The debate among the Democratic presidential candidates about universal health coverage calls to mind a couple of political truths. First, most things that sound too good to be true are, in fact, not true. Second, if you want to take away a public benefit, you’d better have a good replacement for it first.
Three candidates are for full-blown Medicare for All, which means eliminating all employer-provided private insurance. Senators Bernie Sanders and Elizabeth Warren and Mayor Bill de Blasio argue that only this fundamental restructuring of our health care system will cover all Americans. The idea seems popular on the surface. According to a poll from the Kaiser Foundation, 56% of Americans say they support full Medicare for All. But when respondents are told important details about the plan – like how much it costs, and how it abolishes private insurance — that number slips.
In similar polls, when voters are presented with the full details of the Sanders and Warren plans, support falls dramatically. A poll done by David Binder for Third Way found a dramatic drop when factoring in the cost, the increase in payroll tax to pay for it, and the potential for the GOP-controlled Congress to have ultimate control of health care decisions including reproductive rights. That last piece of info drops support for the program to only 23% of Americans.
You can expect the Trump campaign to spend a lot of time and money exposing Medicare for All as too good to be true. But the main reason most of the Democratic field is not with Sanders and Warren has to do with that second rule of politics.
Both Sanders and Warren would advocate taking away the benefit of employer based private insurance – before anyone begins to receive the tangible benefit of going to full blown Medicare for All. And Americans’ first encounter with such a program would be those higher payroll taxes.
Perhaps some think that employers, relieved of providing insurance coverage, will pass along those savings to employees to help ease the burden of increased payroll taxes. But where is the evidence of such corporate behavior, particularly in the aftermath of the Trump corporate tax cut? Stock buybacks aren’t going to help people faced with higher tax rates.
Most in the Democratic field are mindful of these realities, and favor what Mayor Pete Buttigieg calls Medicare for those who want it. They differ on the details, but the concept is that voters should have a choice: they can keep their employer-based private insurance or pay into Medicare at a much cheaper rate. Joe Biden told Chris Cuomo that the right way is to build on Obamacare, not to abandon it.
Now if you were around in 2009-2010, it’s hard sometimes to think of Obamacare as popular. But despite relentless Republican attacks, the benefits provided – guaranteed insurance and coverage of pre-existing conditions – are now seen by many as a benefit to which they’re entitled. Moving to Medicare for those who want it is a logical next step toward a single-payer option, one that maintains choice for millions of Americans.
As much attention as Medicare for All gets, as proposed by Senators Sanders and Warren it is a political loser. Note that Senator Kamala Harris has yet to make up her mind on this subject.
I believe it’s critical for Democrats to maintain their advantage on health care going into 2020, and the best way to do that is to reject Medicare for All and embrace Medicare for those who want it. To put it more starkly, Democrats should listen to one of the most respected Democratic political scientists, William Galston. He told the Wall Street Journal, “If Democrats back single-payer health care, it could assure Trump’s re-election.”
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Medicare for All may eventually be good policy, but for now it’s bad politics and risks what should be the number one goal of all Democrats: to remove Donald Trump at the ballot box and get to work undoing the damage he’s done to the country.