Clendaniel: How Medicare for All could sway voters in 2020

San Jose Mercury News (CA)

July 21--I've been keeping a close watch on Democrats' strategic initiatives as the November midterms and the 2020 presidential election unfold. It's becoming clear that Democrats want to make health care -- specifically, Medicare for All -- the defining issue.

California Sen. Kamala Harris, increasingly seen as a 2020 presidential candidate, is in. So are San Jose Reps. Ro Khanna and Zoe Lofgren, both key players in bringing the tech industry on board. Khanna and Lofgren were part of a group of 70 House Democrats who announced Thursday the formation of the House Medicare for All Caucus that is designed to raise the profile of the fight for health care reform in Congress and voters across the nation.

I've studied and written extensively about health care issues for the better part of the past two decades. Here's some unsolicited advice for Democrats moving in this direction: Sen. Bernie Sanders, a longtime advocate, keeps focusing on the progressive, moral argument for Medicare for All. But in order to be a difference maker for voters, Democrats need to make a compelling economic argument, as well, one that will resonate with the business community as well as their employees.

That means a much clearer, detailed outline for how it would be financed. And a convincing case for how it would drive down costs while improving -- or at the very least maintaining -- health care outcomes for all Americans.

Here's where Khanna has the opportunity to play a key role in the debate. Khanna understands how business works, having taught economics at Stanford and written a book on the importance of entrepreneurs and manufacturing to America's business future.

Khanna believes that in order for the business community to buy into Medicare for All, supporters must make clear that expanding Medicare is a better investment than private sector premiums.

"Medicare for All has to be seen as pro-growth and pro-innovation," Khanna said in a telephone interview Friday. "The biggest competitive disadvantage in this country isn't labor costs. It's health care costs. Benefits are one of the biggest cost drivers in the United States. If you look at wage stagnation, it is almost entirely due to the rise in health care costs. If businesses could take the money they have spent on increasing health care costs and put it instead in workers' raises, you would have the normal increases for working families."

A study by the Kaiser Family Foundation and the Health Research and Education Trust makes that clear. The average worker, they say, paid $5,714 for a family health-insurance plan in 2017, or 30 percent of the total cost of $18,764. Five years ago that same worker paid $4,316, or 27 percent of the $15,745 cost.

But Democrats have yet to rally around a financing plan that makes clear the extent to which Medicare for All would result in savings across the board for taxpayers and the business community.

It's one thing for Democrats to argue that Republicans have no new ideas on how to solve the health care issue. It's quite another for them to agree on specifics for their own approach. The new House caucus must find that common ground.

Sanders' financing plan is a nonstarter. Eliminating private insurance altogether is a tough sell. How would he respond in a debate when Republicans argue that Sanders' plan means Americans won't get the doctor they want or be able to keep the private insurance they want?

The better approach is to allow Americans to retain their private insurance, if they so choose, while making Medicare for All an option for everyone.

"The 10-year cost projection for health care (under the current system) in the United States is $49 trillion, while Medicare for All is $32 trillion, so you could see $17 trillion in savings," said Khanna.

Businesses, he said, wouldn't be paying exorbitant health care insurance premiums and would see lower pharmaceutical drug costs, because the government would be able to negotiate substantially lower prices under Medicare for All.

The real test of Democrats running for president or a leadership position in Congress shouldn't be whether they are for Medicare for All. It's whether they can articulate a plan that both inspires the American people and resonates with the business community and the moderate voters who will decide the November and 2020 elections.

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