By William A. Galston
As the campaign for the presidential nomination heats up, the Medicare for All proposal that became popular with Democrats on the stump in 2018 risks pushing Democratic candidates into a trap in 2020. A political party is asking for trouble when it embraces a position on a high-profile issue that most Americans reject. But it’s not easy for a party to avoid this pitfall when a majority of its own members endorse such a position.
A recent Politico/Morning Consult survey found that endorsing Medicare for All rather than improving the Affordable Care Act did more than any other issue to increase rank-and-file Democratic enthusiasm for a prospective nominee. Fully 57 percent of Democrats said they would be more likely to support such a candidate, compared to just 22 percent who said less likely, and 37 percent said that they would be “much more likely” to do so.
So it was no surprise that at a town hall meeting soon after announcing her candidacy, Senator Kamala Harris vigorously backed Medicare for All. But many observers were surprised when, citing excessive paperwork and delays in the approval process, she told the moderator, CNN’s Jake Tapper, that she wanted to get rid of private health insurance altogether. “Let’s eliminate all of that,” she said. “Let’s move on.”
Harris’ version of Medicare for All means private insurance for none. Even if you like your private plan, you can’t keep it. And many Americans do like their private plans, which is why they find proposals like Harris’s so troubling.
According to the most recent Kaiser Family Foundation survey, 56 percent of Americans initially favor the idea of Medicare for All, in part because they believe that they would be able to keep their current insurance if they choose. But when they are told that versions of this proposal would eliminate private health insurance options, support dwindles to just 35 percent.
But here’s the dilemma for Democratic presidential candidates: even when voters who identify as Democrats are told about Medicare for All’s impact on private insurance, 57 percent continue to favor it. The same percentage still favor it after they are told that it would “require most Americans to pay more in taxes,” a consequence that only 35 percent of the electorate as a whole is willing to accept.
These findings go against the lessons from recent history. First Lady Hillary Clinton failed in her health care reforms in part because people were afraid they would no longer be able to keep their private insurance. With that lesson fresh in his mind, President Obama stated that people would be able to keep their current insurance, only to be confronted with outrage when it turned out that wasn’t the case for people who had bought policies the Affordable Care Act deemed inadequate.
As we turn to the 2020 Democratic primaries it seems that the candidates face a stark choice between pleasing Democrat voters during the primaries and the whole electorate in the general election. But there’s a way out of the trap. By a margin of 51 percent to 39 percent, rank-and-file Democrats want the new Democratic majority in the House to focus on improving and protecting the ACA rather than passing Medicare for All.
In addition, several versions of Medicare expansion enjoy overwhelming support. 77 percent of Americans favor allowing people between the ages of 50 and 64 to buy health insurance through Medicare. 74 percent support a broader plan that could be called “Medicare Open to All,” which would enable everyone to buy into Medicare but would allow people to keep the coverage they have. 49 percent of Americans “strongly” back this approach, and by a margin of 10 percentage points, Democrats prefer it to Harris’s plan.
So there’s a way for Democratic candidates to square the circle. First, support improvements in the ACA, such as protecting people with health insurance from high out-of-network medical bills without advance warning, along with restraints on prescription drug costs. Second, endorse Medicare Open to All. And third, during the candidate debates, unapologetically explain why you oppose forcing people to give up private insurance and pay higher taxes.
In the 2018 campaign health care was a winning issue for Democrats. The 2020 candidates who can’t win this debate should find another line of work, and a party that ends up on the wrong side of it is giving up its best issue and courting defeat.
Source: The Brookings Institute
