By Lee Fang and Nick Surgey
The Intercept, November 20, 2018
Now that the midterms are finally over, the battle against “Medicare for All” that has been quietly waged throughout the year is poised to take center stage.
Internal strategy documents obtained by The Intercept and Documented reveal the strategy that private health care interests plan to use to influence Democratic Party messaging and stymie the momentum toward achieving universal health care coverage.
Over the summer, leading pharmaceutical, insurance, and hospital lobbyists formed the Partnership for America’s Health Care Future, an ad hoc alliance of private health interests, to curb support for expanding Medicare.
The campaign, according to one planning document, is designed to “change the conversation around Medicare for All,” then “minimize the potential for this option in health care from becoming part of a national political party’s platform in 2020.”
Behind the scenes, the group attempted to sway candidates during the midterms, encouraging several of them to focus on shoring up the Affordable Care Act instead of supporting single-payer health care.
In several competitive races, the Partnership pressed candidates to use industry-crafted talking points when speaking about health care.
Several of the candidates who agreed to embrace the Partnership’s messaging and policy ideas came up short on Election Day. But soon after Election Day results came in, the Partnership went on the offensive, informing reporters that candidates who embraced “Medicare for All” had also lost, pointing to the defeat of progressives such as Kara Eastman in Nebraska. The group also relied on research from the business-friendly Democratic think tank Third Way to argue that victorious pro-“Medicare for All” candidates couldn’t attribute their success to having supported “Medicare for All” because few Democrats explicitly mentioned the policy in their campaign advertisements.
The growing momentum for “Medicare for All” could raise expectations for the next time Democrats are in full control of power in Washington, industry groups worry. They are already pressuring conservative-leaning caucuses in the House of Representatives, such as the Blue Dogs and New Democrats Coalition, to push back against insurgent progressives’ demands.
The campaign has worked with advertising agencies to draw up a series of messages to convince select audiences. Several of the messages, categorized as “positive,” are dedicated to educating the public on more minimal reforms that do not include expanding Medicare. Other messages, categorized as “persuasion” and “aggressive,” are designed to instill fear about what could happen if “Medicare for All” passes.
In the coming weeks, the Partnership plans to ramp up a campaign designed to derail support for “Medicare for All.” The group, working with leading Democratic political consultants, will place issue advertisements to target audiences, partner with Beltway think tanks to release studies to raise concerns with the plan, and work to shape the public discourse through targeted advocacy in key congressional districts.
In one planning document circulated over the summer, the Partnership suggested a series of messages to wean Americans away from supporting single payer. The talking points emphasize that the current system provides “world-class care,” and that any move away from the Affordable Care Act would be “ripping apart our current system.”
The strategy exploits familiar themes that have long been used by business groups against new government health care programs, calling for allies to say lines such as “bureaucrats in DC have no understanding of a person’s medical situation and will be making decisions about your health care instead of doctors.”
The Partnership plans to form a speakers bureau of former Democratic elected officials who can leverage the media to make the case that expanding Medicare is bad politics and policy. The memo names former Democratic Majority Leader Tom Daschle, now a health insurance lobbyist at the law firm Baker Donelson, as one such potential surrogate.
The memo points to early success in shaping media coverage, citing several “earned media” columns such as one published in August by former Rep. Jill Long Thompson, D-Ind., which argues that Democrats should only focus on small reforms to the Affordable Care Act, and warns against wasting political capital on pursuing a “government-controlled health insurance system.”
Adam Gaffney, president-elect of Physicians for a National Health Program, a national coalition that advocates in favor of “Medicare for All,” said he is not surprised by the messaging.
“What we’re seeing is the wages of success: With single payer on the rise, it was only a matter of time before the insurance companies, big pharma, and other big-money groups came out swinging,” said Gaffney, who also serves as an instructor at Harvard Medical School.
“The smear of ‘socialized medicine’ has been used a thousand times and has lost its bite,” he added.
