Pundits are questioning the political wisdom of Democratic presidential candidate Hillary Clinton's attacks against her rival, Vermont Sen. Bernie Sanders, over his proposal for a Medicare-for-all, single-payer health insurance system in the U.S.
There's good reason for those questions. Conversations this month with Democratic Party officials and voters in Iowa lend support to comments that Clinton's assault on Sanders over single payer is a risky gambit going into that state's Feb. 1 presidential caucuses.
A recent Kaiser Family Foundation poll found that 81% of Democrats favor a Medicare-for-all approach, and nearly 1 in 5 Democrats said healthcare was their top issue, according to a recent Washington Post/ABC News poll. It's hard to have a conversation about healthcare with people who identify as Democrats or liberals without hearing laments that single payer would be better than the Affordable Care Act.
Polls show Sanders and Clinton in a neck-and-neck race to win the Iowa caucus contest, the nation's first presidential primary contest. In their televised debate Sunday, they almost certainly will face off on the merits of Clinton's approach of “fixing the glitches” in the ACA versus Sanders' proposal to replace it with a government single-payer system.
“People would like single payer,” Dr. Andy McGuire, who chairs the Iowa Democratic Party, said in an interview. “I think it's more the realization that it's difficult to get to single payer. For practical reasons, fixing the ACA is what people talk about.”
“I think the dominant position is to improve the ACA,” said Democratic state Sen. Rob Hogg, who hopes to run against Republican U.S. Sen. Chuck Grassley in November and who takes that “fix-the-glitches” stance. “But on the Democratic side there is still a significant reservoir of people pushing for a single-payer system.”
On Wednesday, the Clinton campaign launched a major assault through surrogates, including the candidate's daughter Chelsea, on Sanders' single-payer proposal. Clinton and her allies criticize Sanders for not saying how he would pay for a single-payer system. They argue that adopting such a system would impose heavy taxes on middle-income Americans. Clinton doesn't acknowledge that the taxes people would pay for national health insurance would replace premiums they and their employers currently pay for private insurance, offsetting the cost.
Sanders has not released a detailed single-payer proposal. On Wednesday, his campaign issued a fact sheet on how he would pay for various programs but did not address financing his healthcare plan. Sanders promised to release his financing plan before the Feb. 1 Iowa caucuses, but his campaign manager subsequently said he may miss that deadline.
The Sanders campaign has counterattacked by accusing Clinton of using “Karl Rove tactics” to demonize the concept of national health insurance, referring to the well-known GOP political strategist.
The Sanders campaign distributed a video of Clinton's 2008 response during her nomination battle with Barack Obama to Obama's attacks on her proposal to require everyone to buy health insurance. “Since when do Democrats attack one another on universal healthcare?” she said at the time.
Clinton may be hoping to raise doubts in the minds of Democratic primary voters about Sanders' electability as a self-proclaimed democratic socialist. Her attacks on his single-payer proposal may prompt Democrats to recognize that if he's nominated, Republican attacks on his healthcare plan and its associated taxes will be much more intense.
But Iowa Democrats may be offended by her fierce rejection of a national health insurance model many of them prefer over Obamacare—and which Clinton herself favored in the distant past.
Jeff Hancock of Independence, Iowa, who attended a speech last week in Cedar Rapids by former President Bill Clinton campaigning for his wife, said he's in a subsidized Obamacare plan and “it's working out really nicely.” He's still deciding whether to support Clinton or Sanders.
But he has a clear preference on healthcare, though he acknowledges his heart tells him one thing and his head another. “I'd like to see single payer,” he said. “I would have liked for Obama to have pushed for it, even though he probably couldn't have gotten it. And Bernie doesn't have much chance to get single payer with a Republican Congress.”