What is this year’s midterm election about?
President Trump wants it to be about him, stumping the country saying that he’s on the ballot. Or that it’s about immigrants, or Supreme Court Justice Brett Kavanaugh, or tax cuts, or about hurricanes, droughts and catastrophic climate change, or about an economy featuring low unemployment and stagnant wages. In fact, what is notable about the election, amid all the mudslinging and name-calling, is that voters are making it increasingly about health care.
According to recent tracking, health care is mentioned in virtually half of all paid ads, and in more than half of Democratic ads. Democrats are focused not on Trump, but on Republicans who voted overwhelmingly to repeal Obamacare, while Republican governors sued to have the Affordable Care Act ruled unconstitutional and the Trump Justice Department withdrew from defending it.
Republicans are discovering that the ACA is increasingly popular, even in Fox News polls, and that Americans particularly like the mandate to cover pre-existing conditions and the provision that allows young people to be covered on their parents’ plans. About 8.8 million people signed up for 2018 coverage through HealthCare.gov, a slight decline from the previous year.
Several vulnerable Republicans have erased any mention of their commitment to repeal ACA from their websites. Virtually all claim that they will protect coverage of children and pre-existing conditions. Few are prepared to run on repealing what’s left of Obamacare, even though Senate Majority Leader Mitch McConnell says if they retain control, they will make another effort to do just that.
At the same time, more and more Democrats have moved to endorsing Medicare for all, a reform popularized by Bernie Sanders in 2016 that would gradually extend expanded Medicare coverage to all Americans.
The plan would finally move America to join the rest of the industrial world in providing affordable health care to all. Even conservative estimates admit that plan would provide better coverage to more people at a lower price that our current slapdash system.
Big, new ideas are easy to burlesque. Republicans have responded by going full frenzy. Led by Trump, they rail against socialized medicine, raise fears about trillions in costs (not mentioning that the reform would save people money), and claim Democrats want to “eviscerate Medicare.”
Suddenly they pose as defenders of Medicare and Medicaid, even though Trump’s budgets would cut these programs, and Republican governors have blocked millions from getting Medicaid. Mitch McConnell says the rising deficits caused largely by Republican tax cuts for the wealthy require adjusting Social Security, Medicare and Medicaid — the earned security programs he calls “entitlements” — “to the demographics,” which is an obscure way of saying slash them.
The promise of Medicare for all is still a long way off. Even if Democrats win a majority in the House, no major reform can survive the Republican filibuster in the Senate or the inevitable Trump veto.
House Democratic leaders promise to focus first on lowering prescription drug prices, repealing the obscene provision that prohibits Medicare from negotiating bulk discounts for drugs, costing Americans tens of billions a year.
Yet the health care debate in 2018 represents a sea change. Republicans now try to cover up their commitment to repeal Obamacare. Democrats have put Medicare for all into the public debate. That debate has only begun.
Both the Trump administration and the Republican Congress have been exposed — they have no coherent plan to make health care affordable and universal. If progressives keep pushing and Democrats don’t lose their nerve, support for Medicare for all is likely to grow, as the hysteria gets punctured over time.
American elections are terribly flawed, corrupted by big money, scarred by partisan efforts to suppress the vote and gerrymander districts. Lies, slanders, insults, racial and nativist dog whistles too often foul the debate. Yet, in the midst of this, there is good news.
Americans have begun to hold politicians accountable for our unaffordable health care system that leaves millions unable to afford the care that should be their right. We may have mountains yet to climb, but we’ve crossed through much of the valley.