Is It OK To Campaign For Congress On "Medicare-For-All?"

The other day I was talking with a first-time Democratic candidate who has a bit of a reputation as a centrist, although he insist-- at least to me-- that he's a progressive. I'm not persuaded. He says he's kind of, sort of good with Medicare-For-All but there's no way he'd say he's going to co-sponsor John Conyers Medicare-For-All bill. He claims the district isn't ready for that yet and maybe he can lead them in that direction and maybe we can go to it incrementally. I do like one argument he makes, which I find refreshingly sincere: he says he doesn't want to pivot after he wins the primary and that whatever he backs now-- to appeal to Democratic audiences-- is exactly what he wants to say to general election audiences. His swingy red district is one of those districts where independents determine who goes to Congress.

Thursday L.A. Times reporter Sarah Wire posted a provocative piece about messaging: How does a progressive Democrat try to unseat a Republican? Step one: Don't talk about single-payer healthcare. And the piece was about a Blue America-endorsed candidate, Katie Hill. Katie was "sitting around a kitchen table with a local activist group last spring when one of the attendees asked her a question: Will she have to 'soft pedal' her stance on any issues to unseat Republican Rep. Steve Knight in the 25th District?"

The progressive Democrat started to answer, then paused to ask a person livestreaming the meeting on Facebook: “This isn’t going to be something that I’m going to be blasted all over Facebook for, right?”

After getting assurances that the video would only be available to a private group, Hill said one of the issues she can’t discuss directly is single-payer healthcare.

"I shouldn't go into the district and talk about single-payer, right? Like, that word by itself is going to be something that just immediately turns off a lot of people," Hill said. "But, if I talk about how we need to make sure that everybody has access to healthcare and that it's affordable for everybody and how having a government option [is needed] at the very least, that is something people can really get behind. It's more about the way we talk about things than being very far apart on issues."

The video, which was posted online to the storage site Dropbox and shared with the Los Angeles Times this week, shows the delicate line some Democratic candidates are walking as the national party goes after the more than 30 seats it needs to win back control of the House. The idea of a single-payer healthcare system, in which the government pays for a base level of healthcare for all citizens, has been growing in popularity in party circles since it became a major policy plank in Sen. Bernie Sanders’ campaign for the Democratic presidential nomination. But it remains a nonstarter for many conservatives, and is unlikely to catch on in a Republican-controlled Congress and White House.

The path to a House Democratic majority goes through the seven California Republican-held districts that backed Hillary Clinton in 2016. That includes places like the 25th District, where voters have sent Republicans to Congress for decades, but Democrats have a 3-percentage-point voter registration lead and voters there chose Clinton by nearly 7 percentage points in 2016.

Hill said in an interview that she believes the country will eventually have single-payer healthcare, but using the term puts off people in a district with a large number of conservative voters. Hill said she asked whether the video-- shot during a May 2 gathering for the liberal activist group Indivisible-- would be widely shared because talking to a liberal group is different than talking to the general public.

“Look, is it the best idea to be talking about the strategy for how we frame conversations? Probably I wouldn’t be advised that’s what I should say,” Hill said.

Hill has spoken publicly about her wish for every person to have healthcare, and paying out of pocket for her teenage brother’s drug addiction treatment. But she said achieving a single-payer healthcare system shouldn’t be prioritized over working for healthcare solutions in the interim, including practical fixes to the system that both sides can embrace.

“It comes down to having nuanced discussions,” Hill said. “As purple districts, we have the opportunity to say, ‘No, we can’t have these binary conversations.’”

Healthcare is expected to be a key issue in the 2018 contests.

Democrats are already lambasting GOP lawmakers, including Knight, for backing their party's House healthcare bill in May. Knight has said it was a tough vote, but he thinks it was the right bill to address changes needed to the Affordable Care Act, and he isn’t worried about Democrats using it against him.

At the same time, some have threatened to make support for single-payer healthcare a litmus test for Democrats. Our Revolution, a political group inspired by Sanders, threatened primary challenges this week against Democrats who aren’t vocal about it.

Former Ohio state Sen. Nina Turner, president of Our Revolution, told Politico, "We're not going to accept no more hemming and hawing. No more game playing. Make your stand."

Backers of single-payer healthcare in California are also trying to recall Democratic Assembly Speaker Anthony Rendon because he shelved a bill to create a state system earlier this year.

