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Bernie Sanders’s Big Obamacare Gamble

He has agreed to a primetime health care debate days before the Senate is set to vote on repealing the ACA. Will he do more harm than good?

Scott Olson/Getty Images

Late Thursday afternoon, CNN announced that it would be holding a town hall debate on Monday billed as “The Fight Over Obamacare.” In one corner we’ll have Republican Senators Lindsey Graham and Bill Cassidy, the architects of the GOP’s most recent legislative effort to repeal the Affordable Care Act. In the other, Democratic Senators Bernie Sanders and Amy Klobuchar. With Majority Leader Mitch McConnell declaring that he will put Graham-Cassidy to a vote next week, with virtually no debate on the floor of the Senate itself, this town hall will be the most public and dramatic opportunity for the bill’s supporters and opponents to make their respective cases, with the potential to even swing the vote either way.

The Graham-Cassidy bill has been condemned by experts as the “most radical” of all the repeal bills that have been put forth since President Donald Trump took office. It would eliminate Obamacare’s subsidies and Medicaid expansion, replacing them with state-run block grants. Coverage of pre-existing conditions would no longer be guaranteed. To try to convince Alaska’s hold-out Senator Lisa Murkowski, the bill’s sponsors are offering to exempt her state from the effects of the bill. (As Matt Fuller of HuffPost pointed out, the bill is so bad that the bribe is to let states keep the very law it is meant to repeal.) Some 32 million people could lose their health insurance under the bill, as it distributes tens of billions of dollars in federal subsidies from mostly blue states like New York and California to mostly red states like Texas.

With so much at stake, the reaction to Monday’s town hall debate has been one of alarm. Democratic aides are privately worrying that Sanders is setting himself up for a trap in which the debate will be framed as “single-payer versus repeal,” following Sanders’s unveiling of a Medicare for All bill last week. (Or, as Republicans will likely call it, “socialism versus capitalism.”) Others see it as a cynical ploy by Sanders, who is allegedly looking out for his own political profile rather than being a team player.

Josh Miller-Lewis, Sanders’s spokesperson, rebuts those claims. He told the New Republic that when CNN approached their team, Sanders jumped on what he saw as an opportunity to “expose Graham-Cassidy as the most egregious and destructive piece of legislation in front of millions of people the week that this bill might come up for a vote.” A potential payoff of this town hall is that it will bring attention to a bill that the GOP has been trying to rush through before a September 30 deadline, after which it will not be able to repeal Obamacare with only a simple majority. As one health care activist told Vox’s Jeff Stein, “I’m still having a really hard time convincing people this is real.”

“We’ve defeated Republican health care, similar bills, so many times, and they’re tired,” Miller-Lewis said of voters. “This is an opportunity to shake things up and get people to pay attention again and understand how bad this bill is.” The town hall will surely shine more daylight on the impending threat of Graham-Cassidy, and this is the best reason for Sanders to accept this debate.

Sanders also plans to focus on defending the Affordable Care Act and unmasking the horror that is Graham-Cassidy, not on his Medicare for All bill. “The focus of this debate is Graham-Cassidy, which is what’s on the table this week,” Miller-Lewis said. Sanders has proven to be an effective defender of the ACA. He is also, as many of his proponents have pointed out, the most popular politician in the country. As the New Republic’s Brian Beutler wrote back in July, Sanders and the progressive left have been tirelessly working to preserve Obamacare despite the fact that repealing the law would be the quickest path to passing single-payer.

But daylight is not necessarily a disinfectant, particularly when the context for this debate is a CNN town hall. The very fact that it is being framed as a debate suggests that Graham-Cassidy is a legitimate proposal whose genuine aim is to solve health care problems in this country, and that the difference between Graham-Cassidy and Obamacare (or even Medicare for All) is a partisan difference over policy. This is simply not the case. No Republican senator has been able to articulate the positive policy effects of this bill because there are none—it is a ploy to fulfill an extremely cynical campaign promise. Framing it as a debate is a way of both-sides-ing the issue, a specialty for a network that has hired Trump mouthpieces like Jeffrey Lord. It also gives some semblance of cover for Graham and Cassidy, who can claim that there has been some discussion of the bill despite the fact that this is a ridiculous stand-in for regular order.

Furthermore, Sanders is not in control of whether the debate devolves into a discussion of the “looming socialist threat” of Medicare for All. Graham and Cassidy will surely try to steer the conversation into this territory as they have already done—during a press conference this week, Graham declared, “Here’s the choice for America: socialism or federalism when it comes to your health care.”

And there is no doubt that Graham and Cassidy will lie, as Republicans have lied throughout this process. They will say that the bill does protect people with preexisting conditions. They will say transferring health care decisions to the states will result in innovation, greater coverage, and lower costs, when the opposite is far more likely, if the history of block grants is any indication. The debate format can expose those lies, but it can also allow them to sink in the viewer’s mind and take hold. And while it’s doubtful that a ton of people will tune into the event, a single viral clip in favor of the bill could spread like wildfire.

Still, the fact is that they are employing all of these arguments already, with no foil to challenge their claims directly. And Sanders is uniquely situated to rebut the claims that defending Obamacare is the same as turning America into a socialist state. This brings us to his partner Amy Klobuchar, who might seem like a strange choice when you consider that the Democratic bench has more luminous figures like Kamala Harris, Cory Booker, and Elizabeth Warren. But the fact that Klobuchar hasn’t endorsed Sanders’s Medicare for All bill might be an advantage, a way to keep the conversation about Obamacare. And, as a former attorney and a legislator who was part of the battle to implement the ACA, Klobuchar will be a formidable advocate.

The most important audience for this debate is an audience of two: Senators John McCain and Lisa Murkowski. Despite all the evidence against the bill, despite all the violations of Senate procedure that have been inflicted, they still remain on the fence. There is a danger that they will be swayed by Graham and Cassidy’s performance, or by the Republican base’s response if the Republican side manages to score a few hits.

There’s also the distinct possibility that the debate will have no impact on their decision-making at all, that they will vote by some mysterious calculus over which none of us has any control. In this respect, Sanders and Klobuchar will be doing what other progressives are doing, the only thing they can do: exposing Graham and Cassidy’s lies and making a convincing, full-throated appeal to keep the ACA.

Update: Literally minutes after this story went up, McCain said he would not vote for Graham-Cassidy: