A big reason Democrats regained the U.S. House in the 2018 elections was the emphasis they put on how Americans are insured against illness. They won in swing districts around the nation by defending Obamacare and the reforms it brought, particularly those ensuring that insurance companies could not deny coverage to patients with pre-existing medical conditions.
In one respect the Democrats were lucky: President Donald Trump’s pledge to repeal and replace former President Barack Obama’s signature health program was an abject failure. And Republicans in Congress seemed to have scant interest in doing anything of substance about health care beyond scuttling the Obamacare program and tossing millions of Americans under the medical insurance bus.
Divided government in Washington, D.C. has done nothing to change things. The country’s health system is still a mess, beset by bloated drug and hospital costs, a drop in life expectancy, a widening mortality gap between the rich and poor, doctor burnout and rising insurance deductibles that crush the middle class.
So it’s not a surprise that health insurance has dominated the early Democratic presidential debates. In the left lane, Senators Bernie Sanders and Elizabeth Warren split hairs over who has a better single-payer, Canadian-style program that puts all Americans in the popular Medicare plan. More centrist candidates, notably Joe Biden, caution against such a huge, costly program and say improving Obamacare is the way to go.
The Sanders argument boils down to this: Even if taxes go up a bit, you’ll save money over the long haul because we’ll do away with insurance premiums and other out-of-pocket costs. Everybody will be as pleased with their medical care as are patients from British Columbia to Nova Scotia.
Sanders and Warren may well be right on the policy, and dead wrong on the politics. At best they are pushing something that will appeal to liberal primary voters. At worst they are handing Trump and his Republican enablers a reliable hammer to slam Democrats running for any federal office.
Americans have fought over health care since Harry Truman’s administration in the 1940s. Truman pushed a single-payer plan, but it never won congressional approval. Lyndon Johnson was able to steer both Medicare and Medicaid through in the 1960s, but Ted Kennedy’s Canadian-style program in the 1970s never made it. Then in the 1990s, Bill Clinton tried to win approval for a universal plan devised by Rhode Islander Ira Magaziner and then First Lady Hillary Clinton. That crashed amid strenuous insurance company opposition.
Sanders’s everything-old-is-new-again rhetoric has drawn support from many Democrats, including every senator from Massachusetts and Rhode Island except for Jack Reed. Reed supports changes closer to the public option Biden model. That opens Medicare to employers of any size and allows individuals not eligible for Medicaid or Medicare to buy into Medicare. It would also allow the government to negotiate prices with drug companies, as the Canadians do. And the pre existing provision would remain. If you want to keep your private insurance, you could.
Next year’s presidential election isn’t going to be decided by Volvo-driving New Englanders who live in college towns. It’s probably going to come down to perhaps five or 10 percent of the electorate –swing voters in the Midwest. Some of these folks are union members –think cops, firefighters, autoworkers, building trades workers, teachers—who fought hard for their good health benefits.
Trump has some advantages that liberals don’t like to face: record low unemployment, tepid inflation and boasting rights to taking out the head of the Islamic State. And a hard core of red state voters who love his stacking the courts with conservatives and the rich salivating over tax cuts and deregulation.
Remember what happened after Obamacare was approved in 2009. It took two years to get the program’s web site running. Republicans blamed everything you didn’t like about the entire health care system on the Democratic president. Co-pays too high? That dreaded Obamacare. You had to wait 45-minutes in the doctor’s office? Damn Obamacare.
The result: Democrats lost control of Congress in 2010.
When it comes to medical care, history shows that change is incremental. A Democratic nominee who wants to blow up the whole system – which represents about 18-percent of the U.S. economy – is taking a huge risk.
Scott MacKay’s commentary can be heard every Monday at 6:45 and 8:45 and at 5:44 in the afternoon.
