‘Medicare for All’ vs. the European way
By SUSAN CORNWELL in Washington, MICHAEL NIENABER in Berlin, COSTAS PITAS in London and RICHARD LOUGH in Paris
A movement among left-wing Democrats in the United States has pushed the party toward wider support of a universal government healthcare program, similar to systems in several European countries.
What left-wing Democrats want:
“Medicare for All” to largely replace private medical insurance – a publicly financed, privately delivered system with all Americans enrolled and all medically necessary services covered. Patients would have a choice of doctors and hospitals. There would be no co-pays or deductibles – a change from existing Medicare, where there is significant cost-sharing. Private health insurance would be prohibited from offering competing services. But private insurers could cover medically unnecessary treatments such as cosmetic surgery. Wealthier Americans could have supplementary insurance for further benefits. The system would be financed by tax increases on the wealthiest, including a financial transactions tax.
How things work in Europe:
GERMANY | Germany has a universal healthcare system that dates to the 1880s. The German system is not a state-run scheme. Instead, it is financed by contributions from its users and their employers, and mixes public and private plans. The public health insurance is mandatory for every citizen earning less than 59,400 euros a year. Contributions are adjusted for how much a citizen earns. People with a salary above the threshold can opt out and choose private insurance where costs are based on risks; this generally means lower costs for younger people, and adults without children.
FRANCE | The French healthcare system, established in 1945, is funded primarily by compulsory contributions levied on all salaries; users normally pay a small share of treatment costs. Patients pay upfront for basic healthcare costs and medicines before being largely reimbursed by the state. Most then have additional private health insurance, known as a “mutuelle,” subsidized in part by their employer, to maximize reimbursements. The state guarantees minimum access to free healthcare to those who do not pay any social security contributions and cannot afford private care, including foreigners. The system is considered one of the world’s best, but an aging population and budget constraints have put it under strain.
GREAT BRITAIN | The taxpayer-funded National Health Service, launched in 1948 by the post-war Labour government, provides most healthcare “free at the point of delivery,” primarily funded through general taxation and National Insurance contributions. Patients pay no additional fees to visit a general practitioner or consultant or to receive most types of surgery, although most have to pay extra for dental and optical care. The system has seen its budget and services expand as it does more work in areas such as contraception and fertility.
Frustrated by a string of defeats at the polls, a progressive wing of the Democratic Party pushes a populist platform across the country. Amid wins and losses, the movement aims to reshape a party in flux.
MIAMI – In another year, Donna Shalala might have had an easy ride to Washington.
Running to become a first-time congresswoman in a Miami seat at age 77, Shalala has long been a member of the Democratic Party elite, with a deep resume that includes supervising U.S. health policy for former President Bill Clinton. Her slogan, printed on the back of her staff’s t-shirts, could have come from Hillary Clinton’s 2016 presidential campaign playbook: “Ready on Day One.”
But this season, Shalala’s record has put her at odds with the surging progressive wing of the Democratic Party. Once derided as the most liberal member of the Clinton administration, Shalala now faces attacks from challengers who contend she is not nearly progressive enough.
Taking nothing for granted, Shalala delivered hot dogs to voters at a campaign barbeque on a recent steamy Saturday. “I’m running like I’m 20 points behind,” she said.
Less than three months before the midterm elections, a rising progressive movement is roiling the Democratic Party – fueled by fury at Republican President Donald Trump’s administration, a growing populism among voters impatient for seismic change, and resentment of party leaders who have presided over a losing streak in national elections.
Republicans disparage Democratic progressives as wild-eyed radicals led by a 28-year-old political neophyte, Alexandria Ocasio-Cortez, whose take-down of senior Democratic leader and 10-term incumbent Congressman Joe Crowley in a June 26 New York contest rocked Washington.
