It is refreshing that in the year of our Lord 2019 that the default position of Democratic candidates for president on health care is universal health insurance. This is usually expressed as "Medicare for All," a smart branding, since it associates universal care with a popular government program. Of course, that phrase means different things to different people.
I have long hoped for this country to have universal health care, but watching the current debate over Medicare for All, I am not getting my hopes up. So many who support it make the typical mistake of assuming that because it's something that would benefit the masses, that the masses would automatically support it.
Historically, however, that has not been the case. When Harry Truman made the push in the 1940s, which failed and led to a strengthening of the employer-based model. In the 1990s Clinton's health care proposal went down in flames, leading to Democrats getting thrown out of office in the 1994 midterm. Obama managed to pass a major program that many folks criticize today for not going far enough. While that is true, it misses how political realities created massive headwinds. Obamacare barely made it through Congress, even in its weakened form. People forget that at the time it was not a popular piece of legislation, and Republicans used it, as in 1994, to take Congress.
So where were the masses who were "naturally" going to support something like this? Mostly on the sideline, or politically engaged AGAINST it. Whenever expanding coverage is proposed Republicans reply by saying "THEY want to take away YOUR insurance and make you take GOVERNMENT insurance instead." Conservatives, no matter their social class, tend to be very persuaded by that argument, as well as a lot of people in the middle. We all know that health insurers are awful, but polling consistently shows that a lot of Americans are reluctant to give up their current health coverage.
That fact was used ruthlessly by the health insurance industry in the 1990s, where their famous "Harry and Louise" propaganda ads helped turn the tide against health reform. In the 1930s and 1940s the AMA used doctors to crush universal coverage. Health care is a massive industry in America, accounting for 18% of the GDP. The people who profit from it are not simply going to have their power and wealth taken away from them. This is why Obama went out of his way to build bridges with health care interest groups, and probably why he succeeded where Clinton failed.
Beyond the fear that health insurance will get worse and machinations of the health care industry, moves to expand the welfare state have a tough road to hoe because they threaten white supremacy. The Republican argument I mentioned before appeals to the subconscious feeling among most white people that "government health care" means "taking money from people like us and giving it other people who don't deserve it." A lot of people who've read too many European Marxists and haven't looked at their own country's history have deluded themselves into thinking that white people will simply abandon this attitude because they stand to benefit from universal health care.
In any case, even if a Democrat wins in 2020, they will still need to get 60 votes in the Senate. No Republican will vote for Medicare For All, so the bill will be DOA unless Democrats grow a spine and suspend the filibuster. And if that is done Democratic Senators in more conservative states still might be afraid of losing reelection. The Republican party, like the health care industry, will fight this to their last breath. They also have a massive conservative media apparatus to fall back on to control the narrative.
I'm not saying this is impossible. What I am saying is that it is going to take a lot of work. Instead of assuming popular support, we need to be organizing people to fight for Medicare for All, and to be making the case to voters. Without a solid organization this effort will wilt in the face of the inevitable conservative and industry opposition. As long as too many on the left want to be right, as opposed to powerful, nothing is going to change. It's time to stop talking to ourselves and long past time to be making the case to others.
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