But the National Republican Congressional Committee is trying to use single-payer healthcare against Democrats. Just last week, it went after another Democrat in the race against Knight, Bryan Caforio, over whether he supports a single-payer system. He has said for months that he does, although Caforio, like Hill, doesn’t use the phrase. He’s more likely to refer to “Medicare for all.”

“This is a universal human rights issue and I’m going to talk about that in the district,” Caforio said.

Caforio lost to Knight in 2016 by 6 percentage points. Three other Democrats have announced challenges, but Caforio and Hill have an early fundraising lead.

DCCC messaging gurus-- they literally only hire morons-- insist that candidates not campaign on "Medicare-For-All." So I asked some of the candidates who Blue America has endorsed and some of the ones we are currently vetting. The question, in fact, is part of the vetting process. We started with Katie. She told me she hasn't gotten any backlash, "Anyone who actually reads the article as opposed to just the headline knows that my comment was about messaging only. And most people who are paying attention have heard me over and over again talk about Medicare for all so they know it's something taken out of context in an attempt to make me look bad. My mistake was asking if the video was going to be shared (or thinking for a second that it wouldn't be). Everything else I said is consistent with what I have said everywhere throughout this campaign, both in public and in private."

I caught up with Randy Bryce just as he was flying back to Wisconsin from having given the keynote speech at Netroots Nation. He reminded me that he talks about Medicare-For-All-- and using that phrase-- in virtually every speech he gives. Then I asked a go-to progressive I know I can always trust to give me an unadulterated progressive perspective, Hawaii state legislator Kaniela Ing. Here's what he told me:

The consultant class is obsessed with having candidates try to sound like America's most popular politician while somehow not upsetting their donors. Unfortunately for them, authenticity matters, and voters are smarter than they think.

A silver tsunami of aging boomers is approaching, and single-payer, Medicare-for-all is America's only sensible and sustainable healthcare solution. Anything short will continue to allow big-pharma, corporate hospitals, and insurance companies to exploit the sick and their cash-strapped families into paying way too much for needed services. This in turn could have devastating effects for our overall economy.

Democrats know that healthcare is a human right. If you want to reach Republicans, add that Medicare is the most efficient system we got, and that Medicare-for-all will save taxpayers $17 trillion. We have facts on our side and shouldn't run from them.

Voters in both parties recognize that the pharmaceutical industry, insurance companies, and corporate hospitals have too much power. The People's trust will go to the party or set of candidates willing to take them on.

Wendy Reed is running in a much redder district than Katie's though they both share part of the Antelope Valley in southern California. Wendy's opponent is the Republican Majority Leader Kevin McCarthy and she told us that she disagrees "that talking about single-payer is a campaign no-no, totally disagree. As candidates, we must talk with voters about good policy, and provide the breadth and depth of information on these issues that might not be provided on mainstream media. Moreover, the only thing that wins elections is integrity. We must never shy away from our commitment to good policy. Health care is a human right and Medicare For All will save us all money. It is good policy. Of course we should have these discussions with those we hope to represent."

Two Blue America-endorsed candidates in Orange County, Doug Applegate and Sam Jammal, progressives opposing, respectively, GOP entrenched incumbents Darrell Issa and Ed Royce. Doug pointed out that "I’ve argued and my platform has always fought for single payer Medicare-for-All. That’s why I’m so proud to have earned the National Nurses United endorsement, and I’ll always have their back." Sam Jammal said simply, "I strongly support Medicare for All, because (1) I believe health care is a human right; and (2) Medicare works and we should invest in what works. Try finding a senior who hates their Medicare and wishes to get rid of their Medicare; that person doesn't exist. As a former business executive, you invest in what works and scale it. Government should be doing the same when it comes to health care. People want quality, affordability and access  Medicare provides all of this for our seniors, which is why we need to protect it and expand it. Additionally, we aren't talking enough about out of pocket costs and how they are crippling our families. This is why I will campaign on universal health care and, in particular, Medicare for All because its the best approach for lowering health care costs. Voters want solutions that will work for them, not millionaires or special interest. My campaign is about voters in my community and finding solutions that will improve their lives. This is why I will continue to campaign on Medicare for All."

