Four of the five leading Democrats for President, Senators Corey Book (NJ), Elizabeth Warren (MA), Bernie Sanders (VT) and Kamala Harris (CA) have come out in favor of a single-payer system citing their support for building off the success of the Affordable Care Act despite House Minority Leader Nancy Pelosi saying the “public just isn’t there on single-payer. She’s right. But the base is and right now they are the ones pushing the potential 2020 nominees to the left.
Political infighting has led to turmoil in the GOP. The national environment is tilting toward Democrats and the boogeyman of Nancy Pelosi, while strong, will likely only give the GOP so much of an edge in already red districts. While Democrats talk up their chances in these reddish hued districts until a wave forms it is just that. Talk!
But, the same cannot be said for the two dozen or so truly purple districts the GOP holds from coast to coast. In these places, merely running against Pelosi will not be enough. With Trump probably dragging Republicans down they will need another foil to attack. Democrats might give it to them in support of single-payer care.
It is easy to see why the leading Democratic Presidential candidates are being forced to support it. In a Pew survey in June only 33 percent of the public supported single-payer but 52 percent of all Democrats did. Additionally, as more Democrats identify as liberal more support single-payer. But, that’s Democrats. Not the voting public.
For all the failures of the ACA the one thing it did do was preserve for the status quo for affluent families with private plans and largely left the employer-coverage market alone. Insurance companies were brought into the plan via generous subsidies to cover low-income Americans and the middle class (while being charged more) had their costs kept low by the same subsidies to insurance companies.
A single-payer system, whether it be Medicare-for-all, a system modelled more along the lines of the UK’s NIH or a hybrid between private and government more along the lines of Germany or Switzerland, would definitely upend the entire market.
It is important to keep in mind that many of the GOP held districts Clinton won are suburban, affluent, well-educated and dominated by many households that rely on employer provided insurance. In other words, these are exactly the kind of voters most directly by a single-payer system yet at the same time most likely to be willing to back a Democrat for Congress.
The trick for Republicans would be turning their worry about a single-payer system into something tangible by next year. After-all, Democrats are a minority in many states and Republicans control all the levers of the federal government. However, Democrats embrace of single-payer combined with an improving economy might give the GOP the edge they need going forward.
In 2008, both Barack Obama and Hillary Clinton recognized the limits of support for a single-payer system. While Obama advocated for a “public option” in 2008 he did so in the context of it being used next to private options. Clinton only grudgingly supported a “public option” in 2016.
The reasoning for this is simple besides the above. There are simply other, more politically palatable, solutions to cover uninsured Americans and hold down costs. Yes, they all require more involvement but they also allow ordinary Americans to acquire private insurance if they want.
Plus, there may be more politically viable ways of expanding coverage. They all have their political risks but expanding Medicaid in the 19 states that have not, covering immigrants, and extending CHIP would be a good start. Or even AmeriCare.
Democrats should realize how politically risky going all in on single-payer is. They have a case study in Vermont. In 2010, Governor Peter Shumlin and the legislature looked into the costs of a single-payer system called Green Mountain Care. They weren’t good. Despite four years of efforts there simply was no way for residents or businesses to afford the costs of the system-11.5 percent payroll tax plus a sliding-scale income tax that peaked at 9.5 percent Residents were so annoyed at the effort they replaced him with his GOP Lt. Governor last November.
Plus, the opponents of single-payer would surely be numerous. Big Pharma, large hospitals, many individual care providers and the insurance companies would join efforts to block such a plan. Once can see the GOP drawing up attack ads based on ideas like life-saving drugs stagnating.
If Democrats are smart they will walk back from this ledge and discuss other alternatives. If not, Republicans might have just been handed a gift from the Gods for next year and 2020.