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Democrats smell blood when it comes to health care as a winning issue. The danger is that their loyalties to various kinds of proposals and their partisan proponents become such a divisive issue, and it loses in 2020. Any hope to improve health insurance to any degree during a second term for President Donald Trump would be lost as well.
The Democratic candidate debates have renewed the national focus on health care policy because nearly all 20 on stage put it on or near the top of the issues they addressed. It is no wonder. A Kaiser Family Foundation tracking poll in June found that 87% of Democrats put health care at the top of the list for candidates to discuss. The various candidates touted their approaches and criticized their opponents’ health care plans with enough passion to give rise to the fear that the party is seriously divided.
Both Republican and Democratic strategists will be sharpening their swords on the issue. In the 2018 midterms, coverage of pre-existing conditions was the hot button topic, even forcing Trump and some GOP candidates to pledge to protect pre-existing condition coverage without even providing a plan of how to do it or its cost.
What we can expect is for the GOP to claim that any plan with “Medicare for All” in its title or any variations thereof are nothing but socialism, a term that frightens GOP voters, but it does not scare most Democrats, especially younger ones, per a recent Pew Research Center poll. The GOP has a grand old historical tradition of calling “socialism” on any government-provided assistance to seniors, such as Medicare and Social Security, and they have begun beating the war drums against Medicare for All now with the same fire breathing tactics of yore. They would benefit from seeing the health care debate becoming lost in a socialism vs. capitalism controversy.
In taking sides of the various health care proposals, Democrats could lose sight of who are the real enemies. They are the GOP who failed in their first attempt to repeal Obamacare without replacing it and the Trump administration that would sabotage Obamacare out of existence, making it either unaffordable for many consumers or economically unsustainable. Using executive orders, Trump has eliminated the mandate for all to be insured and now permits employers to provide junk and cheaper insurance plans without all of the essential benefits.
Both of these Trump actions are undermining the balance in the “pool” of potential claimants. Increasing the numbers in the pool of those who use the benefits more than those who do not, leaves more of the sicker more expensive to treat in the pool, increasing the costs for all of the participants and taxpayers associated with Obamacare. There are fears that if employers offer poorer quality insurance plans, they will dump the underinsured or uninsured sicker into Obamacare, unbalancing the pool even more. Trump will want voters to buy his promises to repeal Obamacare with no comparable replacement proposals. Trump voters were pacified by those empty promises in 2016 and again in 2018 and may believe him again in 2020.
There are several fundamental issues that may decide which plan comes out on top. One is the cost of the total replacement of Obamacare with Medicare compared to the public option method that allows consumers to buy into Medicare as a choice within or outside of Obamacare exchanges. The cost to taxpayers or to consumers of any Medicare for All plan at this stage is speculative and subject to self-serving claims. In fact, we may never get the official nonpartisan actuarial cost projections until the Congressional Budget Office weighs in on specific legislation being proposed in Congress.
The cost factor is not the only a worry to taxpayers, but it is also important to consumers who fear they still have to pay too much out of pocket in co-pays and deductibles in any plan. Bernie Sanders proposed to replace all health insurance, Obamacare, employer or union provided, or private plans with Medicare for All. He will have to convince voters higher taxes will be offset by the elimination of premiums and lower out of pocket expenses. An issue that may scuttle the Sanders-type proposal is the loss of union or employer-provided insurance, private plans, or supplementals being proposed by him and some Democratic party candidates.
The issue is fluid. What was revealed in the KFF poll is that voters currently do not have a clear picture of the differences between the various Medicare for All proposals. The majority feared taxes would increase, there would still be deductibles and co-pays, and 55% thought employer health insurance would still be provided.
Sen. Kamala Harris has supported both Sanders’ plan and public options in the past and clarified her position after the debate to permit private insurance to exist in any case. Julian Castro and Andrew Yang along with Sen. Kristen Gillibrand in the debate, and/or in prior public statements supported Medicare or Medicaid for All closer to the Sanders’ model, but still permitted some limited private insurance. The remainder of the debaters, including former vice president Joe Biden, supported the public option approach to some degree or another and would not eliminate private or employer insurance.
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