Universal Coverage Should Be The Democratic Litmus Test In 2020

Every Democratic president and presidential nominee since Franklin Roosevelt has supported universal coverage. The last two Democratic presidents tried to pass universal health coverage bills over the fierce opposition of the GOP. The failed Clinton effort led (in part) to the GOP take over of the Congress in the 1994 election cycle. President Obama managed to pass the Affordable Care Act (ACA) despite unprecedented GOP obstruction and mendacity. (It’s been nine years. Has anybody been hauled in front of a so-called “death panel?”)

The ACA turned out to be a success despite all of the GOP predictions of doom. (Sasse predicted that “America would cease to exist” if the ACA was implemented.) Twenty million additional Americans were insured and the percentage of Americans who were uninsured declined from 18% to an all time low of 9%. For the first time ever, private health insurance companies weren’t allowed to discriminate against the sick and the injured.

The GOP reacted to this success with rage and fury. Since the passage of the ACA, Republicans at both the federal and the state level have worked overtime to sabotage the ACA. Nebraska’s Congressional delegation voted to defund the insurance co-ops and 120,000 Nebraskans and Iowans lost insurance policies they liked. Heineman and Ricketts refused to cooperate with the implementation of the ACA by rejecting a state based exchange and the Medicaid expansion. This sabotage has caused a 20% increase in insurance premiums in Nebraska.

The ACA was based upon a Republican plan and was probably the last chance for the private sector to play an important role in delivering health insurance in America. Due to GOP sabotage of the ACA, many prominent Democrats are calling for a Medicare For All or single payer system. Every Democratic elected official and candidate supports an increased role for the federal government in America’s broken health care system.

A Medicare For All plan polls well. According to an August 2018 Ipsos-Reuters poll, 70% of Americans support a single payer system. However, support for Medicare For All declines to 37% if it would require higher taxes. Similarly, support for single payer also goes down to 37% when voters are told that they may lose their current health insurance coverage. Due to our deeply flawed system, Americans are risk averse and afraid of losing what they already have.

The reality is that approximately 160 million Americans have employer based coverage and some of that coverage is good. Moreover, the unions have negotiated better health care plans for their members in return for giving up some wage increases.

Medicare For All isn’t the only way to achieve universal coverage. Many first world industrial democracies rely upon a combination of both public and private coverage to achieve universal coverage. For example, the system in the Netherlands is much like the ACA in that everyone is required to buy insurance for basic services from the private health insurance industry. According to a superb article from The Nation website dated August 2, 2017: “But the similarities end there: Insurers are barred from distributing profits to their shareholders, and a separate, entirely public scheme covers long-term care and other costly services. Premiums are subsidized, but most Dutch people purchase supplemental insurance to cover things like dental care, alternative medicine, contraceptives, and their co-payments.”

(I would recommend to everybody that they read the article from the August 2, 2017, The Nation website titled: “Medicare-for-All Isn’t the Solution for Universal Health Care. The health-care debate is moving to the left. But if progressives don’t start sweating the details, we’re going to fail yet again.”) It has had a big influence on my thinking about health care.

Other first world countries have demonstrated that there are multiple paths to the ultimate goal of universal coverage. We can learn from those experiences. The alternative to Medicare For All that has intrigued me is the Medicare Extra proposal from the Center for American Progress. This plan would set up a robust public option with generous benefits that would be available to all Americans.

According to the Center for American Progress:

“All individuals in the United States would be automatically eligible for Medicare Extra. Individuals who are currently covered by other insurance — original Medicare, Medicare Advantage, employer coverage, TRICARE (for active military), Veterans Affairs medical care, or the Federal Employees Health Benefits Program (FEHBP), all of which would remain — would have the option to enroll in Medicare Extra instead. Individuals who are eligible for the Indian Health Service could supplement those services with Medicare Extra.

Newborns and individuals turning age 65 would be automatically enrolled in Medicare Extra. This auto-enrollment ensures that Medicare Extra would continue to increase in enrollment over time.

Individuals who are not enrolled in other coverage would be automatically enrolled in Medicare Extra. Participating medical providers would facilitate this enrollment at the point of care. Premiums for individuals who are not enrolled in other coverage would be automatically collected through tax withholding and on tax returns. Individuals who are not required to file taxes would not pay any premiums.

In concert with comprehensive immigration reform, people who are lawfully residing in the United States would be eligible for Medicare Extra.”

The good thing about Medicare Extra is that it gives consumers and businesses a choice. If you like your plan, you can keep it. However, if you can get a better deal with the public option plan, you can buy into the public option. This fact will help blunt the inevitable Republican lies that consumers will lose their doctor and insurance plan if Medicare Extra should pass and give Americans more choices.

Going forward in 2020, we Democrats need to emphasize what we all agree on — universal health coverage for the American people. We need to focus on what unites us. It doesn’t help for us to engage in a circular firing squad and do the Republicans’ work for them.

At the same time, the Democrats need to focus on how we differ from the GOP on health care. The Republicans simply don’t believe in universal coverage and consumer protections. Conservatives don’t believe it is a legitimate function of government to spend money on health care for the sick, the poor and the elderly. They just don’t believe in it.

We need to constantly emphasize the huge difference between our party and the GOP on health care. We need to say it again and again and again that the Republicans in Congress voted over sixty times during the Obama era to take away insurance from 20 million Americans and end pre-existing condition protections. Similarly, we need to remind the voters that Trump and the Republicans tried to do the same thing all over again when they controlled all of the branches in 2017.

We Democrats made this huge contrast on health care our central message in mid-term elections. We won big in 2018. Now let’s do it again in 2020!



Dennis Crawford

Dennis Crawford


I’m a trial lawyer, defender of democracy and a sports fan.