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Making Ralph Relevant

Ralph Nader is running for president on a platform that includes a call for a national, single-payer healthcare system similar to Canada’s.

Princeton University economist Paul Krugman makes a very compelling and easy-to-understand case on why a national, Canadian-style, single-payer healthcare system would work well in the United States. (“The Health Care Crisis and What to Do About It” is accessible at

President Harry Truman tried to enact a national health system in the late 1940s but was blocked by business interests. In the mid 1960s, President Lyndon Johnson got us partway there when he led Congress to enact Medicare for the elderly and Medicaid for the poor. Bobby Kennedy was assassinated before his advocacy of a national health system ever had a chance to find another presidential sponsor. Republican President Richard Nixon submarined a national system with his “mandate” approach. Hillary Clinton tried but failed in 1993 and 1994 to do comprehensive reform.

But today, when you add up all those served by the Veterans Administration, by Medicare and by Medicaid, somewhere between one-quarter and one-third of Americans are covered by a single-payer system.

This is the year when the issue could move again. An organization called Physicians for a National Healthcare Program ( has been building momentum for specific legislation, HR 676, to create what Harry Truman wanted. This group is a true breakthrough organization: Doctors used to oppose national healthcare, but today there is a growing consensus among physicians that the insurers and other middlemen hurt healthcare by interfering with treatment while gobbling billions, and that the best solution would be to take a leaf off the maple tree.

But Ralph Nader is absolutely correct: None of the major candidates for president will talk about, much less advocate, a true national healthcare system of the kind that keeps Europeans and Canadians healthier than US residents but that costs them one-third to one-half of what our mess costs us.

Unfortunately, Ralph Nader’s decision to run once again for president probably undermines rather than advances the cause.

It is impossible to overlook the fact that Nader’s candidacy on the Green Party ticket in 2000 diverted 75,000 progressive votes from Al Gore in the state of Florida alone. Florida was the state which George Bush won by fewer than 600 votes. Both Hillary Clinton and Barack Obama have been bitterly critical of Nader’s decision to run again. Both John McCain and Mike Huckabee have pointed out the obvious: that Nader’s presence helps the Republican in November.

Worse, though, is that Nader’s candidacy makes it easy for the leading candidates to ignore the tough questions he asks—questions on energy policy, on the military budget, about the plethora of corporate giveaways about which he has complained for many years, about tax-code atrocities and more.

Nader asks hard questions based on sound research. But we have to ask this: Isn’t there a better way to get these issues out than to put a spoiler in?

We are now in the midst of the 2008 campaign’s populist moment, where some of Ralph’s questions may, temporarily, get a hearing.

No thanks to Nader, the Democrats currently all sound increasingly like Democrats—and will, until April. (Except for his regressive, wealthy-coddling call for a national sales tax, even Mike Huckabee sounds vaguely populist these days.) In the remaining primary states—Ohio, Texas, Vermont, Rhode Island and Pennsylvania—the populist rhetoric of grievance about middle-class economic stress, job-killing internationalization, corporate welfare and even tax cuts for high-income individuals is getting hotter. The consultants to both Obama and Clinton have detected that the John Edwards constituency, about 20 percent of the Democratic primary electorate, is looking for a home, and so the appeal to union members is underway in language and gestures that union members like.

It’s time to seize that moment.

What I wish Nader and his friends would do in the next six weeks, until the Pennsylvania primary on April 12, is to focus the debate sharply on national healthcare policy rather than on Nader’s candidacy or on his entire laundry list.

The Physicians for a National Health Program are bitterly critical of Obama, just as Paul Krugman and others have been. But they’re not too keen on Hillary Clinton’s plan, either. Both are seen as half-measures at best. The current Democratic debate, especially in Ohio, is occurring in blissful if bitter ignorance of the more fundamental issue, which is why outcomes in the US—infant mortality, longevity, wellness, obesity and other embarrassments—are so much worse, and so much more expensive, than in countries with nationalized systems.

Nader and his allies could nudge the debate into sharper clarity if they would focus: The Nader candidacy is marginal. The healthcare issue is absolutely central.

If the campaign’s populist moment is allowed to lapse without any sharpening of the issue, then the November debate between the Democrat and John McCain will itself be about differences on the margin—between a tepid Democratic plan to extend insurance coverage to the working poor versus McCain’s criticism of taxes.

Nader has an opportunity to be relevant, and to disappoint all those observers who accuse him of a candidacy of narcissism rather than a candidacy of principle.

Other more learned doctors can diagnose him from a distance. It’s the debate on healthcare itself that needs a remedy. It needs to get better quick.