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| Are We Sure Eliminating Private Insurance is a Good Idea? | Are We Sure Eliminating Private Insurance is a Good Idea? |
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| It would be an exaggeration to say that the Democratic primary race is entirely about health care, but only a little bit of one. The standout moment from the first evening was Elizabeth Warren’s vociferous defense of eliminating private insurance companies, and much of the first half of last night’s debate was consumed with the issue as well. The candidates onstage were eager to recommend their plans and elaborate on their differences: Perhaps more than any other issue, this was one on which the different policy ideas in play were clear. Democrats were offering voters choices. | It would be an exaggeration to say that the Democratic primary race is entirely about health care, but only a little bit of one. The standout moment from the first evening was Elizabeth Warren’s vociferous defense of eliminating private insurance companies, and much of the first half of last night’s debate was consumed with the issue as well. The candidates onstage were eager to recommend their plans and elaborate on their differences: Perhaps more than any other issue, this was one on which the different policy ideas in play were clear. Democrats were offering voters choices. |
| That health care would play such a prominent role in the Democratic primary race is hardly surprising, given its role in last year’s midterm election. Exit polls found that health care was the top issue for voters, and even the Republican leadership in the House has seemingly blamed midterm losses on the issue. | That health care would play such a prominent role in the Democratic primary race is hardly surprising, given its role in last year’s midterm election. Exit polls found that health care was the top issue for voters, and even the Republican leadership in the House has seemingly blamed midterm losses on the issue. |
| Health care, in other words, may have decided the midterm, and is certain to play a pivotal role in the primary. And next year, it could play a pivotal role in the general election, too. But will it help or hurt the Democratic candidate? | Health care, in other words, may have decided the midterm, and is certain to play a pivotal role in the primary. And next year, it could play a pivotal role in the general election, too. But will it help or hurt the Democratic candidate? |
| In one sense, it offers Democrats an advantage. The party is far more engaged with the details of health care policy, and far more willing to promise to extend coverage to those who don’t have it. The debate over the last two nights has not been about whether to expand health coverage, but by how much, and by what policy mechanism. | In one sense, it offers Democrats an advantage. The party is far more engaged with the details of health care policy, and far more willing to promise to extend coverage to those who don’t have it. The debate over the last two nights has not been about whether to expand health coverage, but by how much, and by what policy mechanism. |
| From Medicare for All to a public option that builds on Obamacare, Democrats have plenty to say on the issue. That makes for a stark contrast with Republicans, who tried and failed to repeal Obamacare in 2017, and have since instigated a lawsuit designed to take down the law. President Trump has repeatedly promised that a better plan is coming — but so did Republicans throughout the Obama era, to little tangible result. Although the Trump administration has tweaked health policy in important ways, the Republican Party has largely left health care to the opposition, with some reports that Republicans in Congress have urged President Trump to play down the issue. | From Medicare for All to a public option that builds on Obamacare, Democrats have plenty to say on the issue. That makes for a stark contrast with Republicans, who tried and failed to repeal Obamacare in 2017, and have since instigated a lawsuit designed to take down the law. President Trump has repeatedly promised that a better plan is coming — but so did Republicans throughout the Obama era, to little tangible result. Although the Trump administration has tweaked health policy in important ways, the Republican Party has largely left health care to the opposition, with some reports that Republicans in Congress have urged President Trump to play down the issue. |
| And yet looked at another way, the Democratic advantage on health care is not as strong as it might look. | And yet looked at another way, the Democratic advantage on health care is not as strong as it might look. |
| First, there is the issue of eliminating private coverage. On the debate stage Wednesday night, Ms. Warren said she was for it, explicitly siding with Senator Bernie Sanders of Vermont, whose plan would wipe out nearly all private coverage in four years. | First, there is the issue of eliminating private coverage. On the debate stage Wednesday night, Ms. Warren said she was for it, explicitly siding with Senator Bernie Sanders of Vermont, whose plan would wipe out nearly all private coverage in four years. |
