useful idiot. Turning healthcare over to government will simply enable it to dig even deeper into our wallets.

  • RBear
    April 13, 2019 at 8:28 a.m.

    The copy/paste queen strikes again. BTW, I'm guessing you didn't seek "permission" from PJ Media to post that. Can you copy/paste their response to your request including e-mail addresses?

  • mozarky2
    April 13, 2019 at 8:58 a.m.

    Read the first line in my post, you ignoramus. Yes, I got permission, and no, it wasn't by email.

  • Waitjustaminute
    April 13, 2019 at 10:07 a.m.

    A Christmas tree! Introduce a massive bill, load it with goodies to bribe enough votes to pass it, the federal debt be damned (remember the 'Cornhusker kickback' and the 'Louisiana purchase?'), and let 'er rip! A horrible idea, which is why Krugman is so enamored of it.

  • RobertBolt
    April 13, 2019 at 10:16 a.m.

    Climate and medicine are issues of basic survival (the former for all and the latter individually) and must, therefore, be addressed with extreme urgency. Instead, we will likely await undeniable catastrophe and respond ineffectively while blaming everyone else. The best bet for the planet may be that humans will die in a pandemic before they utterly destroy the environment.

  • Lifelonglearner
    April 13, 2019 at 10:36 a.m.

    Healthcare is another issue where Republican politicians want to claim that America being a "Christian" nation means that paying for the things that help others is voluntary, but they find creative ways to keep claiming that government controls a woman's body from the moment she becomes pregnant. Notice that "heartbeat" legislation has not included any provision to immediately claim a dependent for tax purposes, provide paid maternity leave, housing and nutrition assistance, or even funding for medical care.

  • RBear
    April 13, 2019 at 10:46 a.m.

    LOL @ Frank. So how do you "get permission" if you didn't contact them. I looked at their website and it doesn't have any grants of permission on it. Do you even understand what that concept means? I'm guessing not.
    Regardless, Krugman's column is a good view of two different progressive policies and also a clear example of how right wingers miss the boat in policy discussions. GND is a framework to focus on for moving the country in a more defensible energy position. It's a pragmatic approach to building the infrastructure and technology make us even more energy independent, not having to rely upon a finite resource AND helping improve sustainability and quality by taking STEPS towards a greener economy.
    Case and point is San Antonio where jobs in the solar industry continue to expand and employ many semi-skilled workers. These workers focus on manufacturing of solar panels, installation of them across the nation, and building a city that is less dependent on fossil fuels for energy and a broader portfolio of energy. San Antonio leverages both solar AND wind to augment its current portfolio of nuclear and natural gas. By leveraging both sustainable sources, the balance is struck with solar production during the day and wind at night. By keeping a diversified portfolio, CPS Energy can lessen its consumption of fossil fuels.
    That's what the GND provides in terms of STEPS, not LEAPS as M4ALL does. But I'm sure these concepts fly over the heads of the Trump demographic, a group not known for its strategic thinking.

  • Waitjustaminute
    April 13, 2019 at 11:05 a.m.

    RBear, the GND is toxic because of some of its other outlandish positions, like providing a living wage for those unable to work and doing away with combustible engines. The best thing the Democrats could do is scuttle it, take the rational provisions like those you mention, and pursue them as a smaller scale, realistic, program. Then make that program a campaign issue so that Democrats can start presenting themselves as being for something, rather than just against the current White House occupant.

  • RobertBolt
    April 13, 2019 at 11:30 a.m.

    When it does occur, revolutionary change is often derided as impossible shortly before it happens.