Josh Marshall, Common Sense Democrat

Josh Marshall has a great piece up on Talking Points Memo about the politics off Medicare for All. It is eminently sensible and covers well both the facts of the situation and the standard objections Medicare for All advocates raise when it is pointed out just how electorally difficult this program would make things for the Democrats. Point #6 of the Common Sense Democrat creed is: Don't advocate clearly unpopular policies (if you want to win of course). Josh Marshall agrees!

Marshall's piece is behind a paywall but it's well worth seeking out if you are interested in this issue. But a few telling excerpts;

"In Democratic policy debates since 2016 there’s been a widespread and sometimes near dominant narrative that Medicare for All is the way forward and actually surprisingly popular...The problem is, the whole premise is false. A raft of public surveys show that Medicare for All has anything ranging from public support in the low 40s to dismal support down into the 20s. How is that reconcilable with all the polls showing that clear majorities support it? Like most political labels it’s not clear, beyond in an aspirational sense, what “Medicare for All” actually means. Survey after survey shows that when most people hear “Medicare for All” they assume something like a right for anyone who wanted it, regardless of age, to be able to get or buy into Medicare. Critically, most believe they and others would be able to keep their current private coverage if they chose to.

A new Marist poll illustrates the point, but it’s far from the only example. The poll asked Americans whether they supported “Medicare for all that want it, that is allow all Americans to choose between a national health insurance program or their own private health insurance.” 70% of adults thought that was a “good idea”.

When asked about “Medicare for all, that is a national health insurance program for all Americans that replaces private health insurance” the number fell to 41%. This isn’t an outlier. Numerous polls have shown roughly the same thing. A 2018 Reuters/Ipsos poll found 70.1% support and 51.9% support among self-identified Republicans. The numbers are actually remarkable consistent across many polls. Roughly 70% say they support Medicare for All, assuming that it means people can keep private policies. The numbers hover around 40% if they’re told that’s not true.

But just as consistently polls show that people assume Medicare for All means the option to opt into Medicare or keep their own private insurance. Much like the new Marist poll a January 2019 Kaiser Family Foundation poll found that 55% of adults believed Medicare for All would allow people to retain their private coverage if they chose. When told it would “eliminate private health insurance companies” that support collapses, going from slightly more than 70% to just 37%....

The reaction to these stark numbers from Medicare for All advocates has been telling and instructive. Of course, if you focus on perceived negatives or scare tactics, support falls! But this makes no sense. You can’t understand the popularity or political viability of a policy without figuring in counter-arguments that will certainly be used in the political arena. This is especially the case with counter-arguments which are actually true!

The secondary response has settled down to daring people to find anyone who likes their insurance company. Nobody likes their insurance company ergo these numbers can’t be true or don’t mean anything or don’t matter. It’s a pretty effective dare. Who raises their hand at a town hall meeting to give a big thumbs up to their health insurance company? Unfortunately that doesn’t really prove anything or at least what advocates what it to prove.

Here we have the kernel of magical thinking inspiring this whole debate: advocates belief that if something doesn’t make sense, it actually can’t be true. It’s certainly true that more or less everyone has complaints about their insurance company. And it’s hard to find people who affirmatively like or have some devotion to their insurance company since the whole system is a mess. But it simply doesn’t flow from that that people support doing away with private insurance or being forced to give up their current insurance. To pretend otherwise ignores basically everything we know about public risk aversion, especially tied to health care, and people’s perception that while what they currently may not be ideal something else might be worse. Call it relative privilege or advantage and people’s resistance to losing it....

He concludes:

"Of course, none of this means that people shouldn’t support Medicare for All or other comparable single player plans on the merits. A substantial minority of Americans do support it. Indeed, more practically, without a vibrant left supporting such a model the public debate is inevitably skewed to the right. A decade ago the legislative debate on Capitol Hill largely focused on whether or not what we now call Obamacare would include a “public option.” It failed because of stiff opposition from insurers and opposition from centrist Senate Democrats. Now that’s basically the centrist fallback position and Republicans running for office, as opposed to working the courts, have basically given up on gutting Obamacare. Indeed, ‘Medicare for America’, one of the major Medicare buy-in style plans proposed by wonks at the Center for American Progress, is as the name implies in large measure a reaction to the Medicare for All push. But that’s not what the proposal entitled “Medicare for All” actually does. It’s a single payer plan in which private health care plans would be prohibited except for supplemental plans which covers services or deductibles not covered by the standard plan.

There is every reason to believe that Medicare for All would be a major electoral liability for a Democratic presidential candidate in a general election – just on the basis of what the plan actually does, let alone the way the GOP and the health care industry writ large would pile on to that with a campaign of lies, horror stories and propaganda. It could well mean the difference between Trump’s defeat or reelection by effectively nullifying the Democrats big advantage on health care and giving the GOP a cudgel to sour a significant amount of the electorate on the Democratic candidate."

Like Marshall, I get why people would be attracted to the Medicare for All idea. But I continue to be surprised at people's willingness to ignore or try to explain away the clear evidence that the program would be a serious electoral liability. Sure it would be nice if that weren't so. But it is.