“Medicare for all,” the concept of expanding Medicare into a single payer for seniors and non-seniors alike, has divided the House Democratic caucus ahead of November's midterm elections.
Single-payer advocates continue to push the idea, but Democratic strategists hope the issue remains fringe at best, making it fodder for debate in the primaries but unlikely to define Congress' healthcare platform for 2020.
An April poll on the subject found a slim majority—51% of the public—favors a single-payer system, according to the Washington Post and Kaiser Family Foundation, which conducted the survey.
As far as the actual vote goes, looking district by district, the lead goes away, operatives say. Most Americans get coverage through their employers, and those people are mostly satisfied with the way things are.
The baby boom generation also is opting for Medicare Advantage coverage, making it difficult for members of both political parties to believe a large-scale amorphous shift to an expanded version of Medicare can ever be a political winner. Both Republicans and mainstream Democrats are messaging accordingly.
“The American people don't have an appetite for scrapping everything and starting over,” said Brad Woodhouse, who as campaign director of the liberal advocacy group Protect Our Care is overseeing a massive campaign effort across 14 mostly swing states. “That applies to scrapping the Affordable Care Act for single-payer and scrapping the Affordable Care Act for repeal.”
One insurance industry lobbyist said he believes the “Medicare for all” message will continue to gain momentum because its simplicity appeals to people after the last few years of turmoil over the individual market. Democrats may be pushed to the left before voters understand the complexity of a single-payer plan, he added, and Republicans who don't want to touch repeal-and-replace again may find themselves on the defensive pushing back against “Medicare for all.”
Adding fuel to the debate, an economist from the libertarian Mercatus Center of George Mason University predicted massive reductions for providers as the sole restraint to the healthcare costs spurred by the “Medicare for All” plan put forward by Sen. Bernie Sanders (I-Vt.). The white paper calculated the plan would cut provider payments by more than $380 billion in the first year and nearly $660 billion in 2030.
Ceci Connolly, president of the Alliance of Community Health Plans, compared today's inter-party debate to the massive public backlash against the continuous double-digit premium increases of the late 1990s. But Connolly says the tone of the discussion has changed. “That era was very different than where we are today, when we have small but vocal groups with a very sharp opinion of what they want from the healthcare system,” she said. “I don't see that opinion broadly across the electorate—probably just within the base of the two political parties.