Democrats 'shooting holes in their own boat' with single-payer plan

Democrats 'shooting holes in their own boat' with single-payer plan
© Greg Nash

If Democrats run a presidential candidate and adopt a party position advocating a single-payer health care plan that does away with private insurance, it's likely to cost them any chance to win control of the Senate and may also imperil their House majority.

The major Democratic contenders in the half dozen Senate seats, most of which they need to capture, as well as a number of the freshmen House members who gave the party control by winning last November, fear a focus on a government-run health care plan could be lethal for them next November.

Other potentially problematic positions coming from the presidential candidates, such as decriminalizing illegal immigration, reparations for slavery, or stiff taxes on the rich can either be walked back or are more of a governing than a political problem.


Opponents would have an easier time sticking congressional candidates with a totally government-run health care scheme, advocated by Sens. Bernie SandersBernie SandersBiden wins Louisiana primary Oh, Canada: Should the US emulate Canada's National Health Service? Trump glosses over virus surge during Florida trip MORE (I-Vt.) and Elizabeth WarrenElizabeth WarrenTrump defends Roger Stone move: He was target of 'Witch Hunt' Democrats blast Trump for commuting Roger Stone: 'The most corrupt president in history' Pharma pricing is a problem, but antitrust isn't the (only) solution MORE (D-Mass.) and, on some days, by Sen. Kamala HarrisKamala Devi HarrisHillicon Valley: Facebook considers political ad ban | Senators raise concerns over civil rights audit | Amazon reverses on telling workers to delete TikTok Senators raise concerns over Facebook's civil rights audit Biden's marijuana plan is out of step with public opinion MORE (D-Calif.). This issue affects many millions personally.

This risks the big advantage Democrats enjoy on health care, warns Paul Begala, a prominent party strategist. “Abolishing private health insurance would squander that advantage and allow Trump to accuse Democrats of restricting coverage and limiting options. Far better to expand coverage and increase options with a Medicare buy-in as a public option,” Begala told me.

Those single-payer advocates, he added, “are shooting holes in their own boat, and it could sink the Democrats and re-elect Trump in 2020.”

It's a dream for Trump and Republicans who have been floundering on the issue. Back before the Affordable Care Act became popular, Republicans scored points on Barack ObamaBarack Hussein ObamaHow Trump can get his mojo back Trump confirms 2018 US cyberattack on Russian troll farm Democrats see convention as chance to underscore COVID-19 message MORE's exaggerated claim that “if you like your health insurance you can keep it.” That pales, strategists of both parties agree, next to charges Trump and company are certain to make: “If you like your health insurance the Democrats will force you to give it up.”

Of the 43 newly elected House Democrats who took Republican seats, the vast majority ran on protecting and expanding Obamacare. Only a handful of candidates in competitive contests advocated a single-payer plan, and several of those lost.


Most of the freshman in swing districts, like Kim SchrierKimberly (Kim) Merle SchrierUS ill-prepared for coronavirus-fueled mental health crisis Gun control group rolls out House endorsements Human Rights Campaign rolls out congressional endorsements on Equality Act anniversary MORE (D-Wash.), are progressive and realistic on health care. “The Affordable Health Care Act was a phenomenal first step, and now we need to expand it, bring down costs and offer a public option,” the Washington state lawmaker who's a pediatrician told me. “A lot of my constituents like their health insurance plan; union members who negotiated really good health care benefits are not willing to give them up.”

She and Illinois freshman Karen Underwood, a nurse and former Obama health care official, are among those devising ways to improve the Affordable Care Act.

Democrats scored big gains last year in the suburbs of Philadelphia, New Jersey, New York and northern Virginia. Not one of those new lawmakers supports a single payer measure.

It's simply not realistic, according to Virginia Rep. Abigail SpanbergerAbigail Davis SpanbergerBipartisan lawmakers introduce bill to limit further expansion of 2001 Authorization for Use of Military Force Trade groups make lobbying push to be included in small business loan program Virginia GOP to pick House nominee after candidate misses filing deadline MORE, who beat a Republican incumbent by less than two points. She backs a measure that would allow Americans to buy into a public plan. There's a similar refrain from other freshmen from Michigan to Texas to Colorado.

To take the Senate, Democrats need to win in places like North Carolina, Alabama, Arizona, Iowa and Maine — generally not friendly venues for terminating private insurance plans. In Arizona, Mark Kelly, a former astronaut and the Democrats' top 2020 Senate challenger, backs a public option but pointedly says, “I am not in favor for the 156 million of us that get our health care through our employer to make that go away.”

Another top challenger, North Carolina's Cal Cunningham, a former state legislator and a veteran, likewise says the need is to “strengthen the Affordable Care Act” and “not for taking away employer-sponsored health care.”

Remarkable is the blindness of some liberals and their inability to appreciate how politically disruptive are major changes in health care; that's why the Affordable Care Act was unpopular until the Republicans tried to kill it without an alternative. What Sanders and Warren and company now want to do is kill ObamaCare rather than build on its popularity with cost controls and a public option which, like Medicare today, would allow consumers to choose between a government or private plan.

Leading progressive health care experts like Ezekiel Emanuel of the University of Pennsylvania and Princeton's Paul Starr warn that adopting a single-payer system would be a nightmare. Opposition would come from: the health insurance business, with about 500,000 employees; most hospitals; many doctors and others in the health care industry; lots of seniors, fearful it would disrupt the current system; and, whatever the public posture, many labor unions.

Single-payer polls well, notes the Kaiser Family Foundation health research organization, until voters learn the specifics. Support “shifts significantly” when learning about accompanying tax increases, potential delays in treatments, and that they can't keep their current health insurance.

That's the 2020 message Trump hopes to deliver.

Albert R. Hunt is the former executive editor of Bloomberg News. He previously served as reporter, bureau chief and Washington editor for the Wall Street Journal. For almost a quarter-century he wrote a column on politics for the Wall Street Journal, then the International New York Times and Bloomberg View. Follow him on Twitter @alhuntdc.