| Ms. Warren’s reasoning — that insurers are an obstacle to good care — was delivered with her typical intensity and effectiveness. Yet surveys have found that support for single-payer drops when respondents are told that it would eliminate private coverage. When Senator Kamala Harris of California mounted a similar defense earlier in the year, she quickly moderated her position, saying that she was open to other options as well. (Though last night, she was among the candidates who responded in the affirmative to the idea that they would abolish private health insurance in favor of a government-run plan.) It’s not an accident that when President Barack Obama pitched his health care reform to the nation, he did so by repeatedly promising that those who like their plans could keep them. | |
| The strongest pushback to Ms. Warren’s plan, meanwhile, came from former Maryland Representative John Delaney, who argued that a Sanders-style Medicare for All that paid current Medicare rates would result in the closure of hospitals. Mr. Delaney may have overstated the case by saying that all hospitals would close, but America’s hospitals would stand to lose billions of dollars. | The strongest pushback to Ms. Warren’s plan, meanwhile, came from former Maryland Representative John Delaney, who argued that a Sanders-style Medicare for All that paid current Medicare rates would result in the closure of hospitals. Mr. Delaney may have overstated the case by saying that all hospitals would close, but America’s hospitals would stand to lose billions of dollars. |
| Policy experts reportedly believe “some hospitals, especially struggling rural centers, would close virtually overnight” under such a system. If Mr. Sanders or Ms. Warren won the nomination, they would surely face accusations that they favored a system that would shutter struggling hospitals, reducing access for the rural poor, and closing centers of well-paying middle-class jobs throughout much of the country. | Policy experts reportedly believe “some hospitals, especially struggling rural centers, would close virtually overnight” under such a system. If Mr. Sanders or Ms. Warren won the nomination, they would surely face accusations that they favored a system that would shutter struggling hospitals, reducing access for the rural poor, and closing centers of well-paying middle-class jobs throughout much of the country. |
| Not all of the candidates argued for single payer. Joe Biden made the case for building on Obamacare, which he helped usher into law. But even Mr. Biden’s argument was a tacit admission that the health law that was the signature policy of the previous administration is, at best, insufficient and incomplete. | Not all of the candidates argued for single payer. Joe Biden made the case for building on Obamacare, which he helped usher into law. But even Mr. Biden’s argument was a tacit admission that the health law that was the signature policy of the previous administration is, at best, insufficient and incomplete. |
| And that gets to the mostly unspoken reason that health care has so dominated American politics, and the reason it played such a significant role in the first Democratic debate: It is the sense, shared by Republicans and Democrats alike, that Obamacare has failed or, at minimum, that it still needs considerable work. | And that gets to the mostly unspoken reason that health care has so dominated American politics, and the reason it played such a significant role in the first Democratic debate: It is the sense, shared by Republicans and Democrats alike, that Obamacare has failed or, at minimum, that it still needs considerable work. |
| This is not exactly a complete vindication of the law’s critics, but it does suggest that some of them were on to something, and that those who warned that Obamacare was a steppingstone to single payer might have had at least a partial point. Republicans, by failing to unite around a plan of their own, have given Democrats license to run with their wildest health policy dreams. But single payer is also a live issue at least in part because of the perception that Obamacare has not lived up to its initial promise of more affordable and accessible care. | This is not exactly a complete vindication of the law’s critics, but it does suggest that some of them were on to something, and that those who warned that Obamacare was a steppingstone to single payer might have had at least a partial point. Republicans, by failing to unite around a plan of their own, have given Democrats license to run with their wildest health policy dreams. But single payer is also a live issue at least in part because of the perception that Obamacare has not lived up to its initial promise of more affordable and accessible care. |
| In a 2009 speech about the law that would become Obamacare, Mr. Obama declared, “I am not the first president to take up this cause, but I am determined to be the last.” If nothing else, the first Democratic debates have made clear that he failed in this ambition, and that the lingering frustrations with the law he helped usher into being will be part of the reason. | In a 2009 speech about the law that would become Obamacare, Mr. Obama declared, “I am not the first president to take up this cause, but I am determined to be the last.” If nothing else, the first Democratic debates have made clear that he failed in this ambition, and that the lingering frustrations with the law he helped usher into being will be part of the reason. |
| Peter Suderman (@petersuderman) is the features editor at Reason. | Peter Suderman (@petersuderman) is the features editor at Reason. |
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