Post-primary analysis: Why Hillary won't fight for affordable health care

by Daniel R. Hoffman, Ph.D.

Published Apr. 27, 2016, 11:06 a.m. ET

In very succinct terms, here's the issue.

Health care now consumes 16.5% of GDP. The rising costs of Medicare represent the single biggest contributor to America's growing national debt and, even now, serious illness is the most common factor in personal bankruptcy. Among the health care sectors, drug costs are the fastest growing component of overall spending.

If the unregulated "free" (i.e., corporate controlled) market continues to run health care, the country will spend 20% of its GDP on that sector within a decade. Once health care consumes 20% of GDP, it will erode American competitiveness in global commerce as a result of devouring such an inordinate proportion of the country's wealth. So moving slowly to make health care affordable can put the entire American economy into disarray and turn the U.S. into a second-tier nation. Adopting a single-payer system ASAP is the only proven means of controlling costs, improving access and maintaining quality.

If she is elected president, the likelihood is that Hillary Clinton will address the problem of increasingly unaffordable drug and other health costs only in a negligible, go-slow fashion. Here's why.

1. Her core constituency consists of conservative and moderate Democrats.

As Bernie Sanders' campaign for the nomination fades into the sunset, Hillary supporters claim she will move toward his positions on health care, affordable tuition and Wall Street control because she needs to attract his supporters of young people and liberals. Rubbish. Her core constituency consists of voters over age 45 and those Democrats who do not consider themselves as liberal. These more conservative Democrats have overwhelmingly supported her in states that she won (e.g., New York) as well as those where she lost (such as Michigan). Voters in that group either fail to understand single-payer health care or oppose it. Since people in that segment are typically more reliable voters with a higher turnout percentage than the young who favor single-payer, she is unlikely to forsake them for Bernie supporters who remain cool to her in any case.

2. White men who generally oppose single-payer are the constituency Hillary will increasingly court going forward.

Men usually place a lower priority on health care issues and Hillary does poorly among white men, even in states where she wins. In her resounding New York victory, for example, Sanders won 58% of the white male vote.

Some Hillary supporters claim she will not alter her positions to attract white men because her margins among women are so large that she can win a general election by combining their votes with majorities among blacks and Hispanics. They claim those groups, plus the young, created Barack Obama's path to both of his presidential victories.

Although a modified version of the Obama plan (more women, fewer young people) appears plausible for Hillary, the reflexes she developed during more than twenty years in politics have been to adopt conservative and militaristic policy positions designed to attract white men. This includes her work as Secretary of State, U.S. Senator, and the 1993-2001 period as her husband's "co-president."

Hillary's supporters and the media, in an effort to limit Sanders' criticisms, have emphasized the importance of young people and other Bernie voters for a Clinton victory in the general election. They argue that her need to attract this voting bloc will oblige her to adopt progressive positions on drug costs and health care.

Hillary would doubtlessly benefit from gaining the Sanders voters, but a seasoned politician with her New Democrat persuasion will court them with lip service and then abandon them once she gets into office. Her reasoning is that the Sanders supporters have nowhere else to go. By contrast, white men in both parties have another candidate who generates more enthusiasm among them in both parties than anyone since Ronald Reagan.

Last week's post argued that Hillary Clinton's financial ties to the pharmaceutical industry make it unlikely she would rein in drug costs. Her background as a conservative technocrat who prefers small, mincing steps make it even less probable she would try to overhaul the broader health care system by advocating for a single-payer system. The point this week is that her current voter base, together with the one she feels she must entice, further diminish the chances of her grappling with the corporate interests in pharma and health care. Next week's post will look back on Hillary's record during the first Clinton presidency to see whether that provides a ray of hope.