“We have a Democratic party that’s lurching far to the left,” said Representative Steve Stivers, chairman of the National Republican Congressional Committee. Michael Byerly, a spokesman for the Congressional Leadership Fund, another Republican group, predicted Democrats’ “ultra-progressive views” will be a hard sell with middle-class voters.
Yet Ocasio-Cortez is only the most visible symbol of a grassroots insurgency that has sprung up across the country, including in spots far from deep-blue Democratic strongholds. Most embracing the progressive label share a disdain for corporate money in politics and favor more government-run healthcare, subsidies for college tuition and wage hikes for laborers.
Progressives have a mixed record in early nominating contests, more often than not losing to more mainstream Democrats.
But they have moved the party sharply to the left, particularly on expanding the government role in healthcare, a Reuters review of Democratic positions in the most competitive congressional races found.
Across 41 battleground House of Representatives districts, two-thirds of Democratic nominees want to expand the government’s role in healthcare, the review shows. About a dozen support “Medicare for All,” for many a reference to a single-payer system that would largely replace private insurance. In Congress, most House Democrats support a Medicare for All bill, with six members of the Blue Dog caucus of fiscally conservative Democrats signing on as co-sponsors.
Much of the progressive movement has its roots in the nationwide volunteer network built by Bernie Sanders’ 2016 presidential run. Several groups that sprang from the failed Sanders campaign are now pushing for progressive candidates in the midterms – including Brand New Congress, formed two years ago on the dream of running hundreds of progressive political newcomers to oust establishment incumbents, Democrats and Republicans alike.
In some ways, the splintering in the Democratic Party is simply a new round in the 2016 fight between Clinton and Sanders supporters. Progressive insurgents believe Clinton’s defeat, on top of losing control of Congress and most state governments, proved them right. They aspire to overthrow conventional wisdom that Democrats must stay safely in the middle to compete.
“Democrats have been fixated for 20 years on this elusive, independent, mythical middle of the road voter that did not exist,” said Crystal Rhoades, head of the Democratic Party in Nebraska’s Douglas County, where a progressive candidate, Kara Eastman, is trying to wrest a competitive congressional district from a Republican.
“We’re going to try bold ideas.”
THE MOVEMENT’S BEGINNINGS
The push for a progressive takeover of Congress began long before Trump won office.
One audacious plan began to take hold in early 2016, as a crew of organizers for Sanders’ presidential campaign traveled the country, staging revival-style rallies.
The crew included Zack Exley, a veteran political and tech consultant who cut his teeth as an organizer in union fights in Detroit; Saikat Chakrabarti, a technology consultant who started as a volunteer in an online group called Coders for Sanders; Alexandra Rojas, a just-turned 21-year-old college student who was working three jobs; and Corbin Trent, who was selling gourmet burgers in Morristown, Tennessee.
“I asked the wife if I could sell the food truck and go to work for Bernie,” Trent said. A month and a half later, he was hired on.
When it became clear Sanders would lose, supporters shifted to a new mission. “What if we could do exactly the same thing, not only for president, but Congress, all at once?” asked Chakrabarti.
Brand New Congress was launched in April 2016 with a goal of recruiting 400 candidates, all political outsiders with a record of community activism who would run on a single populist platform. Scornful of the Democratic Party hierarchy and the influence of big-money donors, the founders vowed to stay independent of any party – even if it meant finding progressives willing to run as Republicans.
“We have to think big or go home,” said Isra Allison, a Sanders volunteer from Charlotte, North Carolina.
They toured the country and put out a call for nominations of candidates; more than 10,000 poured in.
One name that surfaced: Ocasio-Cortez, a bartender from the Bronx nominated by her brother. Allison called her the day after Christmas, and a couple months later Exley and Chakrabarti met the fledgling candidate over a Thai dinner in lower Manhattan.
“I wasn’t sure what to make of her,” Chakrabarti said. “She was too articulate, I think is exactly what I told Zack.” But the advocates quickly realized they were sharing a meal with a potential game-changer.
