The powerful healthcare lobby is cranking itself back up, ready to fight every aspect of Medicare expansion Democrats might consider. That's just one of many reasons Democrats should be taking a maximalist approach on Medicare for all—in for a penny, in for a pound when you're fighting the likes of the Federation of American Hospitals, representing investor-owned hospitals, and America's Health Insurance Plans (AHIP) and the Pharmaceutical Research and Manufacturers of America.
They're organizing under the innocuous-sounding umbrella of Partnership for America's Health Care Future, and are using the same arguments they've been using against substantive healthcare reform since the first Medicare bill in the middle of the last century: It's going to cost too much and it will give bureaucrats control over health care. To which the entire nation of people who have health insurance says: It already costs too much, and insurance company bureaucrats are already in control.
Headed up by executive director Lauren Crawford Shaver, who worked on swing states for Hillary Clinton in 2016 (and look how that turned out), the organization has already attacked Sen. Bernie Sanders and his Medicare-for-all plan, of course, saying he's advocating for "upending our nation's health care system in favor of starting from scratch with Medicare for all." Never mind that when the proposed system is based on an existing system, you're not really starting from scratch. But it's not just the maximalist Medicare for all they're going after.
The group is also fighting the "pragmatic," incremental approach other Democrats are proposing, Medicare buy-in for people over 50. Their argument is the usual, as expressed by David Merritt, an executive vice president of AHIP: "This is a slippery slope to government-run health care for every American." It's rejected by the coalition, "whether you call it Medicare for all, Medicare buy-in, single payer or a public option." They point to their support for Medicaid expansion in the remaining states as evidence of their good faith on reform. They also want to increase federal subsidies for people buying insurance under the Affordable Care Act and get more states to set up reinsurance programs (with state and federal funding) to try to stabilize premium costs. Meaning, they want to use public money to get them more customers, essentially.
Public-opinion polls are finding that the status quo, even for people with employer-based health insurance, isn't working so great that they fear change. Everyone sees their out-of-pocket costs rising, because they have to pay more in premiums, in deductibles, and for prescriptions. The harder providers and drug companies and insurance companies work to ignore that, the more they make themselves a salient enemy for Democrats to use in the reform debate.
At this point, fighting for the minimum—Medicare buy-in at 55 or 50—isn't enough. The public debate has moved past that, and voters are ready to hear more. Now's the time to have that bigger conversation.