U.S. Politics

Dem leaders, progressives struggle over Medicare for all

Democratic leaders in the House are offering warnings about the high cost of Medicare for all, underscoring concerns in the party about moving forward with the single-payer healthcare proposal.

Speaker Nancy Pelosi (D-Calif.) in an interview with Rolling Stone published last week said moving to a single-payer health system was the simplest way to bring about universal healthcare, but then noted an estimated $30 trillion cost.

“That is, administratively, the simplest thing to do, but to convert to it? Thirty trillion dollars. Now, how do you pay for that?” Pelosi said.

Separately, Rep. Cheri Bustos (D-Ill.), the head of the Democratic Congressional Campaign Committee, told The Hill this week that the price tag for Medicare for all is “a little scary.”

Bustos is in charge of growing the Democratic majority won in the 2018 midterms — and a big part of her job will be protecting the dozens of members who won seats in districts that were either carried by President Trump or were narrowly won by Democrat Hillary Clinton in the 2016 presidential election.

Many of those centrist Democrats oppose Medicare for all and would be caught between a liberal base and more conservative voters in their districts if forced to do so.

Progressives want a vote on Medicare for all this year, setting the party up for a thorny debate.

Rep. Alexandria Ocasio-Cortez (D-N.Y.) told The Hill she would like a vote on Medicare for all this year.

“I would love for it to come to a vote; I think that it should come for a vote,” she said. “We have an enormous amount of Americans that are excited about the idea and I think we should have the discussion for sure.”

At the same time, Ocasio-Cortez and other progressives say they are playing the long game.

They argue they aren’t frustrated with leadership’s lukewarm comments about their proposal and are looking to lobby Pelosi and other Democrats to warm them up.

Rep. Pramila Jayapal (D-Wash.), a leading sponsor of the Medicare for all bill, said she is trying to set up a meeting with Pelosi to explain the bill to her and try to win her support.

Asked about Pelosi’s comment about the cost, Jayapal replied, “Look, I want to make sure she understands exactly what's in the bill.”

Jayapal said she is “in the process of setting up a member to member meeting just so I can walk her through [the bill].”

Ocasio-Cortez, asked if she is disappointed that Pelosi is not supporting the bill, held her fire.

“I don’t think I’m disappointed often here because I’m kind of more of a realist than I get credit for,” she said.

The Speaker, who was instrumental in shepherding ObamaCare through the House, hasn’t firmly closed the door on Medicare for all either, and says she supports hearings on the measure.

But Pelosi is also in a tricky spot as she seeks to manage liberals and centrists in her caucus with different ideas on policy, all ahead of a 2020 race where she wants to be helpful in winning the White House for Democrats.

Republicans, for their part, are tripping over themselves to attack Democrats over the issue, sensing an opportunity to shift the health care debate away from GOP efforts to weaken ObamaCare, including the law’s protections on those with pre-existing conditions.

Democratic leaders are trying to keep the focus on that issue and not the more sweeping Medicare for all proposals. They have already started moving smaller health care bills through committee that highlight pre-existing conditions, such as a measure to ban cheaper, skimpier “junk” insurance that was expanded by the Trump administration.

Pelosi also noted in the Rolling Stone interview that a single-payer system would mean scrapping the Affordable Care Act system.

“All I want is the goal of every American having access to health care,” Pelosi said. “You don’t get there by dismantling the Affordable Care Act.”

Still, she is careful not to dismiss the idea out of hand. “So I said, ‘Look, just put them all on the table, and let’s have the discussion, and let people see what it is. But know what it is that you’re talking about,’” Pelosi said.

Most of the leading Democratic presidential candidates, mindful of the progressive base in a Democratic primary, have endorsed single-payer, including Sens. Kamala Harris (Calif.), Cory Booker (N.J.) and Elizabeth Warren (Mass.).

But the picture is far different in the House Democratic caucus, where Pelosi must balance progressive firebrands against many centrist members elected from GOP-leaning districts who think Medicare for all goes too far.

“She's obviously balancing lots of different things, but, you know, I'm not frustrated,” Jayapal said of Pelosi, noting the Speaker’s support for holding hearings on Medicare for all.  

Republicans have seized on the price tag of the proposal, pointing to a study from the Mercatus Center at George Mason University that put the price tag for the government at $32 trillion over 10 years.

Defenders of Medicare for all counter that the same study showed total U.S. health care spending, as opposed to just the government’s share, would actually fall by $2 trillion under the proposal.

Spending would be shifted from premiums and out-of-pocket costs people are paying to private insurance companies into taxes that would fund the government-run system, but that transition could be hard to pull off.

“I'm an immigrant, you know, to this country,” Jayapal said. “I'm really used to hard work and I'm going to do all the work. I'm not frustrated at all.”


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