Influencing the 2020 Democratic Field
“We’re all focused on 2020,” Lauren Crawford Shaver, a partner at Forbes-Tate who is helping to manage the Partnership campaign, recently told the National Association of Health Underwriters in a podcast produced by the group.
Shaver, a former top staffer for the Hillary Clinton presidential campaign, explained to the group that she is working to peel support away from the “Medicare for All” bill sponsored by Sen. Bernie Sanders, I-Vt. The Sanders bill is currently sponsored by several rumored 2020 Democratic presidential candidates, including Sens. Elizabeth Warren, D-Mass.; Kamala Harris, D-Calif.; and Kirsten Gillibrand, D-N.Y.
“The No. 1 thing we need to focus on is that there are a lot of likely candidates that currently support the Senate bill,” said Shaver. “We need to make sure we educate the public, we educate both parties, and we educate all the campaigns about both the policy and political challenges.”
Shaver encouraged health care companies concerned about the growing popularity of “Medicare for All” to mobilize opposition among clients, customers, and employees. Industry groups will likely have workers or customers residing in key districts who can be tapped to influence wavering lawmakers on Capitol Hill.
The Partnership plans to “take stories of how these proposals would directly impact your clients and the constituents of the policymakers who are voting for or against these proposals,” Shaver said.
AHIP, the insurance trade group behind the 2008 plan, is also a sponsor of the Partnership’s 2020 campaign, along with the Federation of American Hospitals, Pharmaceutical Research and Manufacturers of America, the Blue Cross Blue Shield Association, the Biotechnology Innovation Organization, and the American Medical Association.
Despite a pledge by many Democratic candidates to eschew corporate PAC donations, health care lobbyists have funneled cash to many incoming lawmakers through the New Democrats PAC, the Blue Dog PAC, and other centrist committees. Unsurprisingly, the centrist New Democrats Coalition, the caucus of business-friendly centrist Democrats, has worked to depress momentum for “Medicare for All,” reprising the role centrist Democrats played in killing the public option during the Obama administration.
Immediately following the midterm elections this month, the Washington Post published a column by Third Way warning that “Medicare for All” “failed the Hippocratic Oath” because opposition to the plan helped Republican candidates, thus causing “harm” to the long-term health interests of voters.
But advocates for “Medicare for All” are feeling optimistic.
“In terms of tactics, it sounds like they will just be updating the same lines they used in the 1990s to sideline reform efforts and in the ACA fight to keep single-payer health care off the table,” said Eagan Kemp, a health care policy advocate with Public Citizen. “The Partnership for America’s Health Care Future would be more accurately titled the ‘Partnership for Profiting Off America’s Health Care.’”
Private health care interests will certainly have much more money, media attention, and political resources with which to campaign. Advocates, however, are hoping Americans see past the public relations smokescreen and support health care as a human right.
“There is no brand loyalty to insurance companies, which are rightly seen as parasitic,” Gaffney, the PNHP leader, said.
“Once single payer is widely understood as a program that covers everyone, that doesn’t impose copays and deductibles, that has more comprehensive benefits than existing plans, and that doesn’t employ restrictive insurance ‘networks,’ support will only grow,” he added.
By Don McCanne, M.D.
Man your battle stations. The messaging war has begun. It’s our message of “lifetime affordable health care for everyone” versus their message of “don’t take my private insurance away.” Let me keep my high premiums, high deductibles, restrictive provider networks, and uncertainty of coverage related to my employment or lack thereof.
It seems like the battle should be no contest. The policies behind our message should clearly prevail: health care for everyone versus perpetuation of the perversities of the private insurance industry. But the hundreds of millions of dollars the opponents of Medicare for All will spend can purchase some very slick government-can’t-do-anything-right messages, ignoring the fact that health care delivery would be predominantly in the private sector.
Winning the message war means that our message must be out there. We have work to do.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.