How Democrats Can Win (Or Lose) On Health Care Reform


Appearing on MSNBC’s All In with Chris Hayes, who is perhaps his greatest media booster, Sen. Bernie vowed to introduce legislation calling for “a Medicare-for-all, single-payer program” — essentially, the much-dreaded socialism of single payer health care. After Republicans failed to pass their ‘repeal and replace’ legislation, Rep. Keith Ellison, a Sanders ally on the Democratic National Committee, told activists to go all the way: “Don’t just be satisfied with defeating Trumpcare — set your sights on creating real Medicare for all!”

Contrary to the articles of faith in progressive politics as voiced by Sanders, having “the guts to take on the insurance companies and the drug companies” is not enough to achieve single payer in the next election cycle. It’s not an advantageous bargaining position, or a winning campaign issue.

About 150 million Americans — roughly half the population — receives health insurance through their employers. A large percentage of these people will revolt against any effort to shove them off their plans and onto Medicare, and that’s not just a Republican talking point. After all, we just had a practical demonstration of what happens when lawmakers try to take insurance away from 24 million Americans. ‘Medicare for all’ lacks an electoral constituency big enough to overcome that kind of opposition. Whatever public opinion polls may say about the issue in the abstract, when push comes to shove, voters protect what they already have. We will see that truth in action again when Sanders’s legislation goes nowhere.

But it is possible to push the nation in the direction of single payer by increments, and luckily, most of the policy work has already been done.

Instead of explicit ‘Medicare for all’ agenda, Democrats would do better to build a health care platform that includes Medicare buy-in for Americans age 55 and up, that shores up the individual markets, that includes a public option — basically, all the progressive proposals that didn’t make the cut when Democrats were formulating the Affordable Care Act. No longer the same political party they were in 2010, Democrats should add language to counter the deleterious effects of Donald Trump’s administrative harms to the ACA.

While they run hard on this platform, Democrats should focus pressure on HHS Secretary Tom Price, who will do most of those harms. Indeed, Democrats would be wise to borrow one of the Republicans’ most effective tactics by suing the Trump administration when it fails to enforce the ACA, or tries to undermine it.

In other words, Democrats can win if they pick a winnable series of fights and keep public attention fixed on them. Admittedly, this will be difficult for a party that has never learned to echo the same talking points, much less march in lockstep. But it would be a far easier sell for both Democratic office-holders and the American electorate than ‘Medicare for all.’

Progress is very possible, but a sudden shift to single payer will not happen. Anyone who says otherwise is admitting they still don’t understand why the socialist argument has consistently failed at the ballot box. You cannot change the minds of half the voters by talking at them about the wonders of socialism more.

I say this as a staunch defender of the Canadian system, and not as a criticism of Sanders or Ellison, or even the logic of single payer health care. It’s just that in 2018, the political logic of the incremental approach — regarding ‘Medicare for all’ as a journey rather than a destination — will prove more popular than a radical realignment.

Featured image via Gage Skidmore Flickr under Creative Commons license

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