The photo is from 1993, when Sanders was in the House of Representatives and Clinton was leading her husband’s efforts to pass health care reform. In the picture, Clinton and Sanders are meeting. Below, the first lady inscribed a message: “To Bernie Sanders with thanks for your commitment to real health care access for all Americans.”
That praise matters because health care has suddenly become a major issue in the Democratic presidential primaries. Sanders, now a senator, is a longtime advocate for single-payer insurance, in which most people get coverage directly from the government. Clinton says single-payer is impractical, as politics and policy.
In just the last week or so, the attacks have gotten increasingly sharp and, in some cases, misleading. Inscribed photos don’t always mean that much; politicians give them out all the time as gestures to supporters. But in this case, the impression is accurate. When it comes to the broad goal of “real health care access for all Americans,” Clinton and Sanders actually agree -- more than Clinton’s recent arguments might suggest.
But Clinton isn't the only one exaggerating their differences -- or, at least, the significance of their differences.While Sanders supports the Affordable Care Act as an important step toward improving health care access, he frequently touts his support for “universal health care” as if that sets him apart from Clinton. In reality, Clinton believes everybody should have health care and that government has a responsibility to make that happen -- that is, she also believes in universal health care. Her difference with Sanders is over how to achieve it.
In some political environments, that distinction would matter a lot. In today’s political environment, it matters very little. Single-payer would be difficult to pass in a Democratic Congress. It has no shot whatsoever with Republicans in charge. Come 2017, when the next president takes office, the big question will be whether to keep the Affordable Care Act or to repeal it. Republicans prefer the latter. Sanders would fight them hard on that, just as surely as Clinton would.
And it’s not just health care. While Clinton and Sanders have clashed on several issues, those arguments mask a common allegiance to progressive goals. Their disputes are largely about emphasis and means. When it comes to what a Democratic president would actually be doing for the next four years -- blocking extreme proposals from the Republicans, while finding opportunities for small liberal reforms when possible -- the two would probably adopt extremely similar postures.
Consider the debate about guns. Clinton has touted her strong and long-standing advocacy for laws that would restrict firearms ownership, and contrasted that with Sanders’ record, which includes votes against background checks and waiting periods in the 1990s -- along with more recent votes to shield gun manufacturers from lawsuits. Her account of their respective histories is correct, and Sanders' attempts to justify his votes have been conspicuously weak. Vermont is a rural state, with high rates of gun ownership. From the looks of things, Sanders was engaging in some pretty typical constituent politics.
But over the years, Sanders also voted in favor of other gun regulation efforts -- like banning assault weapons and closing the “gun show loophole.” In 2013, he voted for a different background check bill. In the last few years, that’s been enough to earn him poor grades from the National Rifle Association (D’s and an F, though he did get a C-minus in 2006). It doesn’t match Clinton’s record, but it puts him on the far opposite side of the gun debate compared with the Republicans, who not only oppose such measures but insist that any effort to restrict ownership amounts to an unconstitutional attempt to confiscate firearms.
Similarly, Clinton would finance paid family leave with taxes on the wealthy, while Sanders co-sponsored bills that called for a small but broad payroll tax -- a difference that matters far less than their shared support for guaranteeing leave in the first place, something the Republicans absolutely oppose. Over the years, Clinton has been much closer to -- and much softer on -- the financial industry than Sanders has. But she’s endorsed some strong tax and regulatory proposals, one of which Paul Krugman has said is actually superior to the analogue from Sanders. Overall, the proposals from both Democrats are far more aggressive than anything the Republicans would try.
This isn’t to say a Clinton and Sanders administration would be devoid of meaningful distinctions over policy and politics -- or that spirited debates over substance lack value. Sanders seems more inclined to appoint more aggressive watchdogs in the agencies regulating the financial industry, for example, while investing more political resources into building the Democratic Party at the grassroots. On foreign policy, where presidents have so much unilateral power, their substantive differences could be even more consequential. But even on national security, the gap separating Clinton and Sanders simply doesn't compare in scale to the gulf that would divide either Democrat from leaders in the Republican Party.
Eight years ago, ironically, incremental differences among Democrats would have been a bigger deal. The party controlled Congress and, after eight years of a Republican presidency, they were geared up to pass major legislation. A more progressive president, somebody who talked and acted like Sanders does now, might have worked harder for a more ambitious economic stimulus, health care with more coverage and more government control of prices, and tougher regulations on Wall Street.
Here in 2016, it’s another story altogether. Barring a crisis that turns the political world upside down, it will be the sharp divergence between Democrats and Republicans, not the comparatively mild disagreements among Democrats, on which history turns in the next four years.
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