Kia Hamadanchy is running for the Orange County seat occupied by Trump pawn Mimi Waters. A young attorney who once worked for Sherrod Brown in Washington, he values clarity and honesty and abhors the kind of murky approach that leaves voters trying to sift through the verbiage to understand where a candidate really is. "When I talked about healthcare," he told us, "I use the terms single payer and Medicare-for-All, because I want to make it clear to everyone as to what kind of healthcare system I believe we need in this country and to make clear then when I'm elected to Congress I will sign on as a co-sponsor of John Conyers' Medicare-for-all bill. And its also important that people know what exactly we stand for as a party and we aren't just against Donald Trump. Mimi Walters voted for a bill that would take healthcare away from 22 million people and she needs to be held accountable for that vote. But at the same time there are real issues with healthcare in this country and its important to demonstrate to the people of Orange County that we as a party have solutions to address these issues."

We also spoke to an Orange County candidate who we haven't endorsed yet but is being looking at closely. Harley Rouda was a Republican, then an independent and now he's a Democrat. Our experience with "ex"-Republicans is horrible. They get into Congress and then revert to their old conservative ways and prove to be more Republican than Democrat. All feel most comfortable joining the Blue Dogs and New Dems. Look at Charlie Crist (FL), Patrick Murphy (FL) and Tom O'Halleran (AZ)-- "ex"-Republicans with horrible voting records on core Democratic issues across the board. HOWEVER, once in a very blue moon we find an Elizabeth Warren, once a Republican who truly saw the light and did not convert for opportunistic career calculations. Is Rouda more like Elizabeth Warren or more like Charlie Crist? He says so. That's what we have to figure out as he runs for the seat currently occupied with Putin-prone GOP nut Dana Rohrabcher. His statement on healthcare was clear and straight-forward: "I support Universal Healthcare across the United States and the development of a Medicare-for-all system. It’s the right thing to do-- and it’s also the smart thing to do. There are 40 industrialized, developed nations in the world. Of these 40 countries, 39 have Universal Healthcare. Only one does not. The United States of America. The United States spends almost 19% of its annual GDP on healthcare insurance, and healthcare needs. That is 2.5 TRILLION dollars a year! The other 39 industrialized countries that do have universal healthcare spend around 10% of their annual GDP on healthcare expenses. These countries are providing better healthcare services to their citizens-- and at half the cost. Something is just not adding up in America. In addition, healthcare expenses are the leading cause of personal bankruptcy in the United States and a leading cause of homelessness. This is why I support Universal Healthcare across the United States and a single-payer system. Developing a Medicare-for-all system is right for the American people-- and right for the American economy.

We spoke to three Blue America-backed candidates in Illinois, Marie Newman who is primarying anti-healthcare Blue Dog Dan Lipinski; Geoff Petzel who is taking on Trump/Ryan rubber-stamp Peter Roskam; and Dr. David Gill in the central part of the state, who's challenging another rubber-stamp, Rodney Davis. Marie reminded us that she uses "Medicare for all" everywhere. "I also use say: 'Medicare for all is the most logical way to achieve single payer for now.' This is not new. I also say that 65-70 percent of the country wants single payer. I believe in single payer and now, most of the country does too."

Pretzel was just as clear, even if his response was more involved. "Personally I agree with Our Revolution. Dems who don't publicly support single payer should get a primary challenge. I strongly support single payer, have since I ran in 2011, and proudly show my battle scars for taking that stance. Because I support single payer I was not endorsed by local media in 2011. In a bigger picture, Dems lack of vocal support for single payer is my biggest personal issue with the party. Just the other day I had a serious discussion about running as an independent instead of a Democrat because the party isn't pushing progressive policy positions like they should. The reason I'm not running as an independent, other than the prohibitive ballot requirements in Illinois, is that I believe we need to re-set the Democratic party and place it back on a track that supports progressive ideas proudly and loudly. [Democrats who] fear to proudly promote single payer makes me believe they're not real progressive and represent the status quo we have been served by the DCCC over and over again."

Dr. Gill was reluctant to offer advice to other candidates-- but never reluctant to talk loudly and clearly about what he believes in. "As an individual who hasn't yet won a general election, far be it from me to try to advise other candidates. But I have had some relative success: I lost in IL-13 by only 0.3%, compared to other Democrats who have lost here by 18 to 20%. And I think the most important part of my ability to appeal to people across the political spectrum, even those who disagree with one or more of my progressive positions, is the fact that I am genuine. I simply say what I believe-- I don't try to tailor my talk or be particularly nuanced. I've been a physician for 29 years and I've been a member of Physicians for a National Health Program for 25 years, and I'm sick and tired of watching the vast majority of Americans get ripped off by a for-profit private health insurance industry that doesn't provide them with one iota of health care or actually give a damn about their well-being. I use that type of language while also incorporating the terms 'single payer' and 'improved Medicare for all', and I make it clear that I'm running because I ACTUALLY CARE about their well-being. The same caring instinct that drove me into a career in medicine is what drives my desire to be a leader in Congress. Each candidate has a unique set of circumstances, but I think that demonstrating a passion is ultimately even more important than the particular words that we put forth."

