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Why the alt-right loves single-payer health care

Richard Spencer conference
Richard Spencer speaks before a panel of Peter Brimelow, Jared Taylor, Kevin MacDonald, and a man who only goes by the name 'Millenial Woes' at a conference by the National Policy Institute in Washington, DC on November 18, 2016.
Linda Davidson/The Washington Post via Getty Images
Dylan Matthews is a senior correspondent and head writer for Vox's Future Perfect section and has worked at Vox since 2014. He is particularly interested in global health and pandemic prevention, anti-poverty efforts, economic policy and theory, and conflicts about the right way to do philanthropy.

When Mike Cernovich, one of the most prominent alt-right internet trolls supporting Donald Trump, was interviewed on 60 Minutes, he used the platform to spread conspiracy theories about Hillary Clinton's health and to allege that she is involved with pedophilic sex trafficking operations. But he also declared his belief in single-payer health care.

"I believe in some form of universal basic income," he told CBS’s Scott Pelley, citing concerns about technological unemployment. "I’m pro-single-payer health care. Is that right-wing or is that left-wing anymore? Well, if you have a lot of people, a large swath of the company, or country, are suffering, then I think that we owe it to all Americans to do right by them and to help them out."

This might seem like a bizarre position for a far-right conspiracy theorist to take. Single-payer health care, after all, entails nationalizing most or all of the health insurance industry and having the government set prices for doctors’ services. Conservatives in America have spent the better part of the past century arguing that the idea is socialistic, would lead to long waits for lifesaving treatment, and would give the government power over the life and death of its citizens.

But Cernovich is less a traditional conservative than he is a Trumpist — and Trumpism in its purest, alt-right variety cares more about white working-class identity politics than traditional conservatism. More and more, Trump fans are seeing single-payer as part of that.

Alt-rightists and other Trump-loyal conservatives — Richard Spencer, VDARE writer and ex–National Review staffer John Derbyshire, Newsmax CEO and Trump friend Christopher Ruddy, and onetime Donald Trump Jr. speechwriter and Scholars & Writers for Trump head F.H. Buckley — all endorsed various models of single-payer in recent months and years.

Even elites in the alt-right mold who once deplored single-payer are changing their tune. Pat Buchanan, the paleoconservative three-time presidential candidate whose white identity politics and fiercely anti-trade and anti-immigration stances helped inspire the modern alt-right, had free market views on health care in the 1990s and condemned Obamacare as a scheme to kill Grandma in 2009. This week, he told me in an email he has “not taken any position on single-payer, and [has] pretty much stayed out of the Obamacare repeal-and-replace debate.”

Curtis Yarvin, a Silicon Valley programmer whose writings under the pen name Mencius Moldbug helped launch the neoreactionary branch of the alt-right, told me he welcomes the movement’s trend toward single-payer, viewing it as a “sincere effort to think realistically in the present tense rather than in abstract ideology.”

Insofar as the alt-right, and the Trump-supporting right more generally, have a coherent economic agenda, it’s a vehement rejection of the free market ideology crucial to post–World War II American conservatism. While Paul Ryan reportedly makes all his interns read Atlas Shrugged, figures like Cernovich, Spencer, and Derbyshire are trying to build an American right where race and identity are more central and laissez-faire economics is ignored or actively avoided.

This has been most obvious on immigration and trade, where libertarians’ opposition to most or any government restrictions is in tension with the alt-right’s economic nationalism. But it’s also true on health care, where the pure alt-righters are joined by more mainstream pro-Trump voices like Ruddy and Buckley and even some Trump-wary conservatives such as Peggy Noonan.

The Trump-supporting right’s case for single-payer is part of a vision of a party where ideological purity on economic issues is much less important, and where welfare state expansion can be accommodated if it serves other goals — like building a political base among working-class whites.

The welfare state has always been more popular with the Republican base than with its elected officials. Trump arguably won the presidency in part by being the first Republican in years to promise to protect Social Security and Medicare. My colleague Sarah Kliff has run focus groups with Trump voters where participants bring up their admiration for Canadian-style single-payer unprompted. The alt-right single-payer fad suggests that elites are finally catching up.

The ultranationalist case for single-payer health care

Some of the arguments that the Trumpists and alt-rightists offer for single-payer are the standard concerns about the plight of sick and suffering Americans that wouldn’t feel out of place in a Bernie Sanders speech — like Cernovich’s insistence that “we owe it to all Americans to do right by them, and to help them out.”

Other arguments are offered more in sorrow than in anger. Derbyshire, for example, laments the fact that Americans are unwilling to accept a true free market in health care — but argues that single-payer makes more sense than the current hodgepodge of insurance subsidies and regulations and tax breaks.

“Citizens of modern states will accept no other kind of health care but the socialized or mostly socialized kind,” he said on a 2012 episode of his podcast, Radio Derb. “This being the case, however regrettably, the most efficient option is to make the socialization as rational as possible.” Single-payer, he concludes, would involve “less socialism, and more private choice,” than “what we now have.” (Derbyshire doesn’t really explain why socializing insurance is less socialist than not socializing insurance.)

But the main argument offered by Trumpists is about their movement. Donald Trump famously promised in May 2016 to turn the Republican Party into a “workers’ party.” The implication was clear: Republican elites before him like Paul Ryan and Mitt Romney prioritized deregulation for businesses and tax cuts for the rich, and offered little or nothing for working-class people, specifically working-class white people. Instead, the party relied on social issues like abortion and immigration to earn their votes.

