Former President Barack Obama embraced “Medicare for all” last week as he rallied Democrats for the midterm elections. Critics pounced, charging that this rhetorical flourish proved that he always meant to use Obamacare as a stalking horse for government-run health care.
It didn’t. Obama’s version of Medicare for all would be an option for people under 65 to enroll in a basic Medicare plan with the same choices that seniors now have to buy supplemental private insurance for more coverage. By contrast, a government-run plan, also known as single-payer, would replace private insurance and Obamacare.
Yet Republicans have grabbed hold of Obama’s phrase for an attack line against Democratic candidates in the final eight weeks before the Nov. 6 elections.
“When it comes to single-payer health care, Barack Obama was against it before he was for it,” a Las Vegas Journal Review editorial charged on Monday. The Journal Review is owned by the billionaire gambling mogul Sheldon Adelson, a Republican activist and campaign contributor.
That’s a political hit job, intended to sow confusion, that Democrats will have to repel.
Substantively and politically, advocacy of single-payer health care is perilous for Democrats. A purely government-run system could require trillions of dollars of tax increases and, despite widespread complaints about the health-care system, many Americans would rebel at the prospect of losing their existing private coverage. The benefits, including universal coverage and increased ability to control health-care costs, are harder to explain persuasively than the impact of big tax hikes.
Republicans are already on the defensive over their unsuccessful and now unpopular efforts to repeal the Affordable Care Act, Obama’s signature domestic achievement. The current Republican threat to repeal an Obamacare rule that bans discrimination by insurance companies against people with preexisting medical conditions is proving to be a political bonanza for Democrats all over the country.
Only where Democratic candidates are openly supporting a single-payer plan are Republicans on the offensive.
A Medicare-for-all option is far more appealing politically. Though specifics remain vague, it wouldn’t entail huge tax increases and would be modeled on the familiar and popular Medicare program.
“Unlike a single-payer plan that forces people into a government system, Medicare-for-all offers lots of choices,” said Ezekiel Emanuel, one of the architects of the Affordable Care Act and now vice provost and professor of medicine at the University of Pennsylvania. In an interview this week, he noted that the private insurance supplemental plans now comprise about one-third of Medicare and are well liked by patients, the insurance industry and the medical community.
Obama’s Sept. 7 speech at the University of Illinois was a blistering assault on President Donald Trump and his administration, breaking a year-and-a-half of restraint in the face of incessant and misleading attacks from Trump.
Still, Obama counseled against the increasingly confrontational politics favored by some of his liberal friends. He said Democrats this year are “running on good new ideas like Medicare for all, giving workers seats on corporate boards, reversing the most egregious corporate tax cuts to make sure college students graduate debt-free.”
These proposals aren’t new, and there aren’t enough “egregious” and reversible corporate tax cuts to free up money to pay for all college students to graduate debt-free. But they are mainstream Democratic ideas, not a call for a the federal government to run the entire health-care system.
Medicare-for-all is not, as the right-wing North Carolina Congressman Mark Walker charged this week, “an admission of Obamacare’s failure.” It’s a way to build on Obamacare, just as President George W. Bush’s prescription drug benefits for seniors built on Medicare.
But when it comes to the health-care politics of 2018, struggling Republicans are desperate.
Albert R. Hunt is a Bloomberg Opinion columnist covering politics and policy. He was the executive editor of Bloomberg News, before which he was a reporter, bureau chief and executive Washington editor at the Wall Street Journal.
