At the heart of the 2020 Democratic Primary is the question of private health insurance: should we eliminate private insurance in favor of a mandatory Medicare-for-All system run by the federal government? Or might a public option be a more practical avenue towards universal healthcare coverage, giving Americans the choice of opting in to Medicare or sticking with their private providers?
The role of private insurance in the next Democratic administration has been the No. 1 point of contention this primary season. Sen. Bernie Sanders and Sen. Elizabeth Warren — the only top candidates in favor of banning private insurance — have spent much of the first three primary debates fending off skepticism that their plan is too extreme and too expensive (Sanders’ Medicare-for-All would cost an estimated $30 trillion over the first decade). The policy merits of a Medicare-for-All vs. Public Option system warrant their own discussion. This column focuses on the electoral politics of eliminating private insurance. And the politics are bad — election-losing bad. Let these three points illustrate my case.
(1) Outlawing private insurance is unpopular with the American public. You may have heard Bernie Sanders claim 70 percent of Americans approve of his plan. But approval turns to disapproval when respondents are told that Sanders’ plan would abolish private insurance and make Medicare enrollment compulsory, according to the nonpartisan Kaiser Family Foundation. By 57 percent disapproval to 37 percent approval, Americans reject the idea of being legally constrained to government-run healthcare.
(2) Eliminating private insurance turns Democrats’ winning issue — healthcare — into a political liability. The Blue Wave of the 2018 midterms, which restored a Democratic majority in the House of Representatives, was not a result of promises of impeachment or Progressive fantasies. Rather, we owe our majority to moderate Democrats who adopted a “Medicare for all who want it” position and won twenty-something swing districts across the country. Their mantra? “Donald Trump and Republicans are going to take away your healthcare.”
Today, 160 million Americans buy private insurance. Seven in ten say they like their insurance and want to keep it, according to a Gallup poll. Any Democratic nominee for President who supports forcing people off their plans and into a government program would dissolve the potency of Democrats’ most effective talking point. I can already hear Trump and the GOP’s coordinated attempt to dissuade swing-state centrists, independents and libertarians that dislike Trump from voting Blue: “The Democrats will take away your healthcare and force you onto a socialist program full of long lines and bureaucracy!” Of course, we’ll be accused of socialism regardless, but giving Trump this political gift will give his skewed sloganeering more weight.
(3) A Democratic nominee in favor of eliminating private insurance will hurt moderate Democrats and erase the gains they made in 2018. Think of it this way: in presidential election years, the position of the nominee can often overshadow — or render irrelevant — the positions of each Congressmember on the ballot. With no presidential candidate on the ballot in the 2018 midterms, Democrats running in swing-districts and battleground states enjoyed a higher degree of autonomy from the Party at large; they could draw distinctions between their candidacy and the positions of more high-profile, Progressive Democrats. Yet Republican strategists are reportedly already trying to tie vulnerable Democrat incumbents to mandatory Medicare-for-All, even if they don’t explicitly support it. A Democratic nominee against private insurance will only make Republicans’ strategy easier.
Most Democratic candidates (including Joe Biden) have in fact admitted that a public option would “crowd out” private insurance, raising premiums and eventually putting them out of business. If they’re right that Medicare is superior to private insurance, Americans will continue to opt-in until private insurance dies out. In the meantime, why should Democrats jeopardize our electoral chances for a position as unpopular and polarizing as this one?