Until quite recently, it seemed almost certain that Medicare-for-all would be a major issue in the presidential election. It came up at every Democratic presidential debate. President Trump turned it into a talking point to be used against a future challenger. And when the novel coronavirus pandemic hit, it all but made the case. Contagious viruses, after all, don’t check insurance status before striking.
Now it’s crickets. Unless, that is, you count Joe Biden’s insistence that he is still not a fan. “I do not support Medicare-for-all. I will not support Medicare-for-all,” he announced last week on CNBC. Instead, Biden supports lowering the age of eligibility for Medicare to 60, improvements to the Affordable Care Act and a public option.
No doubt part of the explanation for the suddenly lowered profile of Medicare-for-all lies in the multifaceted crisis our nation is facing. The pandemic is not simply a medical crisis, it’s also an economic catastrophe. More than 40 million Americans have filed for unemployment since March. Millions of children are going hungry. When you are concerned about keeping a roof over your head, other concerns fade in importance.
It’s also quite possible that Medicare-for-all is quiescent because many people are forgoing medical services, fearful of contracting covid-19 at the doctor’s office or hospital. Visits to primary care doctors are down by at least 50 percent. Knee and hip replacements are postponed. So too are cancer surgeries and chemotherapy. While there are certainly major health consequences to this in the long run, in the short run people aren’t racking up as many medical expenses as in the past. Out of sight, out of mind, as the saying goes.
And, of course, Medicare-for-all champion Sen. Bernie Sanders (I-Vt.) was defeated by Biden in the Democratic primary. Neither Biden or Trump support it. From the perspective of horse race media coverage, there isn’t much of a race here to cover.
But don’t let all that fool you into thinking the battle over Medicare-for-all is over. It most certainly is not. Voters in the Democratic primary — even as they pulled levers for Biden — told exit pollsters they supported the idea. And there is no reason to believe the issue won’t make a reappearance as the country takes steps toward reopening. Not only do the problems that led to support for major health-care reform remain in place, they have only increased over the past several months.
Legislation putting a stop to surprise medical bills is stalled out, caught in a spat between Democratic legislators — one group supporting a bill that favors the financial interests of the insurance industry and another that gives greater consideration to the bottom line of medical practitioners (and the private equity interests that own medical practices). At the same time, insurers are dropping doctors from their networks, increasing the likelihood a patient will need to pay unexpected charges.
There’s little action on bringing the cost of medications down. Yes, earlier this week Trump announced an agreement that would ensure almost all people on Medicare will pay no more than $35 a month out of their own pocket for insulin. But that’s only one drug, and the action does nothing for the millions of Americans who are insured either through their employer or Affordable Care Act exchanges.
And, finally, there is the issue of insurance itself. Millions of Americans have lost or will soon lose their workplace-based health insurance. (The Kaiser Family Foundation put the number at 27 million at the beginning of May). It’s all but certain many of them will decide to go without in an attempt to save money. Legislation introduced earlier this month by Sanders and Rep. Pramila Jayapal (D-Wash.) to expand Medicare to cover all Americans who lack health insurance is receiving little attention. Instead, the Heroes Act, passed by the House, contains provisions subsidizing COBRA — that is, what someone would pay to continue their employer-based health insurance after losing or leaving a job. Not only won’t expanded COBRA not help people who didn’t have workplace insurance, it does nothing to solve the issues of high copays, deductibles and surprise bills — the very things that are driving support for Medicare-for-all.
No matter whether Biden or Trump emerges victorious in the November election, expect to hear more heartbreaking news about people in their twenties who die because they can’t afford insulin, are refused organ transplants because they lack five-figure savings accounts and who eschew desperately needed emergency medical treatment because they can’t afford it. As a result, the struggle for universal and easily affordable health-care coverage will continue.
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