F.H. Buckley, the George Mason University law professor who led Scholars & Writers for Trump, even approvingly cites the leftist writer Thomas Frank’s What’s the Matter With Kansas? on this point. “Frank asked how it was that the poor folks of his home state voted for a Republican Party that cared so little for their economic interests,” Buckley wrote in the New York Post. “Become the jobs and the health-care president, and you [Trump] will have answered Frank’s question.”

“Steve Bannon has said the Republicans will become a party of ‘economic nationalism,’” Buckley continued. “No one has bothered to define this, but here’s one thing it must mean: We’re going to treat Americans better than non-Americans. We’re going to see that Americans have jobs, medical care and an enviable safety net.”

Of course, the Trumpists are big fans of using racialized, not explicitly economic appeals on issues like immigration and crime to win votes. But whereas they see mainstream Republicans like Paul Ryan or Jeb Bush making those appeals as a smokescreen for unpopular economic policies, they want to pair the appeals with an nationalist economic agenda that is actually popular with these voters.

“Unlike Paul Ryan and Rich Lowry, who masturbated to Atlas Shrugged in their college dorms and have no loyalty to their race, Donald Trump is a nationalist,” Richard Spencer writes. “We can’t ignore the politics of this. If Trumpcare passes, leftists can credibly claim that Trump has betrayed his populist vision. They will recycle the hoary script about nationalism and ‘scapegoating’ immigrants as a means of pushing through a draconian agenda. And they’ll have a point!”

Single-payer, Spencer insists, would "serve our constituency" (read: white people), give the right an answer to the appeal of social democrats like Bernie Sanders, and encourage the growth of the alt-right movement: "So many writers, activists, and content creators on our side shy away from becoming more involved, not just out of fear of social punishment, but out of fear of being fired and losing their health insurance."

Moreover, as soon as health care becomes a public issue, an alt-right government could use that power to promote a more vigorous, healthy white race on a number of dimensions. "When single-payer healthcare is implemented, issues like food safety, nutrition, and obesity become matters of public concern,” Spencer writes. “It will draw more attention to the alternative we are presenting to America’s current lowest-common-denominator society."

Of course, single-payer would overwhelmingly benefit a lot of nonwhite Americans as well. But programs like Social Security and Medicare do too, and their universal nature and the fact that they’re tied to work have led them to be less racialized and stigmatized than cash welfare or Medicaid. Single-payer’s universality is appealing because it helps the white working class without making them enroll in means-tested programs traditionally associated with black and Latino beneficiaries.

This is a key strategy of the far right in Europe

French Presidential Candidate Marine Le Pen Holds A Rally Meeting In Lille
Marine Le Pen on the campaign trail in Lille.
Sylvain Lefevre/Getty Images

The ideological vision being offered here is hardly original. The political scientist Sheri Berman has argued that fascism and nationalism succeeded in Europe before World War II largely because unlike traditional conservative parties, fascist parties could provide a real challenge to the social democrats’ promise of relief from the suffering of the Great Depression.

"Across Europe nationalists began openly referring to themselves as 'national' socialists to make clear their commitment to ending the insecurities, injustices, and instabilities that capitalism brought in its wake, while clearly differentiating themselves from their competitors on the left," she writes in The Primacy of Politics.

And more recently, this strategy been adopted by some far-right parties in Europe. Marine Le Pen, the leader of France’s Front National, has relied heavily on "welfare chauvinism” in her presidential bids, a promise to protect and expand social programs for (white) native workers against migrants who might exploit them and drain money that should be going to noble French citizens. Geert Wilders, the far-right leader in the Netherlands, used to be a small-government conservative but began publicly fighting cuts to health programs and calling for expanded pensions once it became clear that this appealed to the lower-income voters who loved his anti-Islam message.

This trend isn’t universal; the Freedom Party in Austria, for example, was a traditional laissez-faire party on economics. But it’s become a popular strategy for several parties, from the Finns Party in Finland to the Danish People’s Party to the Sweden Democrats, whose leader once tweeted, “The election is a choice between mass immigration and welfare. You choose.”

And American far-rightists have noticed. James Kirkpatrick, a fellow writer of Derbyshire’s at VDARE (an anti-immigration site named after the first white person born in the American colonies), has approvingly cited the nationalist, authoritarian Polish Law and Justice Party’s strategy of tacking left on welfare to tack right on everything else. The country’s “patriotic government,” he swoons, “outflanked the Left and strengthened its grip on power with universal health care.”

The difference between those parties and Trump’s would-be workers’ party is that European countries already have universal health care. And one thing that happened once it was established is that mainstream conservative parties got on board with its preservation. The British Conservatives and the Gaullists in France and the Christian Democrats in Germany don’t try to repeal their countries’ universal health care systems. At most, they push for market-based reforms that retain universality but maybe introduce some more copays or an increased role for private insurers and providers.

When that’s the mainstream right-wing alternative, a right-wing party that calls for expanding welfare and health benefits seems more plausible. More to the point, most of the countries enjoying a far-right resurgence employ some system of proportional representation, which allows new parties without much political base to quickly gain ground in the legislature. Tellingly, while Le Pen does well in France’s presidential elections, there are only two Front National members in its National Assembly, which elects by district à la the US or UK.

So even if Trump were to be persuaded by his followers and embrace single-payer, he’d face a tough task. He can’t form a new right-wing party and sweep the legislative elections; he has to change the policies of the existent Republican Party, which has spent decades fighting proposals for universal health care, and get a quorum of members in the House and Senate on his side. That’s much harder, and suggests that the Spencers, Buckleys, and Derbyshires of the world won’t get their wish on this anytime soon.