By Paul Waldman
The Washington Post, May 13, 2019
As Democrats try to figure out precisely what kind of health-care reform they want to pursue if they regain power in Washington, the industries who would be affected by reform aren’t waiting around. In fact, they’ve already begun to put together what will no doubt be a spectacularly well-funded campaign to crush Medicare-for-all or any other ambitious reform that Democrats come up with.
Lee Fang reports on an interesting gathering that took place recently:
At a luxury resort just outside of the nation’s capital last month, around four dozen senior congressional staffers decamped for a weekend of relaxation and discussion at Salamander Resort & Spa. It was an opportunity for Democrats and Republicans to come together and listen to live music from the Trailer Grass Orchestra, sip surprisingly impressive glasses of Virginia wine — and hear from health care lobbyists focused on defeating Medicare for All.
The event was hosted by a group called Center Forward and featured a lecture from industry lobbyists leading the charge on undermining progressive health care proposals. …
The schedule shows that the health care discussion was led by Center Forward board member Liz Greer, a lobbyist at Forbes Tate; the firm manages the Partnership for America’s Health Care Future coalition designed to undermine Medicare-for-All. Paul Kidwell, a lobbyist from the Federation of American Hospitals, and Larry Levitt, from the Kaiser Family Foundation, also spoke. No proponents of Medicare-for-All were included. Kidwell’s trade association is part of the Partnership for America’s Health Care Future group opposing single payer.
These kinds of junkets are not uncommon, but it shows how the groundwork is already being laid to defeat Medicare-for-all long before there’s a Democratic nominee with a proposal that he or she is promising to pursue, let alone legislation that stands a chance of becoming law.
Now, let’s take a moment to talk about the Partnership for America’s Health Care Future. If you go to its website, you can read their inspiring mission statement:
The Partnership for America’s Health Care Future’s (PAHCF) mission is to improve what’s working in health care and fix what’s not. We support building on the strength of employer-provided health coverage and preserving Medicare, Medicaid, and other programs that so many Americans depend on, so we can deliver affordability, expand options, improve access, and foster innovation.
Affordability, options, access, innovation — all that sounds great! And you can watch this video the group produced, which for the first minute and a half seems like a friendly Vox explainer on how the U.S. health-insurance system works, but then takes a dark turn to saying how Medicare-for-all will destroy everything good about health care, full of Republican talking points.
“Health-care decisions would be shifted from patients and their doctors to politicians and bureaucrats,” it says, as opposed to the paradise we live in now, where insurance company bureaucrats have absolutely no role in health-care decisions.
PAHCF, which was formed last year, is a coalition that includes pretty much every industry with a financial interest in keeping medical costs high and avoiding more government oversight: the pharmaceutical industry, the health-insurance industry, the hospital industry, the biotech industry and the American Medical Association, among others. If we were to actually bring down the prices that make U.S. health care by far the most expensive in the world, they’d all suffer.
PAHCF is only getting started, by doing such things as placing op-eds; in March, Libby Watson wrote a revealing article for Splinter on how the “ordinary Americans” writing those op-eds and getting quoted on the partnership’s behalf all turn out to PR executives with insurance-company clients, people in the insurance industry, Republican officials, and the like. Scroll through its Twitter feed and you’ll see that it contains almost nothing about improving the health-care system; it’s virtually all attacks on Medicare-for-all.
If there’s a Democrat elected next year and health-care reform looks like a real possibility, these anti-Medicare-for-all forces will kick their campaign of lobbying and public persuasion into high gear. They have essentially limitless resources; they could easily spend hundreds of millions of dollars to defeat Medicare-for-all, given what they stand to lose.
That will be just one part of the anti-Medicare-for-all effort. It’s also important to understand that these interests are not just going to fight against a full-on single-payer system of the kind that Sen. Bernie Sanders (I-Vt.) advocates. They’ll fight just as hard against what I call “Medicare for anyone,” or plans that allow anyone to join a government program but don’t mandate it. In fact, they’ll fight against pretty much any serious expansion of the federal government’s role in health care, because it could all wind up in the same place: cutting their profits.
And the truth is they stand an excellent chance of winning that fight. This is a classic collective-action problem, as Mancur Olson explained half a century ago. You have a group of concentrated interests with a great deal to lose on one side, and a much larger group of diffuse interests on the other side. Many of the people in that group with diffuse interests — that would be the American public — have a lot to gain from a universal system, but they’re more difficult to organize than a small group of drug companies, insurers and doctors willing to pour millions upon millions of dollars into the effort.
They also have fear and loss aversion on their side as they set out to destroy Medicare-for-all, which is why they’re arguing that if Medicare-for-all passes, you’ll be left with nothing. And if you say, “They can’t say that, it’s transparently bogus,” you obviously weren’t around the last time we debated health reform.
Which is why the Obama administration decided in 2009 that the only way to pass the Affordable Care Act was not to fight those interests but to co-opt them, convincing them that there was enough in it for them in the ACA that they shouldn’t oppose it. And it worked.
Democrats haven’t yet figured out how they’re going to defeat the moneyed interests that will be working with Republican to fight the next version of health-care reform, and I wish I could say I knew exactly how to do it. But if those Democrats don’t come up with some kind of plan, they’re almost guaranteed to fail.