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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Is the Public Option the ‘Sweet Spot’ for Dems?

Democrats who support single-payer, Medicare for all or universal health care coverage have reason to be encouraged by the growing popularity of these reforms with Party leaders and in recent polls. Potential 2020 presidential candidates Sens. Elizabeth Warren and Bernie Sanders, as well as Senate Minority leader Chuck Schumer and many others have said that it’s time for Democrats to rally around a much stronger government role in providing health security for all Americans.

Jocelyn Kiley reports that a Pew Research Center poll condcuted June 8-18 indicates that “Public support for ‘single payer’ health coverage grows, driven by Democrats.”:

Currently, 60% say the federal government is responsible for ensuring health care coverage for all Americans, while 39% say this is not the government’s responsibility. These views are unchanged from January, but the share saying health coverage is a government responsibility remains at its highest level in nearly a decade.

Among those who see a government responsibility to provide health coverage for all, more now say it should be provided through a single health insurance system run by the government, rather than through a mix of private companies and government programs. Overall, 33% of the public now favors such a “single payer” approach to health insurance, up 5 percentage points since January and 12 points since 2014. Democrats – especially liberal Democrats – are much more supportive of this approach than they were even at the start of this year.

…Among Democrats, 52% now say health insurance should be provided through a single national insurance system run by the government, while fewer (31%) say it should be provided through a mix of private companies and government programs. The share of Democrats supporting a single national program to provide health insurance has increased 9 percentage points since January and 19 points since 2014.

Nearly two-thirds of liberal Democrats (64%) now support a single-payer health insurance system, up 13 percentage points since January. Conservative and moderate Democrats remain about evenly divided: 38% prefer that health insurance continue to be provided by a mix of private insurance companies and government programs, while 42% favor a single-payer approach.

Kiley notes also that adults under the age of 30 are more receptive to single-payer, with 45 percent favoring a “single national program,” compared to 30 percent for those 65 and older. Further, “66% of Democrats and Democratic leaners ages 18 to 29 say government health coverage should be provided through a single national system, compared with 48% of Democrats and Democratic leaners ages 30 and older.”

At The Los Angeles Times, Evan Halper reports that “Large numbers of Democratic politicians, emboldened by the failure of Republicans to repeal Obamacare, are now backing” single-payer health care reform. However, Halper also notes some push-back by Democratic centrists and moderates:

“I am completely dubious of these claims that socialized medicine is wildly popular,” said Jonathan Cowan, president of Third Way. “They never tell people in their polls that it would mean taxes go up significantly and they would not keep their doctor. Try that out. The moment you actually tell people what it is, support collapses.”

Cowan noted that Colorado voters in November soundly defeated a single-payer proposal. “This is a dangerous political fantasy,” he said. “If you believe in single-payer health insurance and don’t care about the consequences, fine. But to argue it is a political winner when it literally has never gotten more than 30% in a ballot measure is wrong.”

Cowan is likely wrong about the taxes part of his argument. Americans are already fed up with private insurance premium price-gouging and escalating out-of-pocket and drug costs. Arguments that government would do worse than what is going on are impossible to prove and a tough sell.

But the Republicans and the insurance industry will certainly hammer the meme that single-payer reform would result in many health care consumers losing their doctor. It may prove to be their most effective counter-argument.

Democrats can address this concern by including in any health reform package an iron-clad guarantee that those who are very concerned about keeping their physicians can do so. It would surely require all physicians to work within the system.

Most single-payer advocates would likely agree that it can’t be implemented all at once. That would be too disruptive to the health care and insurance industries and the economy. There will have to be a substantial phasing-in period adequate for health care and insurance companies to diversify and reconfigure their operations.

Perhaps the best way to accomplish this may be to provide a public option amendment to the Affordable Care Act as an interim first step toward a single-payer system. A public option has the appeal of offering health care consumers a choice, and it would provide an incentive to private insurers to expand coverage and reduce premiums and out-of-pocket expenses.

Insurance companies and conservatives will fight any reforms that expand a government role in providing health care. That fight can’t be avoided. But Democrats are holding the better cards in the struggle for health care reform, since the Republicans have squandered what little credibility they had in the Trumpcare fiascoes.

For Democrats, the way forward is to keep urging single-payer reform. The public is awakening to the cost-effective benefits of the single-payer approach, which has an impressive track record in other countries, while privatized health insurance becomes increasingly expensive in the U.S.

Americans have always preferred choices to being told there is only one way they can do something. By offering the choice of a public option for health insurance, Democrats can win the good will of more voters who value having a choice, while moving health care reform toward the cost-savings and expanded coverage of a single-payer system.

It may be that the best system for the U.S. is a stronger mix of public and private health insurance options, similar to that of Germany or the Netherlands, or we may evolve to the more centralized single-payer systems of the U.K. or France. Either way, the public option is a good beginning.

Obamacare was a good start. Indications are, adding a public option would be an excellent next step.

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