If you want to understand how the Medicare for All movement has utterly transformed the Democratic debate about health care—and why it’s almost certainly doomed to fail in Congress—consider John Delaney.
A moderate former congressman from Maryland, Delaney has ever-so-slightly distinguished himself from the pack of other forgettable Caucasian men who decided to run for president in this year’s Democratic primary as the most aggressive and articulate critic of single-payer health care. (Joe Biden is also aggressive, but not especially articulate.) He has claimed that pushing “Medicare for All” is an act “political suicide,” because the bill would force Americans off of their private insurance, including union members who cherish their hard-bargained health benefits and are skeptical of giving them up in favor of a government plan. (He’s big on bringing up the fact that his own father was a union electrician.) He’s also suggested that cutting payment rates to doctors will force a wave of hospital closures. During Tuesday night’s debate, he played the role of a moderate heel, grappling with Bernie Sanders and Elizabeth Warren. “We don’t have to go around and be the party of subtraction, and telling half the country, who has private health insurance, that their health insurance is illegal,” he said.
This kind of rhetoric has, unsurprisingly, earned Delaney the scorn of the left. (It doesn’t help that he’s a former businessman who made part of his fortune in health care finance.) On Tuesday, Warren accused him of recycling Republican talking points, and later leveled him with her most memorable line of the night: “You know,” she said, “I don’t understand why anybody goes through all the trouble of running for president of the United States just to talk about what we really can’t do and shouldn’t fight for.”
Here’s the funny thing about all this: Delaney’s own health care proposal is not actually all that moderate, except in comparison to full-bore, Sanders-style single-payer. Under his plan, all Americans under 65 would enroll in a basic government insurance plan that more or less includes Obamacare’s essential health benefits (Medicaid would be merged into this program). Individuals and companies could then buy supplemental insurance that covered additional services. Medicare for seniors would remain untouched.
One thing you might notice about this approach is that, despite Delaney’s debate stage rhetoric, it would actually create a lot of upheaval in the insurance market, and require pretty much everybody with an employer-sponsored plan to change their coverage in some way. A second thing you might notice is that it is far to the left of what Hillary Clinton proposed in 2016. Her big move to appease progressives that year involved backing a public health insurance option for the Obamacare exchanges. Ambitious? Sure. But much less so than the bona fide national health care plan Delaney, an annoying middle-of-the-road squish, is envisioning.
This speaks to how successful Medicare for All proponents have been at shifting the debate on health care within the Democratic Party. The idea of “moving the Overton Window” might be a bit of cliché, and it sometimes serves as an all-purpose excuse to propose whatever impractical policy idea someone dreams up at a bar in Brooklyn. But when it comes to the national health care debate, advocates really have forced almost everybody in the party to think bigger. (The very important exception, unfortunately, is Joe Biden, who is basically running on a plan similar to Clinton’s.)
And yet, while Delaney oddly embodies some of the movement’s success, he also embodies why Medicare for All would almost certainly fail in Congress. Never mind the Senate, which Democrats may not win, and even if they do, will be inhabited by moderates like Joe Manchin. Just consider the House. During his time on Capitol Hill, Delaney was a truly moderate Democrat. But he wasn’t the most moderate—Govtrack ranked him as the party’s 10th most conservative House member—and after the 2018 midterms, the party’s moderate wing grew. The latest Medicare-for-All bill introduced in the House drew 117 co-sponsors, meaning it would need support from about 101 more members to pass. Grassroots progressives could try to put pressure on the caucus’s right flank to back single-payer health care. But it seems more likely those lawmakers will listen to their own moderate voters and powerful Democratic interest groups like the unions Delaney keeps talking about, many of which are in fact unenthused by a Sanders-style plan. The AFL-CIO, for instance, has said that it will back Medicare for All if “it retains a role for workers’ health plans.”
The arguments you heard Delaney making Tuesday night? Chances are you’d hear a lot of the same talking points around the Capitol before single-payer finally sunk.