Democrats rally to Bernie Sanders’ single-payer health plan

Los Angeles Times

Like passengers leaping for a departing train, leading Democrats are scrambling to support single-payer health insurance, a system that would represent a huge expansion of government control over health care and which the party’s presidential nominee declared last year would “never, ever” come to pass.

Sen. Bernie Sanders, I-Vt., whose support for universal coverage was central to his 2016 presidential campaign, Wednesday unveiled the latest version of his plan to expand Medicare to cover all Americans.

After a parade of testimonials about the failures of the nation’s existing health care system, Sanders cast his measure as a moral and economic issue.

“Today we begin the long and difficult struggle to end the international disgrace of the United States of America, our great nation, being the only major country on earth not to guarantee health care to all of our people,” Sanders said.

In the days before Sanders’ announcement, Democrats as ideologically diverse as liberal Sen. Kamala Harris of California and conservative Sen. Joe Manchin of West Virginia expressed support for his effort. Their statements reflect a significant shift within the Democratic Party, driven by multiple developments: a belief that the window has closed on Republican efforts to repeal Obamacare; a surge in support for government-run insurance among younger, more activist Democrats; and looming 2018 and 2020 contests that demand clarity on what Democrats support — not just whom they oppose.

Most of the party’s potential 2020 presidential candidates have now endorsed the single-payer idea, including Sanders, Harris, Sen. Cory Booker of New Jersey, Sen. Elizabeth Warren of Massachusetts, New York Sen. Kirsten Gillibrand and Minnesota Sen. Al Franken.

Competing Democratic health care plans are due out soon, including one that would allow Americans to buy coverage through Medicaid and another that would expand Medicare, efforts less disruptive than Sanders’ proposal. But the authors of both have cast them as bridges to a time when a single government plan can gain a majority.

The shift toward single payer brings risk for Democrats. The party suffered huge losses after attempts to restructure the nation’s insurance system during the Clinton and Obama administrations.

And although polls show rising support for a government-run insurance plan, much of that increase comes among Democrats and Democratic-leaning independents — meaning the party will be pushing an approach nearly as partisan as President Donald Trump’s recent efforts to repeal the current health care law. (The president’s press secretary, Sarah Huckabee Sanders, said Wednesday that Trump considers the new plan “a horrible idea.”)

Moreover, public opinion appears less than solid. A recent Kaiser Family Foundation poll found support gyrating wildly when criticisms of a Medicare-for-all plan — including increased taxes and more government control over health care — were raised.

“People don’t like uncertainty,” said Lynn Vavreck, a political scientist at the University of California, Los Angeles. “Even the promise of something good might not be seen as better than what you have.”

Already, elements in both parties are on the attack.

In Iowa, Republicans are accusing Democratic candidates for governor of supporting Sanders, citing a $32 trillion estimate for the senator’s 2016 campaign plan. In California, the fight has been between competing Democratic factions, leading to the threatened recall of the Democratic Assembly speaker after he set aside a single-payer bill pushed by a powerful nurses’ union because, he said, its financing was insufficient.

At his announcement, Sanders glided over the tough topic of how to pay for his proposal, saying only that “the average American family” would be better off and increased taxes “will be more than offset” by the absence of insurance premiums.

The swift embrace of a single government-run insurance program belies the long slog that veterans of the capital’s health care wars predict would be required to sell the plan not only to a skeptical public but to legislators on Capitol Hill. For now, with a Republican president and both houses of Congress held by the GOP, the finish line is a distant one under most any calculation.

“I hate to break it to anybody, but we are realistically not within four years of having a single-payer bill or a universal coverage bill passed,” said Andy Slavitt, who oversaw Medicare, Medicaid and insurance markets during the Obama administration.

“I strongly advise that Democrats invest the time in listening … (to) how people think about the trade-offs and how they think about the options and what features they’d like,” he said.

Backers of the plan dismiss any political motives. Harris said Wednesday that the measure “is a nonpartisan issue.”

Despite admonitions from experts like Slavitt, support for a universal government program rapidly is becoming a litmus test for the party’s national and state candidates.

“It’s going to be hard to win a Democratic primary in 2020 without supporting single payer,” Democratic pollster Celinda Lake said.

