Some De­mo­crats Want Me­di­care for All. Others Aren’t So Sure

L'Opinion - - The Wall Street Journal & I'Opinion - Ste­pha­nie Ar­mour

Short­ly af­ter her pri­ma­ry vic­to­ry in New York, De­mo­cra­tic So­cia­list Alexan­dria Oca­sio- Cor­tez de­cla­red her goal of gi­ving Me­di­care to all Ame­ri­cans. Some fel­low De­mo­crats like Ken Har­baugh aren’t convin­ced.

The Na­vy ve­te­ran, who is chal­len­ging Rep. Bob Gibbs (R., Ohio), says the par­ty should fo­cus on bol­ste­ring the Af­for­dable Care Act, not star­ting from scratch with Me­di­care for All. “We need a much qui­cker fix, which is sho­ring up the ACA,” he said. As De­mo­crats en­ter the fi­nal sprint in a cam­pai­gn where health care is a do­mi­nant is­sue and a House ta­keo­ver seems achie­vable, they are split on whe­ther to pro­mise co­ve­rage for eve­ryone, which would fuel an al­rea­dy rev­ved-up li­be­ral base, or tar­get cen­trist vo­ters by cam­pai­gning on the more mo­dest goal of fixing the Oba­mae­ra health law.

No is­sue is more im­por­tant to vo­ters than health care, polls sug­gest, and this in­ter­nal ten­sion car­ries risk. It has ope­ned up De­mo­crats to at­tacks from Re­pu­bli­cans, pit­ted par­ty mem­bers against each other, and could alie­nate ru­ral and red-state De­mo­crats. Ro­bert Blen­don, a health-po­li­cy pro­fes­sor at Har­vard Uni­ver­si­ty, said De­mo­crats should unite around the sim­pler pro­mise of pro­tec­ting people with pre-exis­ting me­di­cal condi­tions.

“They’re mis­sing the boat,” Mr. Blen­don said. “The mes­sage of De­mo­crats should be that ‘un­less we get the House and Se­nate, they’re going to take preexis­ting condi­tions away.’ But there’s no co­herent mes­sage in the ads.”

The gro­wing po­pu­la­ri­ty of Me­di­care for All sur­pri­sed even some sup­por­ters. The idea was wi­de­ly dis­mis­sed two years ago when Sen. Ber­nie San­ders (I., Vt.) couldn’t get any co-spon­sors for a single-payer bill. Now that le­gis­la­tion has 15 co-spon­sors, and 70 De­mo­crats in Con­gress have laun­ched a “Me­di­care for All Cau­cus.” Rep. Pra­mi­la Jaya­pal (D., Wash.) re­cent­ly an­noun­ced a Me­di­care For All PAC to sup­port can­di­dates who back the idea.

In a recent Reu­ters-Ip­sos poll, 70 % of people said they fa­vor Me­di­care for All, but, re­flec­ting the im­por­tance of la­be­ling, 41 % said they sup­port single payer.

Un­der Me­di­care for All, a go­vern­ment agen­cy would pro­vide es­sen­tial health care to eve­ry Ame­ri­can. That would upend the cur­rent health-care sys­tem and erase em­ployer-spon­so­red co­ve­rage, which is how rough­ly 155 mil­lion Ame­ri­cans now get in­su­rance.

Still, there is no clear De­mo­cra­tic consen­sus. Some par­ty mem­bers are ins­tead em­bra­cing pro­po­sals such as let­ting people buy in­to Me­di­care that fall short of a true single-payer sys­tem.

Se­ven­ty percent of swing­dis­trict De­mo­cra­tic can­di­dates who won their pri­ma­ries as of late Ju­ly sup­port Me­di­care for All or single payer, ac­cor­ding to Real Clear Po­li­tics. For­mer Pre­sident Oba­ma, who shied away from it as pre­sident, re­cent­ly cal­led it a “good new idea.” The sup­port can be tra­ced in large part to Re­pu­bli­cans’ fai­led ef­fort to topple the ACA in 2017. Polls sho­wed that pu­blic ap­pro­val for the ACA pea­ked du­ring the most fren­zied days of the re­peal push.

That buoyed single-payer pro­po­nents, who conclu­ded Ame­ri­cans were rea­dy for the go­vern­ment to play a big­ger role in health care. “The move to ex­pand and pro­tect health care has be­come the most po­wer­ful force in Ame­ri­can po­li­tics to­day,” said Jo­na­than Schlei­fer, exe­cu­tive di­rec­tor of the Fair­ness Pro­ject, which sup­ports bal­lot ini­tia­tives to ex­pand Me­di­caid. “If the past year has taught us any­thing, it’s that Ame­ri­cans want more health care, not less.” Ma­ny cen­trist De­mo­crats di­sa­gree. They long ex­pec­ted to hold the po­li­ti­cal edge over Re­pu­bli­cans on health care in 2018 for the first time in years, with a straight­for­ward mes­sage of pro­tec­ting the ACA from the GOP and ex­pan­ding it.

Now they fear the Me­di­care for All slo­gan, with its pro­mise of swee­ping go­vern­ment ac­tion, will alie­nate vo­ters they need. “If we lock our­selves in­to one way of get­ting af­for­dable health care, we’re ne­ver going to get there,” said De­mo­crat An­gie Craig, who is chal­len­ging Rep. Ja­son Le­wis (R., Minn). “My neigh­bors, my dis­trict, can’t wait for some grand plan.”

The De­mo­cra­tic rift hasn’t been lost on Re­pu­bli­cans like House Ma­jo­ri­ty Lea­der Ke­vin McCar­thy (R., Ca­lif.), who told a crowd in Ohio this sum­mer: “If any of you have had health care pro­vi­ded by your em­ploy­ment, or if you’re on Me­di­care now, [De­mo­crats] are pret­ty much going to end it as we know it. They want one go­vern­ment- run sys­tem.”

Last week, Health and Hu­man Ser­vices Se­cre­ta­ry Alex Azar de­ri­ded Me­di­care for All as a mis­no­mer that will take away con­su­mer choice and cost $32 tril­lion over 10 years, re­fe­ren­cing a contro­ver­sial stu­dy pu­bli­shed this sum­mer by the Mer­ca­tus Cen­ter. De­mo­crats say the stu­dy al­so sho­wed sa­vings be­cause U.S. health-care spen­ding would drop by $2 tril­lion over that per­iod.

Kris­ti­na Pe­ter­son contri­bu­ted to this ar­ticle

SIPA PRESS

Sen. Ber­nie San­ders speaks du­ring a health-care ral­ly on Sept. 22, 2017 in San Fran­cis­co. Mr. San­ders has in­tro­du­ced a Me­di­care for All bill.

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