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One of this year’s more intriguing political developments is a change at the helm of the Senate health, education, labor and pensions committee, where Sen. Bernie Sanders (I-Vt.) is taking the gavel. It represents a milestone of sorts for American politics ― and for Sanders himself.
The Brooklyn native and former mayor of Burlington, Vermont, first came to Washington, DC, more than 30 years ago, when he won election for the state’s lone, at-large seat in the US House. Sixteen years later, in 2006, Sanders won the US Senate seat that he holds today.
For much of that time, Sanders has played the role of ideological gadfly, proudly calling himself a “democratic socialist” and just as proudly championing causes that, by American standards, sit out on the fringes of the political left. He’s also been known to throw shade at Democrats with more conservative views, especially when those views look like a form of service to wealthy campaign funders.
The quintessential Sanders cause has been his crusade to create a ‘Medicare for All’ system that would replace existing health insurance arrangements with a single government program. It would look a lot like the systems that exist in the most economically advanced countries, but here in the US, the idea can’t even get a serious hearing ― or, at least, it couldn’t until Sanders ran for the Democratic presidential nomination in 2016 and 2020.
Although neither of his White House bids succeeded, Sanders got mainstream politicians talking about his agenda while building a movement of progressive activists ready to fight for it. Along the way, he increased his own visibility and clout.
Now Sanders leads a committee whose broad jurisdiction overlaps with his priorities almost perfectly. Health care, education, labor, pensions ― Sanders has big ideas about all of these, and you will not be surprised to hear that he has thought a lot about how he can use the committee to promote them.
But you may be surprised to hear how he intends to go about that.
A Focus On Health Care Clinics
Yes, Sanders plans to introduce Medicare for all legislation, as he has so many times before. But, he told me in an interview last week, he doesn’t plan to make that bill a top priority for the committee.
“Unfortunately there are only about 15 or 20 members of the Senate who agree with me,” Sanders said. “We don’t have the votes to pass it.”
Sanders hopes to focus instead on legislation that would bolster federally funded community clinics, which offer primary care and related services to about 30 million people today.
These clinics are a crucial part of the nation’s safety net; by law, they must provide care to anybody, regardless of ability to pay. Many have won acclaim for their proactive, holistic approach to medicine ― an approach that emphasizes preventive care and supports healthy lifestyles, through services such as diet classes and free environmental home screenings. Many also offer dentistry, or run their own pharmacies.
“Primary care in this country should be the backbone of any rational health care system,” Sanders said. “I don’t think it’s too much to ask that in the richest country on earth, every person in their community should have access to a doctor, and get the mental health counseling they need, and get the dentistry that they need, and get low-cost prescription drugs.”
The clinic program has its origins in former President Lyndon Johnson’s War on Poverty, but it’s grown over the years, with strong support from Republicans who would rather fund direct medical services than government-run insurance. Sanders would like to see the program grow even more, and he believes a bill could get enough Republican votes to get through the Senate (where it’d probably have to overcome a filibuster) and the House (where Republicans have a narrow majority).
The idea of a bipartisan health care bill in today’s polarized political environment might seem outlandish. But there’s recent precedent for it. One of the most important (and underappreciated) health care bills of recent years was an initiative from retiring Sen. Debbie Stabenow (D-Mich.) and retired Sen. Roy Blunt (R-Mo.) to expand and transform government-provided mental health care. It became law as part of the bipartisan gun bill that Congress passed and President Joe Biden signed last summer.
It helped that mental health care hasn’t been politicized in the way that, say, “Obacare” has ― and that the need for new services was so apparent in rural America, where voters tend to be Republican. The same is true for community clinics: Nearly half are in rural counties and, in all, the clinics serve about 1 in 5 rural Americans.
“I think we’ll get bipartisan support,” Sanders said, adding that he sees similar possibilities on other issues the committee will address ― like looming workforce shortages in various health care sectors, where employers will likely push Republicans for help.