Some in the party disagree with the rush toward a new program on the heels of existing health care fights.

“Right now, I’m protecting the Affordable Care Act,” Democratic House leader Nancy Pelosi, of San Francisco, said Tuesday, repeating her long-standing position that talk of a single-payer plan, which she supports in theory, remains premature. “None of these other things … can really prevail unless we have the Affordable Care Act protected.”

Lake and other pollsters say there’s an even more basic reality: Most voters have little idea of what single-payer would do and how it would do it. In one focus group, for example, a participant expressed frustration over what “single payer” health care was, Lake said.

“What does single payer mean? The only single payer is me,” the focus group attendee said.

The label refers to a government program that would pay for and regulate health care for all Americans. It would replace the current system dominated by employer-supplied private insurance and supplemented by Obamacare’s government-assisted individual insurance plans.

It also would affect Medicare, which covers those 65 and older, and Medicaid, the program for lower-income people and the disabled that was expanded under Obamacare and now covers about 1 in 5 Americans.

As Sanders alluded to, it would eliminate the need to pay premiums to insurers for coverage but would require a very large tax increase.

The fact that most voters aren’t familiar with single payer could allow candidates who have endorsed it to define for themselves what they’ve signed onto. Then again, they will be defined by opponents as embracing the most extreme version.

“There’s a lot of energy for single payer,” said Bill Burton, a former Obama spokesman and party strategist. But at this point, the parameters of a bill are unknown, he said.

“It’s an idea that people are supporting, not actual legislation.”

Sanders will determine, in large part, how much flexibility his colleagues have. While he remains an independent, somewhat distant from the party whose nomination he sought last year, the Vermont senator has an unparalleled ability to draw in the young voters on whom the Democratic Party’s future depends.

Last year, that ability came at the expenses of the party establishment and eventual nominee Hillary Clinton, with whom he clashed over health care.

Sanders argued that universal coverage was necessary both to protect Americans’ health and to break what he called the “corrupt” control of the health care system by pharmaceutical companies and other interests.

Clinton countered that his plan “will never, ever come to pass.”

Since the campaign — and the monthslong, unsuccessful fight by Republicans to repeal Obamacare — things have changed.

A Pew Research poll in June found that the percentage of Americans favoring a single-payer plan had risen to 33 percent, five points higher than in January and 12 points higher than three years earlier. Two-thirds of Democrats younger than 30 favored a single government plan, as did 22 percent of young Republicans.

Sanders has said support for his plan should not be a litmus test for candidates, but some of his most loyal partisans disagree in words that conjure a coming fight.

“It’s a litmus test,” said RoseAnn DeMoro, the executive director of National Nurses United. “The Democrats hate it when I say that.”

Any intraparty conflict will be piled upon the nervousness that defines every effort by either party to change the nation’s health care system. The persistent problem: Although Americans often vote for change, they also fear it.

Vavreck said she was surprised at the quick shift among Democrats from defending Obamacare, which kept much of the insurance system in place, to fighting for what has been deemed a long shot.

“The idea that you go to the biggest, boldest idea seems to me an unusual way to make progress,” she said. Sanders and other Democrats may have decided, she said, that “if you don’t push for a foot, you never get an inch.”

Talk to us

More in Nation-World

FILE - This undated file photo provided by the Alexandria Sheriff's Office shows John Cameron Denton, founder and former leader of a neo-Nazi group called Atomwaffen Division. Federal prosecutors in Virginia are seeking a five-year prison sentence for Denton, who pleaded guilty to conspiring with other far-right extremists to threaten dozens of targets, including a predominantly African American church, a sitting U.S. Cabinet member and journalists.  U.S. District Judge Liam O’Grady is scheduled to sentence Denton on Tuesday, April 13, 2021. (Alexandria Sheriff's Office via AP, File)
Prosecutors seek 5-year term for ex-leader of neo-Nazi group

Another man, Kaleb Cole, whose weapons were seized in Arlington, is due to face trial in September.

