Paul Fanlund: Does health care seem like the only Democratic presidential issue? | Paul Fanlund


Paul Fanlund: Does health care seem like the only Democratic presidential issue? | Paul Fanlund

Which is it? Are you for or against Medicare for all? Now let’s argue for the next hour.

Provoked in part by media questioners, Democrats running for president talk incessantly about health-care politics. It’s as if the economy, climate change, firearms, foreign affairs and immigration hardly matter.

Sure, Donald Trump and Republicans want to kill the Affordable Care Act and not replace it even though it has helped insure more than 20 million Americans, according to data from the federal Centers for Disease Control and Prevention.

But instead of a focus on the cruelty of the Trump-led GOP or how to improve the ACA, we instead engage in an endless Democratic squabble. And it seems to have become hugely — and unwisely — outsized in its symbolism.

The New York Times summed it up in a story this summer describing the “ferocious” Democratic intraparty health care fight as “a battle between aspiration and pragmatism, a crystallization of the struggle between the party’s left and moderate factions.”

If the main goal is to remove Trump in 2020, then Medicare for all and the schism it creates — sucking up so much oxygen — just seems bonkers.

One assumes U.S. Sen. Bernie Sanders sees it as his ticket to differentiating himself in wooing the true-believer extreme left. He likes to yell that “he wrote the damn bill” on Medicare for all.

That has to be music to Republican ears.

The Trump administration supports court action that would invalidate the entire Affordable Care Act. Moderate Democrats who won last fall, and thus helped the party retake the House, took their GOP opponents to task for that anti-ACA position.

Somehow, to some progressives, the fact that Trump wants to push millions off health insurance coverage altogether seems secondary to making a complete makeover of health care a wedge issue within the Democratic Party.

The Medicare for all topic feels ubiquitous, and it reminds me of the email server topic of 2016.

Remember that? A study by the Kennedy School of Government at Harvard found that coverage of “scandals” like Hillary Clinton’s email server issues got four times as much coverage in major newspapers and on television networks as did Donald Trump’s “grab them by …” harassment of women.

Back then, the resulting narrative among some seemed to be: “Trump is a vile, boorish, lying sexist, but Clinton didn’t handle her government email correctly. So it’s a push, and I’ll stay home.”

Now the media seem transfixed by the Democratic knife fight over health care system design, and so that’s what the candidates and party leaders talk about. Take the recent debate in Houston as an example.

U.S. Sen. Amy Klobuchar is a smart, low-key centrist from the critical swing state of Minnesota who seems to be getting limited campaign traction because she is, well, a low-key centrist.

But in Houston, she said: “While Bernie wrote the bill, I read the bill,” pointing out how it would move millions off their private health insurance. “And on page eight of the bill it says that we will no longer have private insurance as we know it.

“I don’t think that’s a bold idea, I think it’s a bad idea,” she added.

This week, House Speaker Nancy Pelosi was outspoken in calling for improving the ACA instead of “reinventing the wheel” with Medicare for all.

“God bless” the Democratic presidential candidates putting forth Medicare for all proposals, she told a television interviewer. “But know what that entails.”

She added: “I believe the path to ‘health care for all’ is a path following the lead of the Affordable Care Act. Let’s use our energy to have health care for all Americans, and that involves over 150 million families that have it through the private sector.”

To top it off, it appears highly uncertain that Medicare for all could be implemented even if Sanders or Senate colleague Elizabeth Warren, another strong advocate, won the presidency.

The House would need to remain in Democratic hands and the Senate is currently 53-47 Republican. The kind of moderate Democratic candidates who would need to win in competitive districts and states to keep or create majorities are unlikely to uniformly support such a radical vision.

Implied in this crusade is condemnation of Barack Obama. Why couldn’t he have passed Medicare for all as a newly elected president with all that political capital and momentum?

It’s because Obama inhabited the real world. With Pelosi’s help, he squeaked through the ACA, providing health coverage for millions and doubtless saving many lives.

I recall David Axelrod, Obama’s political strategist, talking about the strain of the hard tradeoffs during his appearance at Cap Times Idea Fest last year. Axelrod described how he wept when the bill passed, recalling how he and his wife almost went bankrupt years before due to the costs of treating their daughter’s significant health condition.

In the same vein, there’s Wisconsin Gov. Tony Evers, who has effectively stemmed the Scott Walker politics of division. But has the Democratic governor forced Republicans to accept federal Medicaid funding?

Not yet, but at every opportunity, as he did in my recent interview with him, he points out that in polls Wisconsin citizens overwhelmingly support accepting Medicaid money but that the two Republican legislative leaders refuse to permit a vote.

Oh, he could kick and scream and bicker publicly every day with Republicans, and, I suppose, some progressives would prefer that.

In truth, most pragmatists I know take a back seat to no one in their loathing of Trump, what he is, and what he has done to our country.

They just don’t place ideological purity above actual results.

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