Health care buoyed Democrats in the 2018 midterms, but if they’re not careful, it might land them in a sea of trouble in the 2020 presidential election.
On the face of it, Democrats should have an advantage here. President Trump, who promised health coverage that would be much cheaper and much better than the Affordable Care Act but has produced nothing by way of such a plan, wants Congress to try again to repeal his predecessor’s signal achievement. But having been electorally singed by their unsuccessful 2017 effort, congressional Republicans have little interest in that.
Still, the administration is backing a legal challenge to the law that’s now at the appeals court level. Certainly Democrats can fairly say that, if he wins reelection, Trump will keep up his effort to torpedo Obamacare. So health care should be a strong issue for the Democrats again.
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Unless they blunder and hand the matter to the GOP, that is. And there’s reason to worry. Joining independent-running-as-Democrat Bernie Sanders, first-tier Democratic presidential hopefuls Elizabeth Warren and Kamala Harris have now signed firmly on to single-payer health care, whereby the federal government would set medical payment rates, pay medical bills, and raise the tax revenues necessary for a private-premium-free system. Both indicated their support in the recent Democratic debates.
It’s Sanders, a proud democratic socialist, who has driven the single-payer train. He insists “Medicare for All” is a realistic American solution, noting that many developed countries have some form of a single-payer system. That’s true, but it’s also true that medical sector pay is often significantly lower in those countries than it is here. To work as advertised, Sanders’ benefit-generous single-payer plan would have to reduce compensation to doctors, as well as to hospitals.
And what happens if you want to keep your current employer-sponsored health-insurance plan? Such plans, after all, currently cover some 165 million Americans. You couldn’t; a single-payer system would mean the end of employer-sponsored coverage. Remember the controversy when several million people were forced to give up plans that didn’t meet ACA standards? This disruption would make that one look like a gentle summer rain.
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“The opposition ads attacking the end of private insurance would be pretty easy to write,” notes Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.
Since Warren and Harris had previously been ambiguous about single-payer, I posed some questions to each camp. Do they support Sanders’ four-year transition period? How would they fund single-payer, and what do they say to those who prefer to keep their employer-sponsored plans?
Despite repeated efforts, I got little by way of relevant responses from Harris’s campaign. “As she has for more than two years, Senator Harris supports the Medicare for All bill,” e-mailed Nate Evans, Harris’s New Hampshire communications director. And that was it.
Warren’s camp was a bit better, but still fell well short of providing the answers I sought. Yes, Warren favors “transitioning from private insurance to Medicare for All,” e-mailed Saloni Sharma, a Warren spokeswoman, adding: “Private insurance companies raked in $23 billion last year while premiums skyrocket and prescription drug costs are going through the roof.” For perspective, that’s a profit of about 3.3 percent. I got no response to my follow-up questions about paying for the system. Or about her message to those who wanted to keep their current insurance arrangement.
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And that’s telling. On an issue of this magnitude, a candidate’s stand needs to be cogent, well conceptualized, easily explained, and defensible to lay people.
Adding a public option or Medicare buy-in to the ACA passes that test. Single-payer doesn’t, at least not the way Harris and Warren and their campaigns are going about it.
If they’ve adopted their firmer positions simply to stave off Sanders, then they have made a serious miscalculation. If on the other hand, they truly believe in single-payer, then they need to develop a much better, deeper, and persuasive case than they have thus far.
Scot Lehigh can be reached at lehigh@globe.com. Follow him on Twitter @GlobeScotLehigh.