It infuriated me at the time when Politifact made “if you like your health care, you can keep it” their Lie of the Year in 2013. Unfortunately, that they felt comfortable making that choice is a good indication of how politically toxic it is to screw around with people’s preexisting health care plans. A small percentage of people lost their plan, but it still added up to approximately four million people. Many of them should have been grateful, since their plans were complete rip-offs, but that didn’t make it less of a headache for the Democrats.
In theory, I am very enthusiastically in favor of eliminating the private for-profit health insurance industry entirely. Yet, I know that this would cause a political firestorm unlike anything we’ve seen since George W. Bush tried to privatize Social Security. In fact, it would likely be an order of magnitude more controversial than that fiasco. To make matters worse, it’s a promise that could not be kept. To even contemplate the passage of such a bill, the Democrats would need a supermajority in the Senate, and that’s not in the offing anytime soon. In truth, the Democrats would probably need eighty or ninety senators to feel comfortable about getting 60 of them to vote the health insurance industry out of existence. In addition to the staggering number of negative constituent phone calls the senators would receive, many of them would be representing states that have thousands of health insurance jobs that would be on the line.
The question, then, is why would a presidential candidate run on a platform that included the elimination of private heath insurance? It might help them win the Democratic nomination, but thereafter it would weigh on them like an albatross. As a general election candidate, they would be savaged using rhetoric similar to what caused the Tea Party revolt and the midterm wipeouts of 2010 and 2014. Only this time, the rhetoric would largely be accurate and backed up by the media. If they nevertheless won the election, which is certainly possible, they would have to abandon their promise or they’d wind up taking a huge beating much like Trump did in his effort to repeal Obamacare.
This time, I am going to have to agree with Jonathan Chait that Kamala Harris is taking a huge risk.
In which Jake asks Kamala Harris whether people would be able to keep their private insurance, if they prefer, under Medicare For All system — and she rejects that. "Let's eliminate all of that. Let's move on." pic.twitter.com/A1AY2TOT4g
— Rebecca Buck (@RebeccaBuck) January 29, 2019
For the record, Chait agrees with me about the merits of the policy.
There’s no doubting the worthiness of this ambition. Financing health insurance through private firms does not add any important value. It is obviously possible to run an entire country on a single-payer basis. Lots of countries do it, and people there tend to like the experience much better than Americans do.
He’s just taking the position that it’s not a wise political choice to run on doing something that is unpopular, easy to demonize, highly disruptive, and impossible to deliver. Trump’s promise of a border wall that Mexico will pay for is an example of what can go wrong even if you win the election.
It’s true that if you ask people if they support a national health care plan like Medicare-for-All, they say that they do. If you ask them if they favor eliminating private health insurance, they are significantly more emphatic that they do not.
Now, if the policy is the correct one and the goal is worthy, one might reasonably ask how we can ever achieve it without a presidential candidate running on it and winning. Public opposition must be overcome somehow. There used to be public opposition to gay marriage and a lot of Democrats cowered in fear rather than taking a courageous stand and leading by example. Public opinion shifted very quickly on that issue, so why couldn’t the same happen with a national health care plan?
My short answer to that is that there is too much money involved in health insurance for it to be equivalent, and too many people will feel a direct rather than an abstract threat. The U.S. Congress isn’t passing a national health care plan anytime soon regardless of how many seats the Democrats win.
This isn’t a satisfying answer to countless Democratic voters, but being set up for disappointment isn’t something people should welcome, let alone set as a litmus test for your political support. It’s an odd thing to be upset that a candidate is advocating for a policy I agree with using arguments that I consider completely sound. But the same candidate is also failing to level with me about the prospects of success and the political risks. It’s the latter part that bothers me and that more than cancels out the former part.
In one way, convincing presidential candidates to support a national plan is definitely progress for those of us who want to reach that goal one day. I want them to argue for that goal. I just don’t want them promising to deliver it, because that’s a lie that will produce a risky backlash and just fuel cynicism when it isn’t kept.