Democratic presidents have found it hard to achieve the goal of universal health insurance coverage. Jimmy Carter promised it when he ran in 1976, but he was unable to get a bill passed. Bill Clinton enlisted Hillary Clinton to craft a plan, but it failed in Congress. Barack Obama managed to pass the Affordable Care Act, but it fell well short of covering everyone.
Even Obama’s relatively cautious plan was bad for the Democratic Party, which lost the House in 2010, after Obamacare passed — just as it lost the House in 1994 after the Hillarycare push. But many Democrats have abandoned incremental reform. They insist on pursuing what Rep. Pramila Jayapal, D-Wash., calls “a complete transformation of our health care system.”
Sen. Bernie Sanders, I-Vt., has long advocated a single-payer system he calls “Medicare for All.” Among other presidential candidates who’ve signed on as co-sponsors are Sens. Elizabeth Warren, Kirsten Gillibrand, Kamala Harris and Cory Booker. Rep. Alexandria Ocasio-Cortez, D-N.Y., says, “I reject the idea that single payer is impossible.”
Maybe she should reconsider. There are a couple of major problems with what, in its long history of never happening here, also has been billed as national health care, universal health care, universal coverage, statutory health insurance and socialized medicine.
The first problem is money. A 2016 study by the liberal Urban Institute estimated that Sanders’ program would boost federal outlays by $32 trillion over a decade. To put that in perspective, remember that total federal expenditures this year will be about $4.4 trillion. Advocates say a single-payer system would eliminate so much waste that it would reduce overall national health spending, but the Urban Institute found it would raise costs by a hefty 17 percent. Nor have Sanders & Co. devised a way to pay for that: The liberal Tax Policy Center found a funding shortfall of $16.6 trillion over 10 years, which roughly equals the entire federal debt currently held by the public.
That dire reality brings us to the second problem: public opinion. A recent poll by the Kaiser Family Foundation found that most Americans support the idea of Medicare for All — until they hear that it would raise taxes and eliminate private health insurance companies. More than 150 million people are covered by employer-provided insurance, and most are happy with it. Nobel Laureate economist and liberal New York Times columnist Paul Krugman wrote recently, “A Medicare for All plan would in effect say to these people, ‘We’re going to take away your current plan, but trust us, the replacement will be better. And we’re going to impose a bunch of new taxes to pay for all this, but trust us, it will be less than you and your employer currently pay in premiums.’ “
That’s a tough sell. Americans have shown that while they want more people covered, and want their medical costs lowered, they’re suspicious of change. That’s why public opinion opposed Obamacare from the start — and why, once it was in danger, public opinion opposed repeal. Just as Democrats suffered at the polls in 2010 for passing the ACA, Republicans suffered in 2018 from trying to scrap it.
Incremental reform of the ACA could include improving the efficiency of the health exchanges where individuals buy private insurance, sweetening subsidies for middle-income families, and providing more “navigators” to assist consumers in finding policies that fit their needs. Measures to curb pharmaceutical prices or rationalize hospital bills might help. Congress could also find ways to encourage more states to expand Medicaid.
We’re not endorsing all these changes — merely noting that there are many ways to advance the goal of expanding coverage and containing costs that don’t require a federal takeover of health insurance.
Many Democrats think that when voters gave them a majority in the House, they got a green light to enact bold changes in the U.S. health care system. They would be wiser to act as though they have a yellow light — which means, “proceed with caution.”