Even when Democrats had full control of the federal government, they didn’t push to enact “Medicare for all,” a long-cherished goal of the hard Left. Now, with the House under Republican control, a single-payer national health insurance system is just a legislative pipe dream.
Yet, with the 2024 elections less than a year and a half off, it’s again emerging as a prominent and ambitious goal for Sen. Bernie Sanders (I-VT) and a significant number of House allies.
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It comes amid bitter budget and debt ceiling battles between President Joe Biden and Senate Democrats on one side, facing off against the narrow House Republican majority. Under these circumstances, enacting even the most basic laws to keep the government funded and running is a challenge. And that’s nothing compared to a transformational healthcare bill that can be so politically toxic, congressional Democrats excluded it when, in 2010, they enacted then-President Barack Obama’s signature domestic achievement, Obamacare.
Still, Sanders recently renewed his “Medicare for all” push for the plan along with 14 Senate Democrats and 110 House Democrats.
“The current healthcare system in the United States is totally broken, dysfunctional, and cruel,” Sanders wrote in a Guardian op-ed. “It is long overdue for us to end the international embarrassment of the United States being the only major country on earth that does not guarantee healthcare to all of our people.”
There is some truth to his statements: Almost 1 in 10 adults has medical debts. And healthcare inequality disproportionately affects low-income and minority communities.
But Sanders tends to disregard other research on the effects of a national health system. According to the nonpartisan Congressional Budget Office, “Medicare for all” would create “a shortage of providers, longer wait times, and changes in the quality of care.” Moreover, Chuck Blahous, senior research strategist from the Mercatus Center at George Mason University, said the plan would cost somewhere between $32.6 trillion and $38.8 trillion over 10 years.
Nonetheless, Democrats believe they know best. The newest push for the bill follows previous proposals: comprehensive health benefits for every person in the United States with no networks, premiums, deductibles, or co-pays. Coverage would include primary care, vision, dental, prescriptions, mental healthcare, substance abuse, long-term care, and “reproductive health.” If enacted, the proposal would phase in the universal healthcare model over four years.
However, even with the new plan taken by many Democrats as doctrine, there are still riffs between them. On a podcast hosted by David Sirota, a populist-left writer for Sanders’s 2020 Democratic presidential campaign, Rep. Alexandria Ocasio-Cortez (D-NY) said some Democrats don’t really support “Medicare for all.”
“I do believe that when push comes to shove, the number of people that are willing to really fight for Medicare for All is probably less than the number of co-sponsors on that bill,” AOC said. “Frankly, even if we had a floor vote on it, because of the lack of prospects in the Senate, I also think there would be a lot of disingenuous votes for it, when people know that it’s going to a graveyard.”
Ocasio-Cortez went on to explain the bill’s chance of survival lies strongly on one idea: dismantling the Senate filibuster, which requires 60 votes in the 100-member chamber to bring up legislation for consideration, rather than a bare majority.
“I actually do think that providing and mounting a really strong fight to dismantle the filibuster in the Senate is the only way it has to be a precursor to any fight for universal healthcare and for guaranteed healthcare,” she said.
For their part, conservatives agree on the need to tweak and even fix the U.S. healthcare system, though with drastically different policies. Free market groups have worked on these efforts simultaneously for years.
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And healthcare specialists from the libertarian-leaning think tank the Cato Institute believe they may have the answer: “public option principles.”
This idea envisions expansions of healthcare savings accounts, or HSAs, which offer patients a tax-advantaged means to save for medical expenses. HSA holds can set aside $7,200 for families or $3,600 for individuals, tax-free, each year, and are able to keep that money forever, regardless of their employment or insurance plan changes. Conservatives say this is one way to protect healthcare choices that the public would lose under Democratic reforms.
