Medicare For All is Overplayed

Sen. Bernie Sanders’s Medicare-for-all bill is scheduled for release today, which means we’ve already had a wave of commentary about it, from the progressives hyping a proposal with less than a dozen supporters to the predictable (if largely correct) pushback on the Right.  After all — as at least pundits on both sides acknowledge — single-payer schemes and proposals have fizzled in states like Vermont, California and Colorado, and if you can’t get single-payer in states like those, you can’t get it.

Nevertheless, the hype surrounding the Bernie proposal is useful to the Democratic Party.

For Democrats thinking of running for higher office, supporting single-payer is a form of left-wing virtue signaling.  For them — and other Dems running for re-election in 2018 who are concerned about primaries — it is also a way to ensure that they don’t get outflanked.

Moreover, single-payer is an issue that could keep the Democratic debate on more of a traditional policy axis and away from identity politics.  Any time Dems spend having a hot debate over whether to make their Holy Grail a litmus test is time spent distracting social justice warriors from making the debate about cultural issues that the party leadership does not want at the center of their rebranding effort.

Focusing on single-payer is also a way for Dems to avoid engaging in a full-throated defense of Obamacare beyond what’s necessary in the halls of Congress.  Sure, to many it will seem ridiculous for Dems to double down on government-controlled healthcare given the obvious failures of their last attempt.  But anyone who lived through the Cold War recognizes the “true socialism has never been tried” argument.  And frankly, the GOP has weakened itself on this score by backing a President who campaigned on the theory that big government would work with the right people making the deals.

The coverage of the issue so far has occasionally contained the cautionary note for Dems that single-payer could become their “repeal and replace Obamacare” — an issue that motivates a party’s base voters but becomes a trap when the party eventually regains power.  It’s an argument that sounds clever until you really examine it.

This is not the Dems’ first experience with that type of dynamic.  In 2008, Obama did not run on Obamacare, which more closely resembles the plan Hillary Clinton proposed.  Obama wanted a public plan; Hillary relied on mandates.  The split between the left and the far left on this issue was reflected in the bad poll numbers for Obamacare (and its improving poll numbers once Trump won, raising the theoretical possibility of repeal).

Yet Democrats were not going to lose many votes over having settled for Obamacare (at least not before its failures started affecting voters).  It is a party accustomed to success via incrementalism and O-care was a big increment.

The dynamic on the Right is different.  Having observed Dems win incrementally over the course of decades, the psychology is that the GOP must now pursue dramatic measures to keep America from zooming off a cliff, hence the popularity of 2016’s silly Flight 93 analogy.  Note, however, that on the big O-care increment, the flames of partisanship roar loudly enough these days that the GOP rank-and-file will also likely settle for something, anything on this issue, even if it’s a pathetic “skinny repeal.”

Both parties engage in magical thinking on the campaign trail and find realism in the committee room.  Their voters grumble, but ultimately accept, as partisans do.

Meanwhile, a debate over single-payer helps move the Overton Widow for Democrats.  The GOP’s follies on “repeal and replace” instruct Dems that their next expansions of Medicaid and Medicare will almost certainly survive any GOP promise of rollback.  And this lesson will be doubly potent if the GOP fully embraces the Trump approach of ignoring the unfunded liabilities created by entitlement programs.

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