Democratic leadership have now signaled to voters what their party would look like in power, by introducing their vision for American health care policy: the laughably named Protecting Pre-existing Conditions and Making Healthcare More Affordable Act. Hakeem Jeffries, chair of the House Democratic Caucus, believes this bill presents “a clear contrast in terms of what we as House Democrats are about, and what Republicans are about.”
The bill is aimed at redressing the Trump administration’s early and recent assault on the Affordable Care Act (ACA). Its key features are increased subsidies for private insurance, bolstered funding for enrollment outreach, and the closure of loopholes that allow insurance companies to sell short-term plans that discriminate against people with preexisting conditions. The legislation protects private insurance plans and does not include a public option to compete with them on ACA’s market exchanges.
This is contrary to Donald Trump’s picture of the Democratic Party’s “radical socialist” health care platform. It’s also contrary to what many Democratic candidates ran and won on in the 2018 midterm elections. The disappointing reality is that Democratic leadership opposes Medicare for All, the single-payer policy championed by Bernie Sanders. Steny Hoyer, Nancy Pelosi, and Chuck Schumer all reject the proposal. Pelosi disingenuously asks, “How do you pay for that?” Hoyer claims it has “significant administrative and other issues.” Schumer dodges the question. This relentless focus on tweaking the ACA instead of championing Medicare for All fails to offer a solution to our continued health care crisis, let alone a winning alternative to Trumpism in 2020.
Reforming the ACA Won’t Cut It
While supporters of the ACA hoped the exchanges would become a popular source of insurance for a broad segment of the population, they have instead become an insurer of last resort stocked with precarious, high-deductible plans. The complex, market-based structure of the ACA ensures that any attempted solution is going to have some level of adverse impact. Incredibly, the more the government attempts to subsidize ACA premiums, the higher the costs become for low-income people.
If Democrats actually want to lower costs, protect patients, and guarantee health care as a right, then they already have a bill on the floor: the Medicare for All Act of 2019. The single-payer proposal — which boasts 107 co-sponsors — would cover every American resident, putting an end to a fragmented system that leaves millions behind. It would erase the government subsidies and wasteful administrative spending needed to keep the current system functioning — thereby lowering overall health care costs by trillions of dollars. It would put an end to underinsurance and financial barriers by creating a system in which all patients are guaranteed an equal standard of care, free at the point of use.
Such an approach would make ACA reforms superfluous. Medicare for All would not need subsidies for private insurance, because there would be no private insurance. It would not need more spending for enrollment outreach, because everyone would be enrolled. It would not need to close loopholes for those with preexisting conditions, because everyone would receive equal coverage no matter what.
Medicare for All Can Beat Trump, and Future Trumps
While the ACA has failed to withstand the test of time, Medicare for All offers a bold and resilient alternative. Bolstered as it is by a universal constituency, it won’t be vulnerable to the swift dismantlement Trump has inflicted on the ACA.
Medicare for All would be the first truly universal program in US history and would raise the bar for what Americans should expect from their government. Like other universal programs across the world, it would become a fiercely defended point of pride. Despite the ever present threat of privatization, conservative parties in countries with universal health care systems are unable to openly campaign against them without committing political suicide. Compare this to Trump, and the Republican Party, who have made “repeal and replace” their mantra on the way to power.
In prioritizing a package of reforms that barely move us beyond the status quo of Barack Obama’s administration, Democrats are caving to the pressures of the donor class and doubling down on an approach that has manifestly failed in its pursuit of universal coverage and lower costs. Much of the political energy needed to pass this bill will be spent simply clawing back functions of the ACA that were easily reversed by Trump, promising an indefinite tug-of-war between the parties as insurers profit and working people suffer.
Only one candidate understands this. When asked whether he supports Pelosi’s bill, Sanders was firm: “No. The incremental reform that I support is phasing in Medicare for all.” The United States needs a clear alternative to Trump premised on generous, universal social programs that speak concretely to the needs of the diverse working class. With Sanders running for president in 2020, we have a real opportunity to present such an alternative. We can’t count on Democratic leadership to take up this fight. We must do so ourselves.