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The Media’s Disingenuous Narrative About Medicare for All

The end of Kamala Harris's campaign is being blamed on her flirtations with single-payer. Don't be so sure.

Robyn Beck/AFP/Getty Images

The consensus among wonks is that Democratic politicians who support Medicare for All are saddling themselves with an unpopular policy. Never mind whether they’re supporting an effective policy; it’s considered gauche for savvy pundit types to evince concern over the hoi polloi. No, the tried and true know that the electoral fortunes of political elites is America’s paramount concern. And so, with a certain amount of breathlessness, the end of Kamala Harris’s candidacy and the recent drop in Elizabeth Warren’s poll numbers have been held up as new evidence of this most important dynamic. 

A Daily Beast article in November quoted the always looming and ever-fretful senior Democrats describing Medicare for All as “fucking poison,” adding: “You touch it, you turn to dust.” (As of publication, Bernie Sanders remains in solid corporeal form and in second place in polls nationally.) A Politico article this week referred to the “casualty list” of presidential candidates harmed by having tangled with single-payer. On the left, different explanations have arisen: Harris and Warren were not harmed by endorsing single-payer but by walking back their initial endorsements. A Jacobin article suggested that Harris was actually more harmed by her “flip-flopping” than by supporting single-payer in the first place, as was Warren, and argued that voters “can tell the difference between candidates who are ironclad supporters of a policy because they believe it’s the right thing to do, and candidates who are calibrating their message to avoid criticism and please as many people as possible.” 

The average Democratic primary voter is not paying attention to the online left squabbles about Warren’s and Sanders’s stances on health care; they are not reading Jacobin. They do not necessarily agree with me that Warren’s latter-day proposal to pass a public option before returning to single-payer in her third year represents an obvious, cynical attempt to get out of the Medicare for All fight. They might not even know she has changed her plan at all. Indeed, there’s no real evidence that her declining numbers have much to do with her support for or prevarication on Medicare for All, though it’s perfectly plausible that voters would perceive a certain lack of trustworthiness because of her dodge on how to pay for it. Harris dodged even harder and wavered even more, producing a ridiculous compromise policy; perhaps this is the price Warren pays, perhaps not. It is, however, rather difficult to attribute Warren’s polling dip to her embrace of Medicare for All when her highest poll numbers came at a time when she claimed to be fully “with Bernie” on the issue, and when a significant majority of Democrats still approved of the policy. 

The broader public is not militantly devoted to Medicare for All. It’s unreasonable to expect that most voters are as engaged with the early primary process as its participants are; hence, it’s likely that most don’t fully know what the policy is. We truly cannot yet know how effective a Republican anti–Medicare for All ad campaign would be in swinging independent voters, though we do know that Bernie Sanders, the face of Medicare for All, beats Trump in most polls and that his campaign understands the potency of turning out disaffected voters more than others. 

But while the public isn’t necessarily desperate for Medicare for All, the polls are not as definitive as the headlines would have you believe. In fact, the polls that are most often cited as evidence of public wariness for Medicare for All frequently show the opposite dynamic. A Kaiser Family Foundation poll in November showed 53 percent support Medicare for All, which is lower than it was in March but is still a majority. Of Democratic-leaning independents, 39 percent trust Bernie Sanders on health care, which is 21 points higher than the next candidate, Joe Biden. If Medicare for All were anathema, it is unlikely that the candidate most known for it would outpace the field on this question. 

The wording of poll questions is key. The KFF poll describes a scheme in which “all Americans would get their insurance from a single government plan.” An NPR/Marist poll in July found just 41 percent supported Medicare for All, but described the policy as “a national health insurance program for all Americans that replaces private health insurance”—a small but key difference, which places emphasis on getting rid of private health insurance. (In that poll, 55 percent of self-described moderate Democrats supported this proposal.) Other polls show that Americans tend to oppose Medicare for All when they’re told it means getting rid of private insurance, but the fact that more support it when they’re told it means eliminating all out-of-pocket costs and premiums tends not to inform the discourse as much. The assumption is that Republican messaging about it will be the only thing voters will hear; that the more people learn about it, the less they will like it. (There is also the significant possibility that poll respondents say what they think they’re supposed to believe is a reasonable policy, rather than the one they would truly respond to in a politician’s platform.) 

This is a self-fulfilling prophecy. If prominent Democrats spend all their time road-testing Republican talking points on Donald Trump’s behalf, support for Medicare for All will dip. If nominally supportive Democrats hem and haw in a way that makes them seem sly and untrustworthy—for instance, by asserting that Medicare for All can be done without raising middle-class taxes, instead of just by explaining that taxes would replace health insurance premiums and the wide variety of surprise costs that come with private insurance, and in addition everyone would get health care—then Medicare for All will become unpopular. The party’s fear of bold ideas engenders a public fear of the same. And yet, this fretfulness leads many to attempt to square this circle by promising voters that they will get to keep their insurance, without telling them that their plan is designed to destroy that insurance. This is a recipe for disaster.  

Democrats have for decades tended to chase imagined, perfectly poll-tested policies that will please everyone and rile no one. This kind of policy does not exist; nor would such a policy bring about optimal outcomes. The chase has proven to be a poor long-term political strategy. That is why Bernie Sanders’s candidacy took the party by surprise, and why the burgeoning rise of left-wing politics—not just single-payer, but things like free college and abolishing Immigration and Customs Enforcement—has shocked and confused the Democratic establishment. Its love for policies that play well in focus groups blinded it to the revolutionary possibility of policies that are actually good. Pundits who seek to project their savviness about political reality, at the expense of any kind of moral commitment to a cause, simply cannot grasp how unprecedented it would be for the Democratic nominee to push something as dramatic as single-payer. 

There is absolutely no substantive policy advantage to a public option over single-payer. Private insurance, particularly of the scale and profitability that exists in America, is a catastrophically bad way to pay for our health care. If the goal is to create a public option that’s better than private insurance, people will switch to the public option. The better the public option is, the faster private insurance will disintegrate. (If the public option you create is worse than private insurance, then you’re just a Republican.) The only argument for doing a public option, if it’s just a slower way to get to the same goal, is political—if you know only a public option can pass, then passing it is clearly preferable to our current health care crisis. But if you make that bet, you’d better be damn sure it pays off. Otherwise, when people continue to die from lack of care and fall into destitution from health care debt, all your sins will be remembered, and your party’s credibility will perish.