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    Nancy Pelosi talks sense to the left

    Lesley Becker/Globe Staff;Adobe; Globe file photos
    Lesley Becker/Globe Staff;Adobe; Globe file photos

    Never mind the Profile in Courage award the Kennedy-Industrial Complex will bestow on Nancy Pelosi next month. What the House speaker truly deserves is a Profile in Progressive Pragmatism Award for her political common sense. Sometimes she seems like the only national figure willing and able to speak in a principled but practical way to both President Trump and her party’s own left wing.

    In a sterling display of toughness, she started the year by staring down this reckless president over his idiotic government shutdown. But she also put an early damper on the Democrats’ premature impeachment impulse. And she is now waving a cautionary flag at the charge led by Senator Bernie Sanders of Vermont for a single-payer health care system.

    In a recent interview with The Washington Post, Pelosi said that her preferred health care path is to build on the success of the Affordable Care Act, and not to start from scratch with a single-payer system. Although she prefaced her remarks by saying she was “agnostic” on single-payer, her subsequent comments made it clear she’s skeptical.


    “Show me how you think you can get there,” Pelosi said. “We all share the value of health care for all Americans — quality, affordable health care for all Americans. What is the path to that? I think it’s the Affordable Care Act, and if that leads to Medicare for all, that may be the path.”

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    Here, Pelosi, the nation’s most influential Democratic officeholder and one of its shrewdest tacticians, did two important things: She made clear that the smart political route forward is to defend and improve the Affordable Care Act. And she subtly reinforced the idea that movement toward so-called Medicare for all should come in smaller, popular steps rather than a sweeping, ACA-ending initiative. After all, any single-payer component that becomes part of Obamacare wouldn’t be a wipe-the-slate-clean start-over but rather a limited step, such as adding a public option to the ACA or letting Americans under 65 buy into Medicare.

    That’s not, of course, what Sanders wants to see. The Vermont independent advocates a full-scale single-payer system, with the government paying — and setting rates for — almost all of the nation’s health care.

    That, as Pelosi warned, would create some very real political problems.

    “A lot of people love having their employer-based insurance, and the Affordable Care Act gave them better benefits,” said she. Now, love may not be le mot juste to describe most Americans’ feeling toward their health insurers, but certainly many people are reasonably content with their current coverage.


    Trump has already signaled that he wants to run for reelection in part by accusing the Democratic field of racing toward a full embrace of a disruptive single-payer scheme. Actually, aside from Sanders and (arguably) Kirsten Gillibrand, seemingly no other Democratic candidate is an enthusiastic supporter of a full-bore single-payer system. Indeed, Pelosi might well have been speaking of them when she told the Post, “When most people say they’re for Medicare for all, I think they mean health care for all.”

    Although single-payer has some primary-campaign appeal, “attacking President Trump for his efforts to roll back the ACA and protections for people with preexisting conditions will be a message that attracts much broader support in the general election,” notes Larry Levitt, senior vice president at the Kaiser Family Foundation.

    Meanwhile, anyone who thinks Democrats should blithely campaign on replacing employer-provided health care should review the way the GOP used Barack Obama’s false claim that anyone who liked their doctor would be able to keep their doctor under the ACA as a political cudgel.

    Single-payer advocates note that their favored policy attracts majority support — and that’s true, at first blush. But according to a recent Kaiser Family Foundation poll, 58 percent oppose such a plan if it would mean eliminating private health insurance companies. That opposition hits 60 percent if such a plan would require most Americans to pay more in taxes.

    So it’s a risky (medical) bag as a political proposition. Kudos to Pelosi for using her unique position in American politics to talk liberal common sense to the true believers.

    Scot Lehigh can be reached at lehigh@globe.com. Follow him on Twitter @GlobeScotLehigh.