According to a Kaiser Family Foundation tracking poll, health care was a major issue during the 2018 midterm elections. This was true for Democratic and independent voters, 71% of who listed health care as their number one concern. So it made sense that Democratic candidates emphasized health care in their campaigns, especially concern about raising premiums for consumers with pre-existing conditions. And the more progressive Democratic candidates made “Medicare-for-all” a reoccurring theme. But how likely is the 116th Congress, which now has a Democratic majority in the House of Representatives, to pass new health care legislation?
Obviously, Republicans will oppose any form of universal health care. Like climate change, the Republican Party has fostered a false narrative: (1) health care is a commodity, (2) competition works, and (3) universal health care is socialized medicine. Of course, if competition worked, the cost of health insurance premiums would be going down and not up as they have every year for the past three decades. Unfortunately, like climate change, Republicans have been very successful in selling this fiction and the majority of Americans remain both uninformed and misinformed about universal coverage.
On the Democratic side of the political aisle, a record number of women were elected to the House of Representatives, 13 Republicans and 89 Democrats, and health care was a major issue for the Democratic candidates. Nonetheless, incoming House Speaker Nancy Pelosi has stated she won’t make universal coverage a priority. As the saying goes, “Once burned, twice shy.”
Passage of Obamacare was a policy success, but a political failure, contributing to the Democratic Party losing a majority in both houses for the past eight years. Pelosi is therefore reluctant to put her party through a similar ordeal. New, young progressives will put pressure on the incoming Speaker to place health care at the top of their political agenda and in response Pelosi will likely have the party offer fixes to Obamacare, such as reviving the mandate, expanding coverage through the health insurance exchanges, and reinstating the penalty for not purchasing health insurance. But that’s a far cry from passing legislation offering universal health care.
How to move forward was a question I examined when writing my book and it’s evident to me, based on my analysis, the Democratic Party is not ready to tackle this issue; 2019 will not be the year Democrats propose universal health care legislation. 2020 is also precarious because it’s a presidential election year. However, I do expect Democrats to ramp up the rhetoric and for some presidential candidates to actually propose and support legislature during their first term of office.
What will it actually take to move the process forward.? First, the Democratic Party needs a specific plan it can present, explain, and defend. Many people have heard about Senator Bernie Sander’s Medicare-for-all proposal, but few can describe it. I don’t believe Sander’s proposal is politically feasible because it is funded by increased taxes on the rich, something Republicans will refuse to compromise on. Additionally, I believe his cost estimates are too low and thus revenues will be insufficient to sustain the program.
Obviously, I believe my proposal, with a centralized federal agency to administer the program and multiple sources of revenue, including a health care transaction tax, is more feasible. The transaction tax will replace all forms of private and public health insurance such as Medicare and Medicaid. Consequently, Americans, although paying a new tax, will actually pay less for health coverage. With few exceptions, everyone pays the tax, therefore there are no free-riders, a concern of many conservatives. Most importantly, employers will no longer have to pay their portion of employee health insurance, Medicare, and workers compensation. This will save small companies, large corporations, and even public employers (city, state, and federal government) tens of thousands to millions of dollars each year. Governments will save money and businesses and individuals will have more money to spend and invest, fostering economic expansion, while ensuring every American, without exception has access to health care.
However, legislation is not enough. Democrats also need a long-term strategy to present, explain, and defend their proposal. That’s the intent of my book, but Democrats will need to do much more, including meeting frequently with their constituents, such as town halls; something they failed to do after they passed Obamacare. They’ll need to be knowledgeable about the legislation. The party should have strategies for framing the legislation and how they will use media to support their efforts. And, they need to be prepared to defend the legislation against misleading information, such as attacks from Fox News and other conservative media outlets and pundits. In other words, the party will need to be proactive in their presentation rather than their usual reactive stance.
By the time Democrats are ready with a good proposal and well thought out strategy, Americans should also be ready for change. For example, health insurance premiums have been rising and as a consequence employers are shifting to high deductible plans to save money. But this means workers have higher out-of-pocket expenses when they do access the health system. This is unsustainable. Conversely, the proposal I am offering will provide individuals, businesses, and government substantial savings, something that won’t be lost on both employers and employees.
Achieving universal health care in the U.S. will not be easy
nor immediately attainable. But if we
work toward it, we’ll get a lot closer to universal health care now.
 Democratic women also outnumber Republican women in the Senate: 17 Democratic to 6 Republican.