More Attention To Child Care
Sanders’ agenda for the committee also includes plenty of items that will divide its members, as well as the Senate, along with more familiar partisan lines.
He hopes to push legislation for a higher minimum wage, for example, and to strengthen labor unions by making it easier to organize and protect them from corporate retaliation. He also mentioned working with his predecessor as chair, Sen. Patty Murray (D-Wash.), on expansions of child care that has been her signature cause.
The issue is not a new one for Sanders, who has his own record of support for comprehensive early childhood programs. And in theory, this could be another bipartisan cause. The shortage of workers and slots is a nationwide crisis that’s getting worse, and affecting employers who have influence with Republicans.
But there are still some profound disagreements between the parties over how to design a national child care program, or whether to have one at all. Murray’s initiative in the last Congress failed in part because it would have required a hefty new federal investment that was way too much for Republican senators ― and at least one Democrat too.
Finding money isn’t going to be any easier now that Republicans control the House, Sanders acknowledged. “Obviously, when you’re dealing with child care, we’re talking about community health centers, you’re talking about real dollars,” he said.
“We will see what happens, but I believe these are issues where Republicans at least understand that there are serious problems that need to be addressed,” Sanders added.
The Difficulties Of Dual Messages
When Sanders talks about health care, it’s never long before he brings up the high price of prescription drugs, the burden it places on Americans who can’t afford them and his determination to do something about that.
Now that he’s in charge of a committee with direct jurisdiction, he hopes to introduce legislation tying US prices to lower prices in other developed countries, while holding hearings that put pharmaceutical companies’ financial and marketing practices under scrutiny.
“The pharmaceutical industry makes tens of billions of profits per year, their CEOs get exorbitant compensation and we pay the highest prices in the world for prescription drugs,” Sanders said. “They’re going to have to answer to this committee as to why that’s the case.”
You may recall that the Inflation Reduction Act that Democrats passed and Biden signed included prescription drug reforms, among them a provision giving the federal government new leverage over drug prices. The leverage is a lot smaller than Democratic leaders wanted; they had to pare back the bill in order to satisfy industry-friendly holdouts like Sen. Kyrsten Cinema (I-Ariz.).
At the same time, the changes represent a historic breakthrough, as Sanders himself has said, and already a provision capping the price of insulin for seniors on Medicare is taking effect.
Sanders says it’s possible to celebrate those accomplishments while making the case for more action. But that kind of dual messaging can be tricky. During the 2016 campaign, when Sanders was campaigning on Medicare for All, many Democrats feared he was undermining their attempts to defend the similarly flawed, similarly historic Affordable Care Act from repeal.
A Difference Between Left And Right
At the same time, Sanders has frequently been a good team player, even if he doesn’t formally identify as a member of the team. His role in enactment of the Affordable Care Act is as good an example as any. In 2009, he was one of the last three senators to promise a “yes” vote on legislation. But his big demand was for community clinic funding, which was fully consistent with the goals of health care reform.
Neither the White House nor Senate leaders ever worried about Sanders holding the bill hostage in the way that, say, today’s Republicans are threatening to create an economic crisis by demanding spending cuts in exchange for an increase in the government’s borrowing authority.
That’s one of the obvious ways Sanders and his allies on the Democratic left are different from their right-wing counterparts pulling the Republican Party. The progressives have an ambitious vision for America that involves what would be, by US standards, truly dramatic change. They are not shy about promoting it, and they spend lots of time trying to build a movement behind it.
But these progressives also understand the real-life constraints of policy and politics, take the time to understand and think about substance, and embrace even small progress toward their goals when it’s the most they can get.
It’s safe to assume Sanders will continue to give Democrats grief from time to time, and safe to assume he saw it as part of his job as a progressive leader. But in his role as a committee chair, he’s talking like somebody focused on what he can get done in a time of divided government, including the enactment of bipartisan legislation that could make a real difference in people’s lives. He might not succeed, but if he does, don’t be surprised.