Medicare for All and the 2020 Election

Back in 2007, three years before the Affordable Care Act was signed into law, Michael Moore released his film “Sicko” to highlight what he saw as the flaws in our for-profit healthcare system and advocate for a single-payer, Medicare-for-All solution in the United States. Moore was a supporter of H.R. 676, the Medicare-for-All bill introduced by Senator John Conyers (D-MI) that was picking up some steam at the time.

Medicare for All was embraced by then presidential candidate Dennis Kucinich, who at the time was a senator from Ohio. Kucinich was a fringe candidate who ended up with about one percent of the vote in the 2008 election, but he never waivered from his calls for a single-payer health care system in this country.

Just a few years later, Senator Bernie Sanders was running for President and he, too, embraced Medicare-for-All as a key component of his platform. However, Bernie was not a fringe candidate. Millions of Americans “felt the Bern,” and Sanders helped make Medicare for All a mainstream idea.

Here we are in 2019. President Trump has been in office for more than two years and is gearing up for another presidential run. His popularity among Republicans will help him run mostly unopposed in his own party, but his lack of popularity among Democrats has caused nearly 20 contenders, including Bernie Sanders, to throw their hats into the ring. While these candidates are running on a variety of issues, with their number one priority being to defeat Donald Trump, many of the candidates are making health care a central issue in their campaign. And, as we’ve seen from the Democratic debates, the majority have jumped on the Medicare-for-All bandwagon. Whether that will ultimately be a good strategy or not remains to be seen.

Of course, Medicare for All means different things to different candidates, and each contender is trying to explain how their proposal makes the most sense. Reuters has a great article entitled “Where the top Democratic presidential candidates stand on ‘Medicare for All’” that is worth reading if you’d like to compare the various health care proposals.

Medicare-for-All is certainly a popular idea among likely Democratic primary voters. In fact, as Morning Consult reports, net support among Democrats “grew from 35 points in January to 52 points in the latest poll.” For that reason, it’s difficult to see at this point how a Democrat could win the nomination without supporting at least some version of Medicare-for-All. However, the idea is less popular among all likely voters. Fox News puts it well: “It may be a winning ticket in the battle for the Democratic presidential nomination, but two new polls indicate "Medicare-for-all" is far from the right prescription in the general election race for the White House.” That means that Democratic candidates will need to walk a fine line when talking about Medicare-for-All, and this will be difficult since Republicans, including President Trump, have already dubbed the idea “socialism.”

What should you tell your clients?

If you have not yet formed an opinion about Medicare for All, or if you just want some talking points to share with your clients when they ask, here are a few thoughts:

• The Medicare-for-All bill, H.R. 676, was first introduced in 2003. By 2007, the bill had 88 co-sponsors in the House and was getting national attention. At the time, the bill called for a U.S. national health insurance program completely paid for by taxes. There would be no monthly premiums, no out-of-pocket costs, everything would be covered, including dental and vision, and private insurance would be outlawed.
• H.R. 676 has been reintroduced year after year, and it still exists today, though the bill number has now changed. Most of the original proposals are included in the current bill, but it has been modified a bit over time. The most recent iteration of the proposal is called the Medicare for All Act of 2019, or H.R. 1384.
• While many Democratic presidential candidates are publicly supporting Medicare-for-All, that does not mean they will support all of the ideas in H.R. 1384. It is just one bill, and Medicare-for-All means different things to different candidates. We should be careful about painting everyone with one brush, jumping to conclusions, or terming the proposal “socialism.” The truth is that many candidates support the general idea of expanding Medicare to cover more Americans, but most have not put their ideas into bill format.
• Even those candidates who have put their ideas into writing understand that most laws don’t pass as originally written. There’s a lot of negotiating and compromise, so the final version of any Medicare-for-All bill would likely look very different than it does today. Also, without a super-majority in the Senate, as Democrats had back in 2010 when the Affordable Care Act passed on a party-line basis, it is unlikely that a single-payer bill could make it through the Senate. Supporters of the idea would likely have to start with a watered-down version, like an optional early buy-in to Medicare, or perhaps expanded Medicaid that allows more low-income individuals into the program.
• While health care has been and remains a very important issue, it is not the only issue important to voters. And it’s not the only issue important to your clients. Your clients may or may not agree with your position on Medicare-for-All, and they also may or may not agree with you on other important issues. If you decide to talk politics with your clients, which is always dangerous, try to stay as neutral as possible and simply present both sides of the issue. Getting too political is a great way to lose business.