925: Medicare For All Who Want To Win
Learning from Stef Feldman
For all the bad stuff about social media, every once in a while you find someone to consistently learn from. Substack seems to have a knack for that, and coming across former Biden Policy Director
’s writing earlier this year has been a huge bonus.Here’s an excerpt from a recent piece:
Imagine it is June 2027. We’ve made it through more than half of Trump’s second term and the Democratic presidential primary is in full swing. Fifteen candidates gather for their first televised debate. They’re in Atlanta, Georgia, symbolic of the progress made in 2020 and the ground lost in 2024. The first question from Substacker Terry Moran is for all candidates: “Show of hands—who supports eliminating private health insurance?” Two hands pop up. Other candidates start glancing around the room. Three more hands pop up. Then a few more. You sigh and mumble to yourself, “how did we end up here again?”
This hypothetical could become our reality if Democrats don’t solve our creativity crisis. This piece is my argument for why Democrats need to develop exciting, new policy ideas to win future elections. I’ve also included some thoughts on how we ensure these new ideas are winning ideas.
Thinking like this is very important!! If the first presidential primary is in 925 days, then this debate will probably be in ~700 days. There is a lot of work for policy people to do in a relatively short amount of time!
We love thinking like this. When we wake up after the 2026 midterms, we don’t want to see the same thing we saw after the 2022 midterms (losers celebrating in the locker room because they beat the spread). Or after the 2018 midterms (when the focus remained on the left-wing primary challengers instead of the centrists who flipped districts). So we’re working back from that.
Back to Feldman:
Democrats are moving full steam ahead toward a 2028 presidential primary where support for or opposition to Medicare for All is a key issue, just like it was in 2020.
During the 2020 primary, health care was a top issue for voters. On one side of the Democratic spectrum, Bernie Sanders stood firm on his proposal to establish Medicare for All and end private health insurance. On the other side, Joe Biden opposed Medicare for All. Instead, Biden proposed to create a public option (which he did not successfully enact) and to increase Affordable Care Act premium subsidies (which he did successfully enact). Between Biden and Sanders, candidates took a variety of positions that were mostly on a slippery slope toward establishing Medicare for All and eliminating private health insurance. I’m convinced that Kamala Harris’s flip flopping on Medicare for All and Elizabeth Warren’s inability to explain how she would pay for her health care plan seriously hurt their candidacies.
How did so many 2020 primary Democrats end up on the slippery slope to Medicare for All? One important element of a Democratic presidential primary is that candidates want to explain how they will be different from the Democratic president before them. Campaigning against the current Republican in office is necessary but not sufficient to win. During the 2020 Democratic primary, candidates wanted to explain how they would go bigger than Obamacare.
During the 2028 Democratic primary, candidates are going to want to explain how they will go bigger than Obamacare with the Biden additions. Yes, they can and should talk about how Trump is kicking millions of people off Medicaid and Affordable Care Act-subsidized health plans. But, to win, 2028 Democrats are going to have to do more than critique Trump’s horrendous policies.
Some 2028 Democratic primary candidates will propose Medicare for All and the elimination of private health insurance. They will face the same challenge Warren did (the American people don’t like big tax increases and it is hard to pay for Medicare for All without a big tax increase). I hope a candidate proposing Medicare for All does not win the 2028 Democratic primary. A Medicare for All candidate will likely not win the general election or deliver on that proposal while governing (setting him or her up for a difficult reelection battle).
Some 2028 candidates are going to propose Medicare for All, so the question Democrats need to grapple with now is what the otherDemocratic candidates can propose to improve health care. If we don’t have an answer that feels like a big and bold leap forward from where we were in the Biden Administration, a larger subset of the Democratic primary candidates will be tempted to start down that slippery slope to Medicare for All.
Read the full thing at the link below, and subscribe.
The ACA expanded coverage but did nothing to lower health care prices. Subsidizing premiums helps the big insurers who have no incentive to lower premiums. Hospitals have no incentives to lower prices if insurers pay what they ask. We need to shake up the system without breaking it. Most important is countering the health care lobby—hospitals, insurers, large employers.