Single-payer health care is gaining ground among Democrats.
In a sign of the party’s move to the left on the issue, the Center for American Progress (CAP), a bastion of the Democratic establishment, this week released a plan that comes very close to a single-payer system.
That’s a dramatic change from just two years ago, when Hillary Clinton — tied closely to CAP — dismissed Sen. Bernie Sanders ’s (I-Vt.) push of “Medicare for all” as politically unrealistic.
The CAP plan, called “Medicare Extra for All,” would provide government-run health insurance for everyone, though people would still have the option of obtaining coverage from an employer.
In another sign of the increased prominence of single-payer among Democrats, many lawmakers seen as top contenders for the party’s presidential nomination in 2020, including Sens. Kamala Harris (D-Calif.), Cory Booker (D-N.J.), and Elizabeth Warren (D-Mass.), are backing Sanders’s latest Medicare for all bill.
Democrats acknowledge the embrace of single-payer is part of a broader leftward shift for their party. But they say the experience of trying to make private markets work in ObamaCare — a system that Republicans have opposed at every turn — has changed their perspective on the likelihood of achieving universal coverage.
“I think Bernie Sanders has definitely laid out a vision and created a movement toward Medicare for all, and no doubt that has been a big factor,” said Topher Spiro, vice president for health policy at CAP.
Part of the need for the next step, he said, is “it’s become clear we’re not going to get any cooperation from Republicans in terms of making the current system work optimally, and there’s a lot of frustration there.”
The Medicare Extra plan is a way to take the “final step” to universal coverage after ObamaCare, Spiro said, and “we’re beginning that debate now, which will continue for a few years on how best to finally reach that goal.”
“I don’t think there’s any question that a lot of Democrats think this is very safe ground now,” said Rep. John Yarmuth (D-Ky.), who signed onto a Medicare for all bill in the House, along with 120 other Democrats, which is a majority of the conference.
The shift among Democrats is striking, given that during the fight to pass ObamaCare in 2009 and 2010, a government-run insurance plan or “public option,” was killed because it would not have enough votes from Democrats to pass the Senate.
Even two years ago, in 2016, Clinton pushed back hard against Sanders’s single-payer plan. Clinton instead proposed the somewhat scaled-back step of adding a public option and allowing people 55 and older to buy into Medicare.
“Now, there are things we can do to improve [ObamaCare], but to tear it up and start over again, pushing our country back into that kind of a contentious debate, I think is the wrong direction,” Clinton said in a debate with Sanders in 2016.
Now, many Democrats say that after Republican attacks on the law, including the repeal of the individual mandate, the political terrain is different.
“I think it’s pretty clear that this where we are going as a party,” Jim Manley, a former staffer for Sens. Ted Kennedy (D-Mass.) and Harry Reid (D-Nev.), said of single-payer.
“It’s partly because of what Republicans have done to undermine the current health-care system,” Manley said.
But he added: “The party as a whole is becoming much liberal; I can’t deny that.”
Republicans have been happy to attack single-payer as a government takeover of health care.
The Heritage Foundation’s Robert Moffit said the CAP plan would mean “ power for politicians and bureaucrats to prescribe, define, limit or control what ordinary Americans could access from the health-care system.”
There is always a question of how to pay for single-payer plans, and whether the need for new taxes could make the plan politically toxic.
Yarmuth said he is comfortable supporting the idea in a red state like Kentucky, but recommends framing it as “Medicare for all,” rather than “single-payer.”
“Everybody knows what Medicare is,” he said. “You don’t have to explain it.”
Yarmuth said Democratic leadership wants to keep the election message on the economy and jobs, not Medicare for all, but he thinks a lot of individual candidates will run on the idea.
“I think we can actually move voters with Medicare for all,” he said.
Many red-state Senate Democratic candidates in tough races this year have rejected single-payer, however. “I don’t think it would be good for our debt,” Sen. Claire McCaskill (D-Mo.) told a town hall last April, though she does support ideas like letting people over 55 buy into Medicare.
Other Democrats have proposed incremental steps to broaden health-care coverage. Sens. Tim Kaine (D-Va.) and Michael Bennet (D-Colo.) have a proposal called Medicare X, which would create a public option modeled after Medicare alongside private options on the ObamaCare marketplaces.
Kaine has said he wants “ choices, not fewer.”
The discussion about what to do next on health care is sure to intensify if Democrats win back the House and/or the Senate this year.
Yarmuth, the top Democrat on the House Budget Committee, said he is not sure if the House would pass a single-payer bill if Democrats have the majority in 2019, though he added, “I guarantee you there would be studies and hearings and so forth on where we could go with something like that.”
“One of the inadvertent ramifications of everything the Republicans have been doing to dismantle the ACA is they’re hastening the advent of a single-payer system,” Yarmuth said.
“They’re going to make it impossible for any other system to work. I don’t think they realize that that’s what they’re doing.”