President Joe Biden speaks about the COVID-19 pandemic during a prime-time address from the East Room of the White House, Thursday, March 11, 2021, in Washington. (AP Photo/Andrew Harnik)
Biden: All adults will be eligible to be vaccinated on May 1

The president raised the hope of beginning an “independence from this virus” by the Fourth of July.

President Joe Biden speaks before signing the American Rescue Plan, a coronavirus relief package, in the Oval Office of the White House, Thursday, March 11, 2021, in Washington. (AP Photo/Andrew Harnik)
Biden signs $1.9 trillion relief bill before speech to nation

The president is set to deliver his first prime-time address since taking office on Thursday evening.

Speaker of the House Nancy Pelosi, D-Calif., announces the House has approved a landmark $1.9 trillion COVID-19 relief bill, at the Capitol in Washington, Wednesday, March 10, 2021. (AP Photo/J. Scott Applewhite)
What’s inside the $1.9T COVID-19 bill passed by Congress

Democrats say it will help defeat the coronavirus. Republicans say it’s too expensive.

FILE- In this Oct. 19, 2015, file photo, an airplane flies over a sign at Boeing's newly expanded 737 delivery center at Boeing Field in Seattle. Federal regulators have imposed $5.4 million in civil penalties against Boeing on Thursday, Feb. 25, 2021, for violating terms of a $12 million settlement in 2015, and the aircraft maker has agreed to pay another $1.21 million to settle two current enforcement cases. (AP Photo/Ted S. Warren, File)
Boeing will pay $6.6 million to settle FAA allegations

The company failed to put adequate priority on complying with regulations.

Boeing 777 makes emergency landing in Moscow

The plane landed safely and no one was injured.

FILE - In this Feb. 4, 2020 file photo, Rush Limbaugh reacts as first Lady Melania Trump, and his wife Kathryn, applaud, as President Donald Trump delivers his State of the Union address to a joint session of Congress on Capitol Hill in Washington.  Limbaugh, the talk radio host who became the voice of American conservatism, has died. (AP Photo/Patrick Semansky, File)
Rush Limbaugh, ‘voice of American conservatism,’ has died

His rants during his three-hour weekday radio show shaped the national political conversation.

Law enforcement officers block an area where a shooting wounded several FBI while serving an arrest warrant, Tuesday, Feb. 2, 2021, in Sunrise, Fla. (AP Photo/Marta Lavandier)
AP source: FBI agents shot serving warrant in Florida

They were serving a warrant in a child exploitation. Severity of injuries was not immediately known.

People wait in line for the COVID-19 vaccine in Paterson, N.J., Thursday, Jan. 21, 2021.  Some hospitals around the U.S. are facing complaints about favoritism and line-jumping after their board members and donors received COVID-19 vaccinations or offers for the prized inoculations.   (AP Photo/Seth Wenig)
Playing favorites? Hospital boards, donors get COVID shots

Hospital board members, trustees and donors around the country got early access to the scarce drug.

Joe Biden is sworn in as the 46th president of the United States by Chief Justice John Roberts as Jill Biden holds the Bible during the 59th Presidential Inauguration at the U.S. Capitol in Washington, Wednesday, Jan. 20, 2021. (AP Photo/Andrew Harnik)
Biden becomes the 46th president of the United States

The new president vowed to heal and unite a nation in crisis.

President-elect Joe Biden, his wife Jill Biden and Vice President-elect Kamala Harris and her husband Doug Emhoff arrive at the steps of the U.S. Capitol for the start of the official inauguration ceremonies, in Washington, Wednesday, Jan. 20, 2021. (AP Photo/J. Scott Applewhite)
Watch the presidential inauguration here

Chief Justice John Roberts administered the oath to Biden; Justice Sonya Sotomayor swore in Harris.

Members of the Washington National Guard stand at a sundial near the Legislative Building, Sunday, Jan. 10, 2021, at the Capitol in Olympia, Wash. Governors in some states have called out the National Guard, declared states of emergency and closed their capitols over concerns about potentially violent protests. Though details remain murky, demonstrations are expected at state capitols beginning Sunday and leading up to President-elect Joe Biden's inauguration on Wednesday. (AP Photo/Ted S. Warren)
Washington National Guard members activated for inauguration

The extra security comes in the wake of the insurgence at the U.S. Capitol last week.