The 2 words you can’t say in a Democratic ad
Democratic voters want single payer health care. But don’t expect to hear Democratic candidates talk about it — at least not in those words.
To avoid divisive intraparty fights that drive candidates left — only to be attacked by Republicans for favoring socialized medicine — the Democratic Congressional Campaign Committee warned aspirants last year about the political liabilities of endorsing “single payer,” according to sources familiar with the advice. An influential progressive group even urged candidates to discard the often-misunderstood phrase and embrace “Medicare for all” to draw strong connections with the popular seniors’ health program.
Story Continued Below
A third of the way through the 2018 primaries, Democrats have largely prevented the Bernie Sanders-led groundswell of single payer support from swamping the contests. And they’re fine tuning their messaging to build support for the idea. Kara Eastman, a progressive Democrat hoping to knock out incumbent Republican Don Bacon in Nebraska’s second congressional district, pledged to support the idea but refuses to use the term “single payer,” calling it a “buzzword.”
It’s an important distinction in the handful of races where single payer advocates have made it onto the ballot. Those include many of the GOP-controlled House districts in California that Hillary Clinton won in 2016, and the Senate contest pitting Democrat Sen. Dianne Feinstein against fellow Democrat, Kevin de León, who’s emphasizing health care and civil liberties. It has also made the ballot in more unexpected places, such as Nebraska.
Those contests will decide whether the idea is strong enough to drive turnout from the progressive base, or whether it repels the independent or GOP voters needed to win.
“I certainly have been worried that our party was going to have an internal debate between people who favor single payer and people who didn’t favor single payer,” Sen. Chris Murphy (D-Conn.) said recently when he rolled out legislation with Sen. Jeff Merkley (D-Ore.) to allow all Americans to buy into new Medicare plans, regardless of age.
Expanding health coverage in that kind of way is a largely philosophical discussion as long as President Donald Trump is in the White House. But it is one that Democrats will have to confront before the wide-open 2020 presidential primaries, where ambitious ideas like single payer could be a litmus test, and the general election, where the parties are likely to play up their widening divide on health care.
“It’s important to have a number of different, aggressive proposals out there so that they’ll be subject to debate in 2018 and 2020,” Murphy said.
Some Democrats argue that instead of focusing on the potentially divisive idea of single payer, the party should defend the Affordable Care Act against “sabotage” from Trump and congressional Republicans, who combined to repeal the individual mandate and scrap a key subsidy program that helps cover low-income people. That message is more compelling this year, argues Brad Woodhouse, campaign director of pro-Obamacare group Protect Our Care.
“We’re out of power right now, we can’t make any of that happen,” he said of single payer health care. The vast majority “of what you do when you’re out of power is prosecute the case against what they’ve done — otherwise there is no reason to make a change.”
While Democrats grapple over what kind of health care expansion they support and what to call it, Republicans are poised to brand any support for a public option or expansion of Medicare as a vote for single payer and liken it to Britain’s government-run health system.
Going into this year’s primary season, Democrats worried single payer talk would fuel public feuds between candidates such as California gubernatorial hopeful Gavin Newsom, who came in first in the state’s primary, and Antonio Villariagosa, who advocated against Medicare for all and finished third. They also worried progressives’ support for the idea would force moderates to do likewise in swing districts where the issue is more vulnerable to GOP attacks.
Democrats took several steps to neutralize the threats.
Early last year, the DCCC shared verbal guidance with candidates and political consultants about the liabilities of supporting single payer, including polls that showed support for the idea declined once voters heard that it would likely come with significant tax increases and the potential loss of private health coverage many Americans have today, according to sources who saw the guidance.
Democrats also wrote a number of bills to expand access to health care. In addition to the Murphy-Merkley bill, Democrats proposed allowing people to buy into Medicare, buy into the Medicaid program and add a government-run health option to private payer options. The multiple options provided needed cover for candidates who backed expanding access to government health programs but didn’t feel comfortable embracing Sanders’ plan.
And when the GOP tried to divide Senate Democrats by forcing a vote on a single payer health care bill last July, progressive Democrats banded together to vote “present,” avoiding a visible rift for Republicans to exploit. Red-state Democrats up for reelection this cycle, including Montana’s Jon Tester and Heidi Heitkamp of North Dakota, voted against single payer to firm up their moderate bona fides.
Meanwhile, the Progressive Change Campaign Committee, one of the biggest political organizations promoting a single payer health system, began urging candidates to avoid the term and use “Medicare for all.”