A Medicare-for-All Gift Is Staring the GOP in the Face
When Abdul El-Sayed became Michigan’s Democratic Senate nominee last week, his Republican opponent, Mike Rogers, immediately attacked his “ideological fanaticism” on crime, terrorism and taxes. Unmentioned: El-Sayed’s support for Medicare-for-all, a system in which the federal government would become nearly the only provider of health insurance.
Based on the frequency with which El-Sayed brings up health care, he clearly thinks the issue is an asset for him in the race. Perhaps Rogers agrees with that assessment. If so, he will miss an opportunity to devalue it or even convert it into a liability.
El-Sayed is one of the first candidates in a competitive statewide election to support Medicare-for-all. Troy Jackson, who is running to unseat Republican Sen. Susan Collins in Maine, is another. Peggy Flanagan, seeking to represent Minnesota in the Senate, is a third. Yet there are sound reasons to think the idea could become a weight on these candidacies.
Americans, for all their complaints about the health care system, generally dread the prospect of Washington disrupting their insurance. Many surveys have found that most people are satisfied with what they have. When Bill Clinton proposed a more government-run system a generation ago, the most potent attack against it was that it threatened that coverage. Barack Obama, having learned from Clinton’s failure to enact his legislation, made “if you like your plan, you can keep your plan” a central promise of his own health policy. The lowest political moment for Obamacare was when that promise didn’t bear out for 4 million people who saw their plans canceled.
Support for the status quo — or, perhaps more accurately, fear of what Washington might replace it with — has doomed sweeping conservative plans, too. After Clinton’s ambitions failed, Republicans advanced changes to Medicare that Democrats successfully portrayed as a threat to seniors’ medical care. The GOP’s efforts to repeal Obamacare during President Donald Trump’s first term ran aground because too many Americans had gotten used to getting coverage from it.
Medicare-for-all would impose more radical disruptions on the health care system than any of these earlier proposals and laws. In the book El-Sayed co-authored about Medicare-for-all — styled as a “citizen’s guide” to the idea — he was forthright that everyone with coverage from their employer, private insurance, Medicare Advantage or Medicaid would have to “transition” to the new system: “M4A would not be an opt-in or opt-out program; everyone would be covered.”
The leading Medicare-for-all bill, written by Sen. Bernie Sanders of Vermont and co-sponsored by 17 other senators, would go so far as to make it illegal to enter any private insurance contract to provide a service covered by the new government program. (Sanders allows that buying insurance for cosmetic procedures, should it ever become a viable product, would still be legal.) The bill would impose tight restrictions on paying privately for medical care, too.
It’s Medicare-for-all, whether you like it or not. Even when advocates aren’t explicit about prohibiting most private health insurance — Jackson and Flanagan haven’t tipped their hands — it’s hard to see how the idea could prevail without removing it as a real option.
El-Sayed was cagey about this point in a recent interview, and you can see why. The plan entails tossing hundreds of millions of Americans off their current coverage. Thirty-six million seniors have chosen Medicare Advantage plans alone. Traditional Medicare wouldn’t guarantee stability, either: “Medicare itself would change,” too, he conceded in his book. El-Sayed insists that most people would come out ahead from the new plan. They would receive more benefits and pay no more for health care than before, with any extra taxes offset by no longer having to pay premiums or out-of-pocket medical bills.
But it’s questionable whether most voters would, or should, share that confidence. Rosy cost projections for such plans depend on slashing payments to doctors and hospitals, which would probably disrupt care further and not for the better.
In the race for the Democratic presidential nomination for 2020, several candidates endorsed some version of Medicare-for-all. The winner was, however, an opponent of the idea: Joe Biden, who warned, “Medicare goes away as you know it.”
At the start of that campaign, a poll found that two-thirds of Medicare-for-all supporters believed it would let people keep the health insurance they already had. More recent polling has found that most Americans like the idea in broad outlines but that only 29 percent had “some” or “a lot” of confidence in the federal government’s ability to administer it. Seventy percent said they’d prefer to stay with their current insurance.
Perhaps Republicans should inform them that they wouldn’t have the choice.