Support among Democrats for a single-payer health care system never went away. But it’s definitely front-and-center again, as I explained at New York:
With the recent upsurge of outspoken progressivism in Democratic primaries, Medicare for All has returned as a chief policy demand. M4A (as it’s often abbreviated) is the favored poll-tested moniker for a single-payer health-care system that would provide universal public insurance regardless of age or means. It has been associated strongly with Bernie Sanders, who first offered single-payer legislation in the House way back in 1993 and introduced what is now the gold-standard proposal in the Senate in 2017, right after his first presidential campaign. But more than that, support for M4A has been the policy proposal that instantly separates progressive sheep from centrist goats in the Democratic ranks.
In the crowded 2020 Democratic presidential primaries, support for M4A as opposed to incremental health reforms building on Medicaid or Obamacare was a topic all the candidates had to address. For at least one, future vice-president and 2024 presidential nominee Kamala Harris, waffling on M4A helped derail a once-promising candidacy.
While support for Medicare for All did not go away after 2020, it did take a back seat to the Biden legislative agenda that virtually all Democrats supported, which focused on non-health-care priorities, aside from efforts to shore up existing programs that had been scaled back during Trump’s first term. And after Trump’s return to the White House in 2024, Democrats were in the minority in Congress and very much on the defensive as the GOP hammered Medicaid in last year’s One Big Beautiful Bill Act and threatened to gut Obamacare this year.
But now that Democrats can envision themselves controlling Congress next year and reconquering the White House in 2028, they’re being forced to articulate policy goals more elaborate than resisting Trump and defending the status-quo ante. And as always, Medicare for All is attractive to Democrats as a relatively simple health-care policy panacea, and as a signal to left-bent activists and voters alike that the candidate embracing it is a true progressive unafraid of offending either centrist donors or private insurance companies and their investors. M4A is particularly catnip to insurgent Democratic candidates who want to show their anti-Establishment bona fides and their hostility to timid Democratic incrementalism. At a time when health-care costs are a critical component of an affordability crisis that remains the top voter concern for Americans across the political spectrum, expanding the wildly popular Medicare program to cover everyone seems less radical than ever.
Strong support for Medicare for All has become a must-have credential for candidates backed by the Democratic Socialists of America and like-minded activists and influencers. And so, as Axios reports, it’s an old idea whose time has come round again:
Democratic socialist and progressives’ success in this year’s primaries is evidence of new enthusiasm for Medicare for All plans that many centrists have long dismissed as costly pipe dreams.
The health affordability crisis and widespread frustration with the medical system are fueling a new appetite for big-government solutions to address drug prices, insurance premiums and long-term care costs.
“This does feel like a moment where the Democratic base is looking for bigger ideas that go beyond incremental policies,” said Larry Levitt, executive vice president of policy at KFF.
Non-incumbent Democratic Senate candidates like Juliana Hatton of Illinois (who won a highly competitive primary in March) and Abdul El-Sayed of Michigan (the current front-runner in that key race) have used support for M4A to differentiate themselves from ho-hum Democratic Party foes. And several House insurgents sponsored by DSA (Pennsylvania’s Chris Rabb, New York’s Darializa Avila Chevalier and Claire Valdez, and Colorado’s Melat Kiros) or Bernie Sanders’s Our Revolution outfit (California’s Aisha Wahab, Mai Vang, and Randy Villegos) have made strong Medicare for All advocacy a key differentiator from other Democrats. It seems certain that if Democrats do flip either congressional chamber in Congress, there will instantly be a demand for proactive health-care reform legislation, and M4A is likely to have more support than ever.
The cost of Medicare for All remains its biggest problem — perhaps even a bigger problem than ever given the recent explosion in health-care costs. It’s not just the cost of expanding Medicare eligibility to non-seniors that’s a huge cost center; most proposals like Sanders’s also expand the medical services covered, and most crucially, eliminate copayments and premiums. In that respect, it’s not Medicare for All we’re talking about, but Medicare for Free for All, which is another proposition entirely.
Still, as the clearest and most coherent health-care reform idea on the table, and no more “socialistic” than the health systems already in place in most of the world (and less than many), M4A remains the progressive default position on a topic that grows more urgent every year. It’s Democratic centrists who need a reboot of their mostly reactive thinking on health-care policy going into the post-Trump era. Perhaps some hybrid of subsidized private health insurance with a robust “public option” — what Texas Senate candidate James Talarico cleverly calls “Medicare for Y’all” — will become the lower-cost alternative to Medicare for All, but not just because it’s less ambitious and closer to the status quo. That’s not a good message for Democrats right now.
