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One of the more intriguing policy developments this year is a change at the top of the Senate Committee on Health, Education, Labor and Pensions, where Sen. Bernie Sanders (I-Vt.) takes the hammer. It’s kind of a milestone 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 only seat in the US House of Representatives. Sixteen years later, in 2006, Sanders won the US Senate seat he holds today.
Sanders played the role of ideological brake most of the time, proudly calling himself a “democratic socialist” and just as proudly championing causes that by American standards are on the fringes of the political left. He has also been known to shadow Democrats with more conservative views, particularly when those views appear as a form of service to wealthy campaign funders.
The quintessential Sanders cause was his crusade to create one ‘Health insurance for everyone’ System that would replace existing health insurance schemes with a single government program. It would look very similar to the systems that exist in the most economically advanced countries, but here in the US, the idea can’t even be heard seriously — or at least it couldn’t until Sanders ran for the Democratic presidential nomination in 2016 and 2020.
Though none of his White House bids were successful, Sanders got mainstream politicians speaking out about his agenda while building a movement of progressive activists willing to fight for it. Along the way, he increased his own visibility and clout.
Now Sanders chairs a committee whose broad remit almost perfectly overlaps with his priorities. Health care, education, jobs, pensions — Sanders has big ideas on all of these, and you won’t be surprised to hear that he put a lot of thought into how to use the committee to promote them.
But you’ll be surprised to hear how he intends to proceed.
Healthcare clinics in focus
Yes, Sanders plans to introduce a Medicare-for-All law, as he has done so many times before. But, he told me in an interview last week, he has no plans to make this bill the top priority for the committee.
“Unfortunately, there’s only about 15 or 20 members of the Senate who agree with me,” Sanders said. “We don’t have the votes to pass it.”
Instead, Sanders hopes to focus on legislation that would strengthen federally funded community clinics that provide things like primary care and related services 30 million people today.
These clinics are a crucial part of the nation’s safety net; By law, they must provide for everyone regardless of their ability to pay. Many have won recognition for their proactive, holistic approach to medicine – an approach that emphasizes prevention and the support of a healthy lifestyle through services such as nutrition classes and free home environmental assessments. Many also offer dentistry or run their own pharmacy.
“Primary care in this country should be the backbone of any rational healthcare system,” Sanders said. “I don’t think it’s asking too much that in the wealthiest country on earth everyone in their community should have access to a doctor and be able to get the mental health counseling they need and the dentistry they need and get cheap prescriptions medicines.”
The clinic program has its origins in former President Lyndon Johnson War on Poverty, but it’s grown over the years, with strong support from Republicans who prefer to fund direct medical services rather than state insurance. Sanders wants the program to grow even further, and he believes a bill could garner enough Republican votes to get through the Senate (where it would likely have to overcome a filibuster) and the House of Representatives (where Republicans have a slim majority). .
The idea of a bipartisan health bill may seem crazy in today’s polarized political environment. But there is a new precedent for it. One of the most important (and underappreciated) health care laws of recent years was an initiative by retired Sen. Debbie Stabenow (D-Mich.) and retired Sen. Roy Blunt (R-Mo.) to expand and transform the services provided by the government mental health care. It became law as part of the bipartisan gun bill that Congress passed and that President Joe Biden signed into law last summer.
It helped that mental health care wasn’t so politicized that, say, “Obamacare” — and that the need for new services in rural America, where voters tend to be more Republican, was so evident. The same applies to community clinics: Almost half are located in rural districts and overall the clinics serve approximately 1 out of 5 rural Americans.
“I think we’re going to get bipartisan support,” Sanders said, adding that he sees similar opportunities on other issues that the committee will address — such as the looming labor shortages in various health sectors, where employers are likely to be pressing Republicans for help.
More attention to childcare
Sanders’ agenda for the committee also includes many issues that will divide its members, as well as the Senate, along more familiar party lines.
For example, he hopes to push legislation for a higher minimum wage and strengthen unions by making it easier to organize and protecting them from corporate retaliation. He also mentioned working with his predecessor as Chairman, Sen. Patty Murray (D-Wash.), on Extensions to child care that was their signature cause.
The problem is not new to Sanders, who has his own support for comprehensive early childhood programs. And theoretically, this could be another bipartisan cause. The labor and job shortage is a national crisis that is getting worse, affecting employers who have influence with Republicans.
But there are still some deep disagreements between the parties over how a national childcare program should be designed, or even if there should be one at all. Murray’s initiative at the last Congress failed in part because it would have required a hefty new federal investment that was far too much for Republican senators — and at least one Democrat to.
Now that Republicans control the House of Representatives, finding money isn’t getting any easier, Sanders admitted. “Of course when it comes to childcare, we’re talking about community health centers, you’re talking about real dollars,” he said.
“We’ll see what happens, but I believe these are issues where Republicans at least understand there are serious issues that need to be addressed,” Sanders added.
The Difficulties of Dual Messages
When Sanders talks about healthcare, it’s never long before he addresses the high prices of prescription drugs, the burden they place on Americans who can’t afford them, and his determination to do something about it.
Now that he chairs a committee with direct jurisdiction, he hopes to introduce legislation that ties U.S. prices to lower prices in other developed countries, while holding hearings that scrutinize pharmaceutical companies’ financial and marketing practices .
“The pharmaceutical industry makes tens of billions of dollars in profits every year, their CEOs get exorbitant compensation, and we pay the highest prescription drug prices in the world,” Sanders said. “You will have to answer before this committee why that is.”
You may recall that the Inflation Control Act that the Democrats passed and that Biden signed into law was included Reforms of prescription drugs, including a provision giving the federal government new leverage over drug prices. The leverage is much less than Democratic leaders wanted; They had to cut the bill to please pro-industry holdouts like Sen. Kyrsten Sinema (I-Ariz.).
At the same time, the changes represent a historic breakthrough, as Sanders himself said, and a provision capping the price of insulin for Medicare seniors is already in place.
Sanders says it’s possible to celebrate those achievements while arguing for more action. But this kind of double messaging can be tricky. During the 2016 campaign, when Sanders campaigned for Medicare for All, many Democrats feared he would undermine their attempts to protect the similarly flawed, similarly historic Affordable Care Act from repeal.
A difference between left and right
At the same time, Sanders was often a good team player, even if he didn’t formally identify himself as a member of the team. His role in getting the Affordable Care Act passed is as good an example as any. In 2009, he was one of the last three senators to pledge a “yes” to a bill. But his big demand was for funding for community clinics that were fully consistent with the goals of health care reform.
Neither the White House nor Senate leaders ever concerned about Sanders holding the law hostage so today’s Republicans, for example, are threatening to cause an economic crisis by demanding spending cuts in exchange for increased government borrowing powers.
That’s one of the obvious differences between Sanders and his allies on the Democratic left and their right-wing counterparts who pull the Republican party. The progressives have an ambitious vision for America that involves truly dramatic change by US standards. They’re not shy about promoting it, and they spend a lot of time building a movement behind it.
But these progressives also understand the real-world imperatives of politics and politics, take the time to understand and reflect on issues, and welcome even small advances toward their goals when it’s the best they can achieve.
It’s safe to assume that Sanders will continue to cause grief to Democrats from time to time, and it’s safe to assume he sees this as part of his job as a progressive leader. But in his role as committee chair, he speaks like someone focused on what he can accomplish in a time of divided government, including passing bipartisan legislation that could really transform people’s lives. He may not succeed, but if he does, don’t be surprised.