Medicare for All: A Decade After Obamacare Democrats Embrace Healthcare Radicalism

Defining issue of Democrats 2020 Race includes extreme elements even Obama said he wanted to avoid

By Peter Suderman

A decade ago Democrats in Congress were deep into the process of designing and debating the health care law that would become Obamacare. And President Barack Obama was on the verge of delivering a major address defending the law from its critics hoping to rally support from within his own party. 


In that speech Obama positioned his approach as a middle ground between two extremes.

There are those on the left he said who believe that the only way to fix the system is through a single-payer system like Canadas where we would severely restrict the private insurance market and have the government provide coverage for everyone.

On the right there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own. 

The following year Obamacare became the law of the land and the signature initiative of Obamas two-term presidency.

But in this years Democratic Primary Debates one of which even featured a full half-hour segment focused on health care introduced as the #1 issue for Democrat voters it was virtually absent. Instead the evenings leading contenders extensively defended Medicare for All a single-payer plan that captured elements of both the extremes Obama said he wanted to avoid. 

Medicare for All as proposed by Sen. Bernie Sanders (IVt.) and vigorously supported by Sen. Elizabeth Warren (DMass.) would end the nations employer-based health care system and in the space of four years replace it with a fully government-run system that is closest to Canadas but even more restrictive leaving virtually no room for private insurance.

It would according to both independent estimates and Sanders himself raise government spending on health care by something like $30 or $40 trillion over the next decade.

width=324And it would require tax hikes or tax-like fees or premiums on the middle class.  In terms of both cost and transition complexity it would dwarf Obamacare. 

Sanders and Warren spent much of one of the recent debates opening segments defending these ideas from tough questioning by the moderators and criticism from more moderate candidates who argued that the plan was too radical too unpopular and too unworkable.

The polls at least suggest that there is some truth to this: Medicare for All is popular in the abstract but quickly becomes unpopular when respondents are told that it would eliminate private health insurance or raise taxes. 

Arguably the strongest criticisms came from John Delaney a Maryland Democrat who in the early 1990s founded a health care financing company. Delaney warned that the radicalism espoused by Warren and Sanders would turn off more moderate voters in an election.

We dont have to go around and be the party of subtraction and telling half the country who has private health insurance that their health insurance is illegal he said.

Half of Medicare beneficiaries now have Medicare Advantage which is private insurance or supplemental plans.

width=227My dad the union electrician loved the health care he got from the IBEW. He would never want someone to take that away.

Its also bad policy. Itll underfund the industry many hospitals will close. 

He repeated it later in the evening. Ive been going around rural America he said and I ask rural hospital administrators one question If all your bills were paid at the Medicare rate last year what would happen? And they all look at me and say We would close.  

Warren and Sanders had essentially no response to this.

Warren accused moderates on the stage of spinelessness and both she and Sanders argued that questions and criticisms about single-payer health care amounted to Republican talking points.

Nor would Warren respond directly to a question about whether she would raise taxes on the middle class to fund the plan.

Sanders has admitted that it would require higher taxes and Warren has said shes with him on his ideas. But when asked by moderator Jake Tapper whether shes with Bernie on Medicare for all when it comes to raising taxes on middle-class Americans to pay for it? she prevaricated.

So giant corporations and billionaires are going to pay more she said.

Middle-class families are going to pay less out of pocket for their health care. (Weve heard that before havent we?)

And then she went on to attack insurance companies repeating the same basic formulation about total costs going down when Tapper pressed her again on taxes.

width=360Warren clearly didnt want to answer the question.

Following the debate CNNs Anderson Cooper pressed her on the question of upheaval: What would she say to people to liked their current health plans? How did she respond to the idea that Obamacare was already a tough sell politically and Medicare for All would therefore be even more difficult?

Once again Warren deflected accusing critics of timidity and spinelessness. 

But the critics who fought with Warren and Sanders have essentially zero support in the party. Delaney for example currently polls at 0.7. And while better-polling contenders like Kamala Harris and Pete Buttigieg have plans that call for something less than full-fledged single-payer they are speaking something like the language of Warren and Sanders.

The only Democratic candidate who has strongly attacked Medicare for All who has performed well so far is former Vice President Joe Biden but even Bidens plan has been framed largely as a response to Medicare for All. 

Somehow in the space of 10 years Democrats have drifted away from Obamas performative centrism his (at least rhetorical) sense that what Americans want is a middle way an anti-radical solution rather than the big structural change that Warren insists is needed.

Medicare for All and all the troublesome questions it raises is defining the 2020 Democratic race and the Democratic Party with it.


Peter Suderman is features editor at Reason. His writing has appeared in The New York Times The Washington Post Slate The Wall Street Journal Vox Politico The New York Post Newsweek The Washington Examiner and numerous other publications. 

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