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Medicare for All is Repeal and Replace for Democrats

Over-promising is a bad thing, especially in politics. Doing so makes your supporters angry if you promise big on high profile issues and fail to deliver. Especially over time.

Just ask Republicans as the campaign promises of some conservatives such as building the wall, defunding Planned Parenthood, and repealing Obamacare have withered on the vine of political reality.

Attempting to push for such things that don’t necessarily hold a critical mass of political support can be politically damaging for more reasons than just a disgruntled base. Republicans got hammered on health care in the 2018 midterms in the wake of failed, unpopular efforts to Repeal and Replace. Pushing repeal didn’t appeal to many suburbanites already uncomfortable with Trump, contributing to decisive GOP losses in suburban Congressional seats.

That entire outcome was largely predictable since it was clear during and after the Repeal and Replace battle that GOP policy reality (and understanding) didn’t line up with those promises made on the campaign trail in a way that wasn’t political suicide with anyone outside the conservative base.

Democrats are risking the same thing on their side of the political spectrum with Medicare for All.

Kamala Harris’ even-now somewhat equivocated support of Medicare for All and Howard Schultz’s rejection of the idea as “not American” have nearly cemented that support of that proposal will be an entry-level requirement for the Democratic standard bearer in 2020.

That veritable prerequisite shouldn’t surprise as 57% of Democrats support a candidate backing Medicare for All versus only 22% taking a lesser view of such candidates. But, that top-level popularity, even among non-Democratic voters, is a paper tiger. Much has already been written about how even polling finding Medicare for All generally popular changes quickly when respondents are presented with additional information on the impact of the proposal:

Public support of Medicare for All collapses once voters look under the hood. Source: KFF.

Those shifts in voter perception with additional information are not a surprise. They also point to obvious critiques for opponents of Medicare for All to amplify: higher taxes, delays in receiving care, and likely disruption to existing Medicare programs.

Yet, with the potential exception of disrupting existing Medicare, the arguments against higher taxes and potential delays in care are pretty standard conservative fare in opposing single payer health care. Supporters of Medicare for All will have their own counter arguments to those points, some of them compelling to less ideological voters frustrated with the current system.

Even the disruption for existing Medicare can be dampened if a new Medicare for All program is phased-in in a way that clearly leaves current-or-near beneficiaries alone.  Though, as veterans of the Social Security reform debate in 2005, before W’s Presidency descended into the doldrums of Katrina and Iraq, can attest: that’s an still an easy nuance with which to cudgel the other side politically, and with vigor.

No, the greatest political weakness in Medicare for All is only obliquely touched on in that KFF polling, when asking about voter reaction to Medicare for All with the understanding it would “eliminate private insurance companies.” The results there are substantial, with a negative 35 point swing in net favorability. But, even that question understates the case.

The question isn’t how do you feel about Medicare for All if private health insurance companies are eliminated, the question is “how do you feel about Medicare for All if your current employer coverage is eliminated and you have to go on a government-run plan”? The issue isn’t whether voters want insurance companies to exist, it’s whether people want to stay on the plan they and their kids are currently happy to have.

Much like voters often take dim views on approval of Congress and the quality of public education as a whole, they concurrently often support their member of Congress and their local public school. Same too with employer coverage. People may not love the insurance company, but Gallup has shown 70% of people on private health care coverage view it as excellent or good.

While the ACA/Obamacare have consumed a lot of political oxygen in the last decade, a more applicable lesson in health care politics and policy comes from the Clinton Administration and a Democratic Congress attempting to pass health care reform, Hilarycare, in 1993 and 1994. One of the strategic tipping points of the public turning against the effort were the Harry & Louise ads emphasizing the message that you would lose your current plan for one designed and run by the government.

Even the primary incremental change of Obamacare, significantly re-constructing the market for something over 17 million people on individual health plans, resulted in savage Democratic electoral losses at the federal and state levels in 2010 and 2014. Defeats so severe Democrats needed the Trump-infused 2018 midterms to rebuild their otherwise depleted bench of future seekers of higher office in the wake of the “if you like your plan you can keep it” disaster.

What do you think happens if that 17 million affected people also adds the 155 million people currently on employer coverage?

People covered by employers remain the 800 pound gorilla of health care coverage in America. Credit: Charles Gaba/

Political suicide, that’s what.

Not too different from Repeal and Replace in way. Implausible to pass, let alone implement. Yet, a starry-eyed Democratic base looking at, say, a President Harris and a more Democratic House, if not a Democratic Senate, after 2020 is not likely to be content playing small ball.

While the time between here and January 2021 is long and will be full of political twists and turns beyond count in the daily soap opera that is the Age of Trump, the trajectory is already clear that much like Republicans in the close of the Obama Administration, Democrats are building their leaders a plank in Medicare for All that they will be made to walk.

And the water in any given November is never very warm.


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