With all the recent talk about how Republicans might respond to an invalidation (in whole or substantial part) of the Affordable Care Act, it’s worth asking now and then how Democrats will respond, other than (for the most part) anger. And among many progressives, the answer is actually pretty clear: with a renewed push for a single-payer national health insurance system, which is what many preferred in the first place.
This is not the time or place for a discussion of single-payer on the merits, though I have to say I’ve personally begun warming to it more with each recent encounter with the health care system.
But I do want to address something that I think an awful lot of progressives believe reflexively: that single-payer, if marketed as “Medicare For All,” would be politically unassailable thanks to the popularity of Medicare itself. This seems to be the premise of a drive already underway in anticipation of an adverse Supreme Court ruling on ACA, as reported by TPM’s Brian Beutler:
[D]isappointed activists aren’t sweating Thursday’s Supreme Court ruling. If the health care law fails, they believe it will open up a whole new set of political and substantive opportunities for liberals.
“The right fought [the Affordable Care Act] just as bitterly as they would have fought if it was single payer,” said Chuck Idelson, spokesman for National Nurses United — a union and trade association of registered nurses that has consistently supported Medicare for all.
“Medicare continues to be an extremely popular reform — it’s one of the most popular reforms in U.S. history,” said Idelson.
Absolutely true. But the idea of making Medicare universal—even if it initially gains a positive response in public opinion—is going to run into some serious heavy weather once specifics are discussed and criticism begins.
As I’ve argued for a good while as others wondered why Republicans have been able to pit Medicare beneficiaries against those benefitting from ACA, many and perhaps most seniors receiving Medicare do not perceive the program as a social good that government gives them, but as an earned benefit—earned through lifelong payroll taxes, premium payments (once retirement age is reached), and more abstractly, through a lifetime of work that is performed before eligibility is reached. Extending “Medicare” to “all” would change that assumption rather dramatically, particularly with respect to younger beneficiaries (including children) who haven’t “earned” much of anything, from the point of view of seniors. The GOP talking points write themselves: Liberals want to give YOUR Medicare to THOSE PEOPLE! If “Medicare For All” is vastly easier to understand than ObamaCare, then so, too, are the racial and generational arguments against making it available to darker and younger people as opposed to just “cutting” Medicare (or setting up “death panels”) to give something new to THOSE PEOPLE. I’m afraid anyone who thinks a universal Medicare would be as popular as the current Medicare is missing this important if unfortunate point.
The bottom line is that the case for universal health coverage has to be made, on both moral and economic grounds, again and again until a durable majority insists on it. Hijacking the popularity of Medicare to turn it into something very different won’t get around that painful but essential task.
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