The progressive running in the Oklahoma City district (OK-05, where Trump beat Hillary 53.2% to 39.8%) is Tom Guild, who Blue America has endorsed. "A single payer Medicare-for-All health care system," he told us, "ensures that every American will have essential health care coverage. Since health care is a right and not a luxury, it is tragic that the United States is the only major world class nation without a health care system that covers everyone. Our system is one of the most expensive in the world, yet isn’t one that enjoys the best health care outcomes for its citizens. The current system leaves millions without coverage every year. Australia, Canada, and Great Britain all have national health care plans, that are considered three of the best health care systems in the world. The cost of health care is much higher in the U.S. than in any of these three western democracies. Single payer cuts paperwork and takes the profit motive of current insurance mega corporations out of the equation. It also reins in the huge profits and sky high prices of prescription drugs manufactured by Big Pharma. If we can cover every American for a lower cost, it makes sense to do so. We can use the trillions saved by not fighting the next expensive and endless wars and put that savings towards providing universal health care for our fellow Americans. For now, it makes sense to shore up the Affordable Care Act, and strengthen the individual market. Adding a public option would go a long way towards making the ACA function at a higher level. However, certain politicians have made a living and guaranteed their elections and re-elections recently by demonizing what they distastefully refer to as Obamacare. It is unlikely that they can get beyond their strong dislike or even hatred of anything named after former President Barack Obama, and take a mend it, don’t end it approach. If so, their inability to move forward hastens the day when America will join the rest of the world and adopt a single payer universal coverage Medicare-for-All system. When we have a majority of progressives in the U.S. House and Senate, and a new president we can make single payer a reality. As  the simple prayer goes, God grant me patience, and please hurry!"

South of Oklahoma City is Texas and one of the districts worth targeting is the Austin-San Antonio corridor seat held by crackpot science denier Lamar Smith. The progressive running against him-- likely to be Blue America's next endorsee-- is Derrick Crowe. He told us "I support Medicare For All in virtually every speech, in front of every audience. It's in our literature and is one of our main platform planks. Democrats shouldn't shy away from it for any reason. Most Americans think our country should make sure everyone has health care coverage, and among those under 30, a stunning 89 percent support that statement, with 66 percent of those young people saying they want a single national government program. Nearly two-thirds of Americans have a positive reaction to the term, 'Medicare For All.' If Republicans want to try to attack you for supporting Medicare For All in public, hand them a microphone, because we'll take their seats. Beyond the polling, it's just simply time for America to get back into a leadership role on health care. We spend more money on health care and have worse outcomes than virtually any other well-developed nation. Of the 35 countries in the OECD, we rank 27th in life expectancy, despite spending the most on health care-- so for those worried about the cost of a single-payer system, I'd challenge them to prove the value of a private system. Tell me why we should die earlier so insurance CEOs and pharma bosses can get richer off our misery."

Paul Perry is one of the Democrats running in a crowded primary in the Philly 'burbs in the hope of running against Pat Meehan. "Yes," he said, "I use Medicare for All. There's still plenty of nuance in terms of process that progressives (and folks on all sides really) can work with even when we use that term. It's about how we get there. Medicare for All is an identifiable program that successfully provides healthcare already for millions of Americans, so expanding it to cover more just plain makes sense to a lot of folks. I don't think we should be compromising on our destination which is a system that truly covers every single person in this country affordably and effectively. But the nuance on how we get there, the process, is fine. It'll of course be a phased approach."

Running in the same district is state Senator Daylin Leach who calls for Medicare for all in his platform and agrees that the way you do that successfully is embrace it openly, and defend it aggressively. "Health care," he told us, "is a basic human right. And a 'right' is something you are born with and keep until you shuffle off this mortal coil. The only way to guarantee that right is with a universal health-care system that can never be taken away from you. Medicare for all does that. Currently, we spend 25% of every health care dollar on insurance company profits. We should instead use that money to improve access to care and quality of care. I will fight to make sure that happens."