They looked for others. At weekend “boot camps,” candidates were coached in the basics of electioneering, and thrashed out a platform including Medicare for All, a $15 per hour minimum wage and free college tuition. Another bold idea, to abolish U.S. Immigration and Customs Enforcement, ICE, surfaced at a Brand New Congress event in 2017.
Soon the group was swamped by the challenge of vetting so many candidates – and convincing promising aspirants they could win.
There were other problems. After Trump’s polarizing election, the notion that progressives could transcend partisan politics faded, and Brand New Congress began to struggle with fundraising. The group was told it couldn’t use ActBlue, the popular Democratic fundraising platform, if it backed candidates running as Republicans, Trent said.
“It was like pushing a rock up a hill,” Trent said.
Many of the original BNC people, including Exley, Trent, Chakrabarti and Rojas, abandoned the nonpartisan idea to join Justice Democrats, formed in early 2017 with a mission to rebuild the party to align with a progressive agenda. Others stayed behind at the BNC. “I didn’t want to work with any organization that had a political affiliation,” said Allison.
The two organizations tried sharing a political action committee, but separated entirely last October. Trent and Chakrabarti now work for Ocasio-Cortez’ campaign.
Overall, Justice Democrats endorsed 68 House candidates, including some originally recruited by the BNC: 21 won primaries or made it to the general election, 37 lost, two dropped out and eight are in races yet to be decided.
Still, the BNC founders cite the Ocasio-Cortez breakthrough as a sign of what is possible.
“I think now when we approach people for 2020, they’re going to think we’re a little less nuts,” Trent said.
Brand New Congress and Justice Democrats are just two players in a movement where different groups with different agendas jostle for donations and influence in the midterms. Some, like Democracy for America and the Progressive Change Campaign Committee, were in place years before the Sanders campaign.
California billionaire Tom Steyer, the Democrats’ largest donor, has spent millions of his own money on NextGen America, a group that aims to mobilize young voters. The hedge-fund manager turned activist vows to build the largest progressive operation in America.
“The overwhelming number of people whatever their particular affiliation – whether Republican or Democrat or independent – feel as if the political establishment is not hearing them,” he said. The result, he says, is low turnout – particularly by young people who lean toward Democrats.
With his fiery calls to impeach Trump, Steyer is among the progressives butting heads with leaders of the Democratic Party’s establishment, who fear turning off moderate voters.
This year, progressives have complained about the Democratic Congressional Campaign Committee, which recruits candidates, fundraises and helps plan campaigns for Democrats vying for House seats. In some competitive districts, the DCCC has intervened to back more centrist candidates, ones they consider more electable.
The DCCC focuses on finding candidates with records that fit their districts, a spokeswoman said. “The DCCC has long valued the unprecedented influence that the grassroots have in these races,” said communications director Meredith Kelly.
Leon Panetta, who served 16 years in Congress and then as a top official in the Clinton and Obama administrations, said Democrats are “going through turmoil” trying to settle on a vision.
“Very frankly, it’s a party of a lot of very different voices right now,” Panetta said.
Others downplay the notion of a civil war. Elaine Kamarck, among the founders of the New Democrat movement that helped move the party away from liberal policies in the 1990s, now analyzes the midterms as a senior fellow at the Brookings Institution. She found most primaries in competitive districts were captured by centrist candidates.
Kamarck, who also served as a super delegate for Clinton in 2016, says Democrats need to appeal to moderate voters if they hope to retake Congress. She calls the idea that unabashed progressivism can win in Republican-tilting districts the political equivalent of “repealing the laws of physics.”
“I find myself doing a lot of eye-rolling,” she said. “There’s always the argument in the Democratic Party, if only we had really liberal candidates, we would do better. It has never been true before.”
Could this year be different? “We’ll see.”
THE RACE IN NEBRASKA
One race that may help answer the question is in Omaha, where Eastman will try to unseat a Republican incumbent, Don Bacon, in a district with 13,000 more Republicans than Democrats.
