Single-Payer Health Care Looms as 2020 Campaign Issue

Single-Payer Health Care Looms as 2020 Campaign Issue
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With 115 co-sponsors, a House bill that calls for single-payer health insurance now enjoys majority Democratic support in the lower chamber. Paired with Bernie Sanders’ presidential campaign, which helped bring national attention to the issue, some observers say that a single-payer push may become part of Democrats’ platform in 2020.

“I think it’s very realistic,” said Adam Gaffney of Physicians for a National Health Program, a single-payer advocacy group. “If you look at the level of popular support in this country, people want single-payer.”

A June report from Pew Research Center echoed that sentiment, finding that 58 percent of Americans feel that the federal government has a responsibility to ensure that all citizens have health coverage; of that figure, 33 percent specified that universal insurance should come from a “single national government program.” Moreover, a January Kaiser Family Foundation poll found that 19 percent of Americans named “health care” as the issue they would most like to see President Trump and Congress address in 2017. 

Rep. John Conyers’ Expanded & Improved Medicare for All Act, which the Michigan lawmaker has proposed in every Congress since 2003, has never seen as much support as it currently has, which may stem from more than the Sanders campaign.

“I think this is a broader struggle over the soul of the Democratic Party, and it has a lot to do with who the party represents in terms of class and race,” said Ben Day of Healthcare-NOW!, a single-payer advocacy group. “Who’s the base of the Democratic Party going to be moving forward?”

In other words, the unaffordability and exclusivity of America’s current “failed” health care system calls for its replacement, said Ken Zinn of National Nurses United, a registered nurses union.  The struggle over – and against – Republican health care reform plans, added Gaffney, has also energized an expanded base of advocates. 

With California as an example – the state Senate passed the single-payer Healthy California Act in late May – some supporters point to the states as potential starting places for such an ambitious proposal. Charles Idelson of the California Nurses Association, although frustrated at California State Assembly Speaker Anthony Rendon’s decision to freeze the bill, is hopeful thanks to Democratic control of the Assembly, Senate, and governorship.

House Minority Leader Nancy Pelosi, who has represented the Golden State since 1987, described states as potential laboratories for single-payer, despite having not yet signed on to Conyers’ proposal.

Jim Capretta of the American Enterprise Institute, however, holds an opposing view.

“It’s very hard for a state to do that just because … you have to override the existing federal law that allows large employers to self-insure under federal law outside the jurisdiction of state insurance rules,” he said. “It’s almost impossible for a state to make the math work. And I don’t see that happening politically. I think that’s a fundamental flaw of Vermont and California and many other states.”

Even on the national scale, Capretta asserted, single-payer would not deliver on the efficiency, savings and fairness that Gaffney, Zinn, Idelson, and Day all described. A lack of adaptation, innovation and change, Capretta said, could be expected with a system implemented by a “big” and “clumsy” national government. Although somewhere between 25 and 30 percent of Americans had always favored single-payer, he said, most would prefer employer-sponsored health insurance to an untested alternative. 

In a country that spends almost 17 percent of GDP on health care costs, Zinn responded, “the country cannot afford not to [adopt single-payer].” With more than 28 million uninsured and tens of millions more under-insured, Gaffney added, the required tax increase – which would be levied on the top 5 percent of income earners – would be a “reasonable” price to pay.

Looking forward, Gaffney predicted that the toughest challenge in implementing single-payer nationwide would be the “huge opposition” coming from the private health insurance lobby, the pharmaceutical industry, and other vested interests for whom the status quo is more profitable. Even so, said Day, Medicare and Medicaid passed despite looking “impossible, right up until about when they happened.”

“I think the better question is if the American people are going to allow the top earners and self-interested health insurance industry to stop them from having good health,” added Zinn.

Whether the government slowly expands insurance to ever-larger populations, moves forward with existing proposals in Congress, or neither, Capretta said, “one can imagine” the 2020 Democratic candidate for president moving in the direction of single-payer. Although some Democratic leaders, such as Senate Minority Leader Chuck Schumer, have remained non-committal on the topic, supporters remain optimistic for the future.

“Once legislation is passed, I think that the actual implementation of single-payer could proceed more quickly than most people realize,” said Gaffney. “Most likely, this is going to happen under a new government.”

Ford Carson is an editorial intern for RealClearPolitics. He can be reached at

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