On Tuesday, more than 100 Democrats in the U.S. House of Representatives co-sponsored a bill to introduce a universal publicly funded health-care system, putting Medicare for all solidly on the political agenda as their party begins the process of selecting a 2020 presidential nominee.
This House version of the bill reprises the main elements of the Medicare-for-all legislation that Vermont Senator and 2020 presidential candidate Bernie Sanders tabled in 2017, with one important distinction: Mr. Sanders’s bill would entirely eliminate private health insurance in the United States, while the House version would let Americans purchase supplemental private coverage for some services not covered by the public plan.
Nevertheless, both bills represent a paradigm shift in U.S. politics.
Not long ago, not even liberal Democrats would have dared telling Americans with private coverage that they would have to give up their current health plan in favour of a government-provided one. The two most recent Democratic attempts at overhauling the health-care system – an unsuccessful one by president Bill Clinton in 1993 and president Barack Obama’s successful passage of the Affordable Care Act in 2010 – focused on providing coverage for only uninsured Americans. But both were based on preserving the private core of the U.S. system under which the majority of Americans are covered by employer-provided health plans. Both wholly rejected the concept of “socialized” medicine.
Mr. Sanders broke that taboo during his 2016 run for the Democratic nomination against Hillary Clinton. Ms. Clinton bore the scars of the 1993 battle over health care that she waged on behalf of her husband. That experience explained her cautious approach during the campaign, when she proposed strengthening the Affordable Care Act, under which low-income Americans without an employer plan are eligible for subsidies to purchase a private plan of their own. Under the ACA, the federal government also tops up grants to states that have expanded Medicaid programs for the very poor.
“I don’t want us to be thrown back into a terrible, terrible national debate,” Ms. Clinton said in 2016. “People with health emergencies can’t wait for us to have a theoretical debate about some better idea that will never, ever come to pass.”
Since then, a new generation of progressive Democrats, for whom socialism is not a dirty word, has signalled its unwillingness to accept incremental change. For these Democrats, Medicare for all is not an aspirational goal. It is a 2020 imperative.
This has put most of the Democrats who have so far declared their candidacy for the nomination in a dicey position. Except for Mr. Sanders, who has long embraced the democratic-socialist label, most others have offered conditional support for Medicare for all. They are twisting themselves into knots to explain their positions.
This is particularly true of California Senator Kamala Harris. After first declaring her support for the elimination of private health coverage during her first visit to Iowa last month, she backtracked almost completely on her second trip to the first caucus state on Saturday: “In my vision of Medicare for all, there would be a phasing-in of it, and there would still be the option to have private insurance for supplemental coverage."
This illustrates the trap Democrats have set for themselves in making Medicare for all a central campaign issue. The existing federal Medicare program, which provides health coverage for Americans over the age of 65, is already considered financially unsustainable. The Office of the Actuary at the Centers for Medicare and Medicaid Services recently projected that Medicare spending will rise by 7.4 per cent a year between 2018 and 2027, compared with a 4.8-per-cent annual increase in the private system.
Expanding Medicare to cover everyone would require millions of Americans who are happy with their cushy private plan to give it up in favour of the same government plan that everyone else has. It would require a massive overhaul of the federal budget, as trillions in new taxes would have to be raised to pay for the new public system. Mr. Sanders insists most of those taxes would come from businesses, which would no longer have to provide health insurance for their workers. But his plan is based on unrealistic spending projections for Medicare.
Medicare-for-all Democrats have already made themselves vulnerable to attacks by President Donald Trump, who declared in his State of the Union speech this month: “We are alarmed by new calls to adopt socialism in our country. America was founded on liberty and independence – not government coercion, domination and control. We are born free, and we will stay free. Tonight, we renew our resolve that America will never be a socialist country.”
Do Democrats really want to risk making this the 2020 ballot question?
Konrad Yakabuski