Unlike the rest of deeply Republican Nebraska, though, Democrats have been able to win in this district, which stretches from the gentrifying neighborhoods of Omaha, now attracting a surge of millennials, to conservative-leaning suburban neighborhoods near Offutt Air Force Base, where Bacon once served as commanding officer. Obama narrowly won the district in 2008; Trump took it by two points in 2016.
Eastman, a nonprofit executive, was considered by the party establishment as far too liberal for Nebraska. She supported a single-payer healthcare system that would replace private insurance, and a list of other progressive causes: tough gun rules, support for abortion rights, a $15 minimum wage.
Democratic state and national party leaders mostly lined up behind Brad Ashford, a moderate one-time Republican who already represented the district for one term. Thanks in part to backing from the DCCC and other national groups, Ashford had far more money.
The Eastman campaign said it knocked on 60,000 doors. On May 15, she won by 3 percentage points. After the primary, the DCCC added her to its “Red to Blue” list, along with other progressives who beat establishment candidates.
Seeking to pummel Eastman, the Congressional Leadership Fund, a group working in swing districts to protect the GOP majority, has opened a field office in Omaha and already purchased $1.6 million worth of ads, while the Republican National Committee calls her an “out of touch, single-payer touting radical.” One CLF ad chides Eastman for her teenage membership in a band with an obscene name – Pieces of Fuck.
Eastman’s positions “might work in some districts in California, but it’s not representative of Nebraska 2,” said Courtney Alexander, CLF communications director.
“Everybody sounds progressive now.”
Eastman says Omaha voters are not scared by “pragmatic and common-sense” ideas to remake the healthcare system. She believes the key to winning districts like hers is inspiring more Democrats to turn out – not running as a “Republican-light” moderate.
“When they lose, we say, ‘See? Democrats can’t win here,’ ” she said. “We have to get people inspired to vote, and just running against Donald Trump is not enough.”
THE FIGHT IN MIAMI
The same debate is playing out this summer in South Florida, where the progressive insurgency has touched off a raucous fight between Democratic hopefuls in Florida’s Congressional District 27, which includes trendy Miami Beach, affluent Coral Gables and Little Havana’s Hispanic immigrants.
Represented for three decades by a retiring Cuban-American Republican, Ileana Ros-Lehtinen, the district favored Hillary Clinton by nearly 20 percentage points in 2016. It’s considered perhaps the easiest takeover target for Democrats in the country, though nine Republicans are running, including former Miami-Dade County Commissioner Bruno Barreiro and television journalist Maria Elvira Salazar.
Four Democrats have challenged Shalala in the August 28 primary. One, David Richardson, has attacked Shalala as a “corporate” Democrat who “sold out progressive values,” running ads slamming her for serving on the board of UnitedHealth Group and for once telling a comedian she opposed universal healthcare. Shalala says it was a joke.
A state representative, Richardson has won the endorsement of progressive groups including Our Revolution 305 in Miami and the Congressional Progressive Caucus – caucus co-chair Wisconsin Representative Mark Pocan campaigned with him Friday – and boasts of raising more than $900,000 in small-dollar donations. Progressive support has helped him match Shalala in fundraising – although both are wealthy and each pumped $500,000 into their campaigns.
Matt Haggman, a former Miami Herald reporter who also is running, broadcast a TV commercial calling for the abolishment of ICE, the federal agency under fire for separating immigrant children from their parents on the U.S.-Mexico border. “This is a moment when our politics are fundamentally broken, and this must be a moment of renewal,” he said.
That idea has begun to catch on with Democratic voters across the country, who are now evenly split on whether to abolish the border control agency formed after the September 11, 2001, attacks, a Reuters/Ipsos poll found. The same poll shows how the idea of expanding Medicare has won wide support among Democratic voters – and even many Republicans.