David M Rothschild on Posted on

The Republicans control all three branches of the US government and the rate of Americans uninsured for healthcare is going up, after years of decline under President Obama. The Democrats appear somewhat shy about backing meaningful healthcare reform if/when they get back into power: I think they should be bold. It will help them get elected and make them more effective if/when they do.

There is widespread support for pushing the healthcare uninsured rate towards ZERO. We consistently get nearly 80 percent support from the general voting population for universal healthcare, with 60 percent of REPUBLICANS supporting. We have asked this a dozen different ways and creating universal healthcare coverage is very, very popular. Further, it is not secret: Kaiser has some great polling and Polling Report collects a bunch of polling. Single payer plans, where there is just one government insurance for all, is the least popular type of universal coverage with polling still reaching the low 50’s or high 40’s.

Universal healthcare will become less popular if/when concrete plans are discussed, because right now people focus more on the benefits than the costs, but plans to let people buy Medicare (if/only they choose to) are poised to hold up well. There is a well formulated plan for this called: Medicare Extra from from Center for American Progress. Key points of Medicare Extra:
1) Universal: It will push uninsured rate towards ZERO, and that is very popular.
2) Optional: It is specifically built to make sure that most employers stick with their plan, as it does not subsidize the employers’ portion (beyond whatever subsidies are built into Medicare) if they choose to move their employees to Medicare. Some employers may drop their insurance and subsidize Medicare, but it is not designed to be widespread.
3) Medicare is Popular: It is a good insurance plan that people like.
4) Costs are Controlled: Using Medicare versus private insurance plans slashes overhead costs, and it would include bargaining for drugs prices. And, if the government is going to subsidize healthcare anyway through other insurance programs, emergency room visits, etc, centralizing the subsidy with Medicare is much more cost-effective (and healthy) way for them to do it.

Democrats should push for Medicare Extra (along with Repeal/Replace of Trump Tax Cut for Corporations) as a core, national priority. It is popular, unifying, and defining of a pro-productive Americans economic agenda. So maybe Medicare Extra starts at nearly 80 percent, but drops to 60 percent once people internalize the costs with the benefits. Maybe slightly less than half of the Republicans support it in the long-run. But, that means that this policy is still insanely popular for a core Democratic policy position.

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1) Democrats currently lack any unified economic message. Quick, what is the Democratic economic message? They need one that counters the Republican message of lower taxes and lower regulation (both of which are actually really unpopular when polled in detail, almost no one supports massive tax cuts for the rich or eliminating consumer protection, but resonate as a topline slogan).
2) What is the point of the Democratic party if they do not fight for a few key issues of their voters? Getting all Americans healthcare insurance is central to believing in the power of the safety net as necessary for people be productive. When people need to worry about healthcare, shelter, or food, it is not just very hard work, but luck, to be productive, to achieve goals. One unlucky illness can send a family into bankruptcy, or worse.
3) There are few issue that are more popular among Democrats, core to their fundamentals, that are also popular among Republicans. I get that it will become less popular as it becomes more salient, but this is an outstanding starting position. And, I am very confident it will remain popular with some good messaging.
4) If the Democrats do not own the healthcare debate, the Republicans are going to attack every Democrat as a supporter of socialist single payer (i.e., Bernie Sanders’ plan). This is not a value judgement on Sanders’ plan, but it is much less popular than Medicare Extra, as it would likely force people off of their current insurance onto Medicare.  Thus, if the Democrats do not back a plan, they will get pegged with the most extreme, least popular version of reform. It is a strictly dominant to propose what most of them actually, back that plan, and do meaningful messaging around it. If Democrats really do back the Sanders’ plan over Medicare Extra, then do that do, but polling does not suggest rank-and-file do.
5) Some Democratic “pollsters” learned the wrong lesson from Republicans’ “repeal and replace” of Obamacare: Republicans won by not having a plan, which is great only if your actual plan is evil. Republicans benefited from no plan, because what they wanted to do was evil and the mainstream media was too bashful of imposing assumptions of what their plan could look like: pushing 30 million people off of insurance, driving up premiums, and costing money! Clearly, if they ran on that plan explicitly, it would be worse than being vague as it is worse than what people assume it will be. But, the Democratic plan is popular, so makes sense to embrace it.
6) Democrats are more effective as a party if there are some unifying things they can create positive national movements for. People will believe that they are a meaningful party with a unifying agenda, if they are a meaningful party with a unifying agenda. It will help in 2020 and beyond, regardless of the impact in 2018. And, there is an economy of scales: it is a lot cheaper to create a few national ads, than 435 carefully tailored local ads.
7) The 2018 election will be a referendum on President Trump, no matter what the Democrats propose, but it relatively cost-less (actually positive) to promote good policy and cast one of President Trump/Republicans policy positions as even more evil than people currently assume it is. Any argument I have seen against the Democrats unifying embrace of Medicare Extra is some combination of deceptive and stupid.