Republicans from President Trump on down have sought to define Democrats around proposals to extend Medicare to everybody, and conservative writers and activists have joined the pile on.
This is certainly understandable. Even the liberal Urban Institute has pegged the cost of such a program at a staggering $ 32 trillion over a decade. Any such plan to migrate everybody over to Medicare would mean massive taxes, cause significant disruption to the industry that’s the largest employer in the U.S. as well as disrupt the healthcare arrangements of hundreds of millions of Americans who are currently satisfied with what they have.
Meanwhile, the idea has been endorsed by former President Obama and is supported in the Senate by five potential candidates for the 2020 Democratic presidential nomination led by Sen. Bernie Sanders. For decades, Republicans have accused Democrats of wanting to impose a socialized healthcare system on the U.S., and now many prominent members of the party are openly advocating a proposal that would outlaw private insurance plans offering the same coverage as the government and turn government into the primary financier of everybody’s healthcare.
All of these points need to be made, for sure. But there is a risk that those on the Right will get distracted by attacking the easy target of “Medicare for all,” which despite its fans is still likely a political fantasy in the near-term, and thus allow more practical Democrats to push through policies that are presented as moderate compromises, even though they still represent another radical expansion of the government’s role in healthcare.
Obamacare, once implemented, cost about $ 2 trillion over a decade, and it was a significant enlargement of the welfare state. If the main focus of Republican attacks in the coming years is on “Medicare for all,” then once they obtain power again, Democrats could advance a bill that is larger in scale and scope than Obamacare, and still make it seem relatively reasonable because it would be far less than the insane $ 32 trillion price put on the more extreme single-payer.
There is some precedent for this. During the 2008 presidential campaign, leading Democratic candidates made a decision to avoid endorsing a full single-payer plan (even though Obama said it would be his preference if he were starting a system “ from scratch”). Instead, to placate single-payer advocates, they endorsed the idea of a “public option,” which was designed as a way to get to single-payer in a more gradual way.
The idea was to was to create a government-run plan to be sold along privately-administered plans on a government-run exchange. Liberals hoped that over time, more and more Americans would migrate to this plan and so after a certain number of years, between Medicare, Medicaid, and the public option, nearly everybody would be on some sort of government healthcare plan. This would ease the transition to full single-payer.
Liberals fought bitterly for a public option, but the idea couldn’t secure enough votes in the Senate and Harry Reid had to remove it. Viewed one way, this could be seen as an epic liberal failure. But viewed another way, the public option could be seen as a lightning rod that absorbed much of the fire against Democrats’ healthcare push and ultimately helped keep the rest of Obamacare intact.
The public option moved the debate significantly to the Left of where it otherwise might have been. Scrapping the public option was a sacrifice that allowed Joe Lieberman and other more centrist Democrats to feel like they got a concession, helping secure their votes. Getting rid of it weakened Republican attacks on Obamacare as a government takeover, since they could no longer site studies like the one saying 100 million people would end up on the government-run plan if the bill became law.
Industry was bitterly opposed to a public option, as it would have been a direct threat to private insurance and would have given the government more power to set prices for hospitals, doctors, and prescription drugs. Once it was taken out, it was much easier for industry to either openly support Obamacare or at least remain neutral.
Sen.-elect Rick Scott’s first foray into national politics came during the Obamacare debate, when he put up $ 5 million of his own money to create an anti-Obamacare group called Conservatives for Patients’ Rights. The group branded the public option “patient enemy number one” and once it was defeated, Scott declared victory and the group sat out the rest of the fight as Scott went on to run for governor in Florida, where he was elected later in the year.
It’s very easy to see a similar scenario playing out. Democrats have a range of options on healthcare that stop short of “Medicare for all” but would still move the ball forward. As examples, they could: revisit the public option; propose allowing those over 50 to “buy in” to Medicare; increase Obamacare subsidies; ramp up regulations; allow larger employers to dump workers onto the exchanges, and so on. None of these options would be as costly or as disruptive as a quick transition to single-payer, but they nonetheless would make more incremental progress toward that eventual goal.
So, by all means, conservatives should make their case against the extravagance of “Medicare for all.” But they shouldn’t lose sight of Democratic proposals to drastically augment the role of government in healthcare that actually have a much greater more realistic chance of becoming law.