The Bulls-Eye: Affordable Health Care for Every American

Democrats should have a robust discussion about the various pathways to reach that goal.

Conflict sells, which is probably why so many people in the media continue their attachment to the narrative that Democrats are in disarray. Nowhere is that more obvious than a report by Gregory Krieg and Tami Luhby at CNN titled: “Democratic anxieties over ‘Medicare for all’ kick off first 2020 primary fight.”

At the center of the early debate is whether Medicare for all — a national, government-run system — should be a centerpiece of the party’s platform. Beyond that, there is a more vexing question, given broad public support for the concept: how to both define what Medicare for all means and sketch out a realistic path to enacting it.

The ensuing disputes have frayed Democratic solidarity over health care, kicking off the first meaningful policy scrap of the 2020 primary contest. What had recently been passed off as minor or, given the Republicans’ grip on government, academic differences, are now opening up like seismic rifts — offering insights for voters not only into the candidates’ visions for health care, but on how they might act as president.

Rather than use the phrase “Democrats in disarray,” the authors would have you believe that “seismic rifts” are opening up between potential 2020 candidates. But in response, Sen. Elizabeth Warren did a great job of demonstrating how foolish that characterization is.

“How do we get universal coverage, Medicare for all? Lots of paths for how to do that,” Warren said. “But we know where we are aiming. And that is, every American has health care at a price they can afford. And that the overall costs in the system are held as low as possible.”

Pressed to be more specific, she added: “There are multiple bills on the floor in the United States Senate. I’ve signed onto Medicare for All. I’ve signed on to another one that gives an option for buying in to Medicaid. There are different ways we can get there. But the key has to be always keep the center of the bulls-eye in mind. And that is affordable health care for every American.”

Just a few paragraphs after using the words “seismic rifts” to describe what is happening with Democrats, the authors write this:

Warren’s assessment holds up as an accurate description of where most of the candidates — including Sanders, up to a point — and party people come down on the issue. Warren, Harris, and Booker were among the cosponsors of Sanders’ 2017 Medicare for all bill. But they are also supporters of more moderate legislation, like a bill from Hawaii Sen. Brian Schatz, himself a Medicare for all cosponsor, that would allow Americans to buy into the Medicaid program for the low-income. Among its backers: Bernie Sanders.

The one thing all Democrats agree on is that, as Warren said, the goal is to get to universal coverage that is affordable for all Americans. The good news is that proposals that move the country in that direction—like the Schatz plan for Medicaid buy-in—are now being described as “moderate.”

Even so, there is a small group on the left who seem intent on feeding the “Democrats in disarray” narrative. For example:

“There is a major scramble and counter-offensive happening among the Democratic Party establishment to ensure that leading 2020 candidates back off from single-payer, Medicare for All,” Waleed Shahid, the Justice Democrats top spokesman, tweeted on Saturday. “They will try to redefine M4A as a buy-in. Don’t let them.”

The crux of their argument is to suggest that “the Democratic Party establishment” is undermining the potential for single payer by exploring a variety of pathways to get there. Ezra Klein noted how this is framed as a policy difference when it is really a matter of political strategy.

There can be a tendency, when judging presidential candidates, to let ambition act as a signal of commitment. Under that view, if Harris wants to abolish all private insurance, then she’s more committed to Medicare-for-all than Booker, and both of them are more committed than Brown, who just wants to expand the program to 55-year-olds.

But that’s a flawed way to look at policymaking. The point here is expanding better coverage to more people, so the question has to expand to include political strategy. A Medicare plan that passes into law and successfully extends coverage to 40 million people gets the country a lot closer to Medicare-for-all than a plan that envisions expanding Medicare to everyone but fails in Congress and costs Democrats the House in 2022.

Activists like Shahid have every right to make their case that an attempt to implement single payer wouldn’t fail in Congress or hurt Democrats in the House. But so often, they attack supporters of plans that get the country closer to Medicare for All by claiming they are establishment Democrats who are sellouts to private insurers.

Over the course of the 2020 Democratic primary, it could be very helpful to have a robust discussion about the various pathways to reach universal affordable health care. The disrupters to that kind of conversation will be those who assign malicious intentions to those who simply have a different political strategy.

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Nancy LeTourneau

Nancy LeTourneau is a contributing writer for the Washington Monthly. Follow her on Twitter @Smartypants60.