Gramsci Is Alive and Well at Yale

The latest New England Journal of Medicine contains an essay by Yale political scientist Jacob Hacker laying out his roadmap for universal health care coverage. His plan, released earlier this year by the Economic Policy Institute, would give Medicare-like coverage to everyone without insurance. He would finance the plan with a tax on employers who fail to provide their employees with private health insurance.

He frames his well-written piece as a critique of Michael Moore's film, Sicko. Moore, he says, calls for "evicting insurance companies and establishing a national health program instead."

It is an appealing vision, in many ways. We could use more populism and less caution in our health care debate. But it is also unrealistic.

Read Hacker's essay here, and see for yourself why most progressives -- even those like myself who support a single-payer national health insurance plan -- will be lining up behind some version of the Hacker plan as the health care debate unfolds. If enacted, it will not only provide universal coverage, it will create incentives for employers to gradually shift their own workers into the public plan and drop private coverage. Over time, Hacker suggests, the public plan will evolve into "Medicare for all," a single-payer system that will make the U.S. -- finally -- more or less like the rest of the civilized world.

For those who don't get the reference in the headline, Antonio Gramsci was an Italian communist, imprisoned by Fascist leader Mussolini from 1926 until his death in 1937. He believed the radicals of his day should push for reforms whose enactment would gradually move a nation toward socialism without violent revolution. The post-war Italian and French Communist parties largely embraced his vision by becoming indistinguishable from pre-war social democratic parties.

Clearly, a latter-day Gramsci is alive and well at Yale. The difference here is that Hacker wants to pull a moribund Democratic Party out of the clutches of the special interests and put it once more on the path of transformational reform.