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How the Democratic presidential field could unite in health care messaging

They have shared goals. And perhaps they should remind the country of this history: If Republicans had had their way: No Medicare, no Medicaid, no Affordable Care Act.

Sen. Elizabeth Warren
Democrats running against Sen. Elizabeth Warren, above, and Sen. Bernie Sanders are going to argue that single-payer is too scary, and too expensive, too big a disruption.
REUTERS/Yuri Gripas

Now that Sen. Elizabeth Warren has put out a plan to pay for her approach to providing access to health care for all Americans, the right will go ballistic with red-baiting and the more moderate left will say it’s too expensive and scary but that they prefer a less costly, less ambitious plan that reduces but doesn’t  eliminate the problem of uninsured Americans.

People will score the plan and may, for political purposes, exaggerate how much it will raise some costs and lower others. Legitimate technical quibbles may challenge whether Warren’s proposal will raise enough revenue. That’s fine, but roughly unknowable. Those unfriendly to the plan will exaggerate the costs and underestimate or completely ignore the benefits of having a plan that covers health care costs for all Americans, especially the estimated 44 million who currently have no health insurance, because their jobs don’t provide it, they’re too young for Medicare and not poor enough for Medicaid.

Others have figured it out

Quite a few countries have figured out how to cover everyone without going bankrupt. Personally, as I’ve said many times, there’s no good reason why the United States, which is among the wealthiest countries on earth, should proudly cling to the honor of having simultaneously the most expensive health care system on the planet, and one that simultaneously leaves a large portion of its residents uninsured.

My main point in this piece is to suggest how the Democrats in the presidential field should talk about this issue. But first a bit of history of the difference between the way our two major American political parties approach the issue of health insurance.

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One party thinks more people should have access to health care. The other party doesn’t.

The status quo is (according to me) a scandal. If the question is posed, as it ought to be: If so many other countries can afford to cover everyone, why can’t we?, there is no good answer.

Like most of you, I find my eyes glazing a bit when trying to ingest the details of Warren’s plan. Paul Krugman writes that the math she rolled out at least passes the laugh test. That will hold me for now on the question of whether the plan is within hailing distance of balanced.

As a political matter, I understand why more moderate Democrats worry that such an ambitious and expensive plan will frighten the electorate. If, for reasons of political cowardice or caution, it is smarter for Democrats to nominate someone with a less ambitious proposal that will only cut the ranks of uninsured in half or so, I can understand that as a matter of political logic, because it is a matter approaching national emergency that Donald Trump be defeated in 2020.

Political logic

Also as a matter of political logic, Democrats running against Warren and Sen. Bernie Sanders are going to argue that single-payer is too scary, and too expensive, too big a disruption, and that too many Americans who are happy with their existing private insurance will freak out if the Democrats nominate someone who will do away with the status quo. I understand that, as a political (not a moral) argument.

I also feel confident that Warren’s universal coverage plan will not be adopted, even if she wins, and certainly won’t be adopted if, as seems likely given the map of Senate seats that are up in 2020, Republicans maintain control of the Senate. In fact, given the filibuster rules in the Senate, it’s hard to see how such a plan will be enacted unless Democrats control the White House, the House and something close to a filibuster-proof majority in the Senate.

Republicans (in general) oppose every single effort to reduce the share of Americans who lack health insurance. Ronald Reagan rose to political prominence warning in the 1960s against the adoption of Medicare as the critical step that would convert America from freedom to Socialism. Medicare! Reagan was just a washed-up actor at the time, preparing to become a Republican politician. And his argument resonated with Republicans.

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When Medicare was adopted in 1965, pushed through by Democratic President Lyndon Johnson, the Senate vote for its adoption was as follows: Among Democrats: 57-7 in favor. Among Republicans 17-13 opposed. (Back then, there were more moderate and even some liberal Republicans in Congress.)

That was Medicare, a program now so popular it’s untouchable.

No Republican support in Senate for Obamacare

The Affordable Care Act (aka Obamacare) was adopted in the House with 219 votes. After Democrats voted 218-39, giving the bill enough to pass, one Republican voted “aye.” In the Senate, where 60 votes were necessary to break a Republican filibuster, the bill squeaked through with 59 Democrats and one independent voting aye. All Republicans voted no, except one who did not vote.

(As an aside, I’ll mention that Obama had supported a single-payer approach earlier in his career. But, as president, he knew that could not pass. The ACA was crafted as the approach that could increase the ranks of the insured as much as possible and still pass.)

Republicans have been trying to repeal it ever since, but have been unable to muster the 60 Senate votes necessary. In 2017, when Republicans had a three-seat majority, Majority Leader Mitch McConnell cooked up a filibuster-proof way to sort of get rid of Obamacare (called “skinny repeal”). But the three most moderate Republicans wouldn’t go along with it, ending with John McCain’s famous thumbs down.

Perhaps Democrats should remind the country of this history. If Republicans had had their way: No Medicare, no Medicaid, no Affordable Care Act. Tens of millions more American would be uninsured.

But that’s just history.

A range of Democratic ideas for insuring more

At present, most major Democrats are looking for ways to reduce the ranks of the uninsured, and most Republicans are opposed to those ways. The Democratic field ranges from those with ideas that help more Americans get coverage to those, like Warren and Sanders, who want to cover everyone.

Since Warren and Sanders are among the leaders in the current race for the Democratic presidential nomination, it makes sense that many of the others are portraying their plans as too radical or too expensive or too close to the dreaded word “socialism.” I get that, and I don’t expect it to stop. People who have private health insurance and are happy with it can perhaps be mobilized by fear of the more “radical” or “socialistic” elements of the Sanders/Warren single-payer or “Medicare for all” approach.

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What I would recommend to the whole Democratic field, hard as this might be with Warren surging in the polls, is that they not use scare tactics and not demagogue the issue. I believe they could unite around a message that goes something like this:

All the Democrats in the race want more Americans, rich and poor, old and young, employed or unemployed, to be covered by health insurance. The more the better and the sooner the better.

We have a lot of ideas for making that happen. They differ in important details. Some go further and faster than others. Each of us believes we have the best and most practical plan for the next step. We’ll continue to debate the differences among our approaches.

But all of us believe that the best outcome, in the medium- and long-term, is that all Americans, rich, poor and middle class, should have guaranteed access to health care when they need it.

Lots of the other rich countries in the world have figured out how to do this, and they haven’t gone bankrupt, and in many of those places they are healthier and live longer. Why not America?

Republicans, who opposed Medicare, opposed Medicaid, opposed Obamacare, and are still try to repeal it, don’t seem to share that goal. They need to explain why. It doesn’t make sense to us.

Whoever wins the Democratic nomination will run on a plan to increase access to health care for all Americans. Donald Trump still wants to reduce the progress made toward that goal under President Obama. He needs to explain why.