Opinion: Pelosi’s ‘Medicare for All’ Problem

Democrats want it, but at what cost?

House Minority Leader Nancy Pelosi is trying to squash her own party’s desire to fight for a health care system in which the government is the single payer for necessary medical expenses, Allen writes. (Tom Williams/CQ Roll Call File Photo)

Last month, Democratic House members were given polling data and a set of talking points on health care.

The thrust: Hammer Republicans on their Obamacare repeal-and-replace plan, but do it with precision. More implicit, but just as clear, Democrats were advised to stay away from promoting the “Medicare for All” plan that has energized the party’s grass-roots activists and its rank and file in Congress.

“Keep the focus on the Republican plan and make them own it,” the polling memo from GBA Strategies & Greenberg Quinlan Rosner Research reads. “The Republican plan is extremely unpopular and Democrats have little to gain by shifting the spotlight to new Democratic proposals or fixes.”

The polling data showed that President Donald Trump and Speaker Paul Ryan remain underwater in approval ratings, that health care is a top-of-mind issue for many voters, and that the GOP base — but nowhere near a majority of the public — wants the Republican American Health Care Act to advance. It was accompanied by a three-page memo on messaging, two pages of which were dedicated to likely GOP attacks on a single-payer system. Notably, none of those arguments were refuted in the message document.

Fighting the desire

The documents help explain why and how Democratic leader Nancy Pelosi is trying to squash her own party’s desire to fight for a health care system in which the government is the single payer for necessary medical expenses and the health insurance industry is all but eliminated as a middle man.

Asked by VICE News’ Evan McMorris-Santoro whether she was for a single-payer system, Pelosi said she’s supported the idea for decades but that the American public isn’t there yet.

“I say to people, ‘If you want it, do it in your states. States are laboratories,’” she said. “States are a good place to start.”

For a proposal that used to be a rallying cry for only a handful of House Democrats, Michigan Rep. John Conyers now has 112 members of the caucus signed up for his “Medicare for All” bill — nearly 60 percent of the rank and file.

Similarly, it’s clear that grass-roots activists, energized by Bernie Sanders’ presidential campaign last year, are more interested in moving to a single-payer plan than shoring up Obamacare. Many of them were disappointed by the limits of that law’s reach and its dependence on the cooperation of the insurance industry, which has proved a fickle partner.

When I asked a Pelosi aide about her position, I was sent a Vox piece on the cost of California’s single-payer health care plan — $400 billion per year, or twice the state’s budget.

Paying the price

And therein lies the rub. In a vacuum, most Americans think the government should provide health care for all — either through a single-payer or hybrid system — but the question isn’t usually asked with a price tag attached.

Conyers’ plan would require massive tax increases not only on the 1 percent but on the top 5 percent of earners. It’s hard to see Democrats running successfully on such a platform in the midterm elections, but some believe they can run on it and capture swing districts.

Pelosi outlined her alternative at the California Democratic Party’s convention earlier this month.

“We must defeat the repeal of the Affordable Care Act,” she said. “But that is not our only fight. We must go further. The Affordable Care Act enables every state to create a public option. I believe California can lead the way for America by creating a strong public option.”

It’s not the first time Pelosi has found herself out of step with the demands of the party base. She ran afoul of them in the last Congress when she tried and failed to help President Barack Obama execute the Trans-Pacific Partnership trade deal. At that time, Rep. Rosa DeLauro, D-Conn., one of her closest friends and allies, accused Pelosi of having “misread” the caucus.

Personally, I think Democrats should offer an alternative for fixing Obamacare at the very least.

But it’s a fool who believes he understands Democratic priorities and constituencies better than Pelosi, who has demonstrated her acumen over the course of 14-plus years as the party’s leader in the House — longer than any Republican or Democrat since Sam Rayburn.

Now, with a populist renaissance in the electorate, the key questions are whether it makes sense to essentially sit on the Democratic base in the interest of winning swing districts and whether Democrats can take back the House just by attacking Trump and Republicans in Congress?

And, for Pelosi personally, the big question is whether she’ll suffer politically if she ignores a base that doesn’t seem to agree with the calculation that embracing the single-payer model will hurt Democrats. Pelosi’s a tough customer who has shown a willingness to stand up to her base at times, but it’s getting harder for leaders in Washington to tell activists that they’re wrong and survive the backlash.

This will be a big test of Democrats’ faith in her leadership and of Pelosi’s ability to navigate the increasingly treacherous shoals of modern politics. 

Roll Call columnist Jonathan Allen is a co-author of “Shattered: Inside Hillary Clinton’s Doomed Campaign” and has covered Congress, the White House and elections over the past 16 years.

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