Hillary Clinton’s campaign justifies its criticism as an effort to protect the coverage expansions achieved under Obamacare. | Getty Clinton’s health-care assault on Sanders backfires

Hillary Clinton’s assault on Bernie Sanders for his support of a single-payer health system has stunned and irritated liberals who see it as an abandonment of core progressive principles.

“Even though its real-world prospects are pretty close to nil, [single payer] is still iconic in the eyes of a large proportion of the Democratic left,” said John McDonough, former Senate staffer who helped draft the Affordable Care Act. “A lot of people will interpret this attack in a way that may be even more hostile to Clinton.”


Bashing your rival for embracing a touchstone liberal value, still supported by 81 percent of Democrats according to a poll last month, is a risky maneuver just weeks before the first Democratic caucuses and primary.

But the Clinton campaign’s broadsides seem aimed at conveying another, more central campaign message — that she is the candidate who will protect the paychecks of middle-class workers. Her campaign contends Sanders’ plan would cost $15 trillion and mean a 9 percent tax hike for middle-class families.

She is also sending a coded message to strategic-minded Democrats, said Larry Jacobs, director of the Center for the Study of Politics and Governance at the University of Minnesota. “What she is saying is that Bernie Sanders is not electable, she is saying this is a lightning rod that will sink the party in the fall,” he said.

It’s a dangerous move for a candidate who has struggled to persuade primary voters of her own progressive credentials — indeed, who has spent months tacking left on policy questions from tax rates to financial regulation. The attacks are already drawing fire from the left: “Clinton Shows Desperation With Dishonest Attacks Against Sanders On Health Care & Guns,” wrote Liberal Values blog.

The strategy also sets Clinton up for accusations of hypocrisy after she chastised then-Sen. Barack Obama during the 2008 campaign for attacking her health care plan.

"Since when do Democrats attack one another on universal health care?” Clinton said at the time. “I thought we were trying to realize Harry Truman's dream. I thought this campaign finally gave us an opportunity to put together a coalition to achieve universal health care."

Clinton’s campaign justifies its criticism as an effort to protect the coverage expansions achieved under Obamacare. "I would underscore that to put this country back into that debate on health care is to put all of the progress that we’ve made on the Affordable Care Act” at risk, said Jake Sullivan, the campaign’s senior policy adviser.

But on Thursday, fact-checking outlet Politifact shredded that argument, classifying as “mostly false” Chelsea Clinton's claim that Sanders' health care plan would, in part, "empower" Republican governors to dismantle the Affordable Care Act.

Sanders’ campaign has declined comment. But the candidate himself acknowledged during the second Democratic debate in November that a Medicare-for-all system is “not going to happen tomorrow. And it's probably not going to happen until we have real campaign finance reform.”

Economic experts have said it would be impossible to institute single payer relying solely on tax hikes on the wealthy. Sanders camp has argued in response that in the long run, single payer will save the country trillions of currently wasted dollars and would save families money on health insurance costs.

Republicans are thrilled that Clinton’s criticisms closely hew to their own critiques of government-run health care and create an opening for a topic they’d love to dwell on — her own history on health policy. Clinton’s 1993 health plan in many ways was for more prescriptive and complicated than the 2010 Affordable Care Act, which Republicans have depicted as a government takeover of health care and a slippery slope to single payer.

“It’s ironic that Clinton would attack anyone on single payer when 20 years ago she proposed, not exactly single payer, but something more radical than Obamacare, which was then defeated in a Democratic Congress,” said veteran Republican strategist Charlie Black. “If I were Sanders, I think I would know how to respond.”

Longtime conservative health care analyst Stuart Butler said he appreciated Clinton’s efforts to put a price tag on Sanders’ plan. The Brookings Institution scholar noted that Vermont, Sanders’ home state and the only one to seriously pursue single payer, abandoned the effort in December 2014 after its Democratic governor decided it would be too costly. The plan would have required a new 11.5 percent payroll tax on Vermont businesses and up to a 9.5 percent premium tax on individuals.

“Single payer is always attractive in the abstract, as it was in the state of Vermont, but when people see the actual costs of it, they drop it,” Butler said.

Clinton didn’t push single payer during her own effort to extend health coverage during her husband’s administration, but advocates who met with her at the time said she was respectful of the idea, while noting its challenging politics.

“She is a very smart woman, I doubt she has forgotten,” said Steffie Woolhandler, a prominent single-payer advocate who met with Clinton in 1994 and called her recent attacks on the plan “incredibly disingenuous.” Woolhandler said Clinton told her during their 1994 meeting, “I get it that single payer would work for everyone and be affordable, but it is not politically feasible.”

The Clintons’ own health plan also politically imploded that year.

As she pushed for its approval, Clinton had warned groups that opposing their plan would spur a tide of populist support for single payer.

“I think the momentum for a single-payer system will sweep the country,” Clinton told Lehman Brothers Health Corp. “So for those who think that building on the existing public-private system with an employer mandate is radical, I think they are extremely short-sighted.”

Barack Obama, during the debate over his own reform effort that would become known as Obamacare, ruled out the idea of single payer, saying it would be too disruptive to the existing employer-based coverage system. Instead, he pushed for tighter regulation of insurers, combined with expanding Medicaid and subsidizing coverage for millions of Americans.

“I recognize that there are lot of people who are passionate — they look at France or some of these other systems and they say, well, why can't we just do that?” Obama said during a July 2009 online town hall. “Well, the answer is, is that this is one-sixth of our economy, and we're not suddenly just going to completely upend the system.”

Obamacare ultimately gave Democrats a near-universal health care plan — albeit one filled with compromises that maintain the private insurance system and that still leaves about 30 million people uninsured.

But liberals have long held onto single payer as an aspirational goal — it’s why retired Rep. John Dingell (D-Mich.), who helped shaped Obamacare, introduced a single-payer bill in Congress every year for more than half a century.

Former Republican House leadership aide John Feehery attributed Clinton’s new attacks to a growing sense of desperation as Sanders extends his lead in New Hampshire and closes the gap in Iowa. “It seems to me that if you’re attacking Bernie for single-payer system, you’re not really going for the liberal crowd,” he said. “The other possibility is that she panicking and throwing the kitchen sink at Bernie and trying to hit him with anything she can.”

The Clinton campaign said it is focused on defending the coverage gains made under Obamacare, while assuring voters that she “absolutely respects” single-payer supporters.

“Our task now is to defend the Affordable Care Act from Republicans, who are persistently voting to repeal it — as we saw very recently — and to build on it,” said Clinton spokesman Brian Fallon on a press call Wednesday.

Long-time health care advocates, who’ve battled for decades to expand coverage, are trying to offer Clinton cover on this fight.

“I think that it comes more from a strongly held view that a single payer is just not achievable,” said Ron Pollack, founding executive director of Families USA, a health care advocacy group closely aligned with the White House. “She may be thinking: ‘Let’s make sure that we don’t lose key advances such as extending overage because we are pushing something that is impossible from a political standpoint.’”