Lessons from the Past Part 2: The Political Price of “Medicare for All”

Much has been said over the past year about the potential cost of “Medicare for All,” Bernie Sanders’s radical proposal to create a single-payer healthcare system. From estimates about the federal cost of implementing such a program to speculation about the economic toll of overhauling the nation’s largest private industry, there is no shortage of analysis on the impact of this plan. And yet much of this analysis fails to mention perhaps its greatest cost of all: the political price. Looking back at the past two attempts by a Democratic president to pass healthcare reform (the Health Security Act of 1993 and the Affordable Care Act of 2009), it becomes clear that by making “Medicare for All” a central promise of his campaign, Sanders risks further polarizing an already divided country and losing the ability to pass his other legislative proposals.

“Harry and Louise” heralded a new era of campaign advertisements when it first aired in 1993. This simple, succinct commercial, portraying two everyday Americans worrying over the dinner table about their rising health insurance costs, was part of a massive, fourteen million-dollar campaign against President Clinton’s push for health care reform, funded by the Health Insurance Association of America (HIAA). As Raymond Goldstein of West Virginia University observed in a 2001 analysis, “Harry and Louise” was “the most coherent and well-funded attempt to sway public opinion during the 1993–1994 health care reform debate”—a “highly successful example of a political strategy whereby interest groups, such as the HIAA, and politicians carefully craft mass media messages to manipulate public opinion.” In fact, its immense success led him to conclude his paper with the question, “Is the Harry and Louise campaign the future of political action?”

That insurance companies’ concerns over “Hillarycare” prompted one of the most effective advertising campaigns in the past two decades is only a small reflection of the devastating extent of the backlash to the proposal. To truly understand the extent of the damage incurred by the Clintons’ health care debacle, consider the 1994 midterm elections, later dubbed the “Republican Revolution.” The election was a catastrophe of historic proportions for the Democrats, who lost in a fifty-four seat swing, losing a majority they had held for over four decades. Moreover, they were outvoted nationally by Republicans for the first time since 1946. The Republicans won their majority by seizing control of the South, which had long served as the bedrock of the Democratic party. The Republicans’ victories here marked the first time the GOP had won a majority of Southern seats since Reconstruction.

What is especially interesting about the 1994 midterm elections, however, is the manner in which the Republicans won. As mentioned before, the thrashing the Democrats endured was unprecedented; swings that large had always been associated with abnormal stresses like war or depression, or, in the case of Watergate, presidential scandal. The absence of any such factors in the 1994 midterms led many political scientists to ponder what had caused a defeat of this magnitude and inspired Walter Dean Burnham’s article “Theses on the 1994 Election.” Burnham, of the University of Texas at Austin, argued that while the “Republican Revolution” could not be attributed to any single political action, Clinton’s decision to “devote so much domestic capital to a Rube-Goldberg 1,200+ [sic] page plan for universal health opened wide the gates for Republican/industry seizure of the agenda's high ground” and, in doing so, had allowed the Republicans to make the midterms an “old-fashioned partisan election.” He concluded that the midterms “appear to have marked a major accelerating point in the political crisis which has been increasingly engulfing the United States,” proclaiming ominously that “we are in for explosively polarizing times.”

If the 1994 elections foreshadowed polarization, the 2010 midterms embodied it. For the second time in a little over a decade, the Democratic party suffered a humiliating defeat, losing not fifty-four but sixty-three seats. The Republican party’s immense victory was not a sign of faith in the party: paradoxically, 53 percent of voters held an unfavorable view of the GOP, compared to 41 percent who supported the party. It was instead, in the words of the Pew Research Center, a “clear rejection of the status quo.” 37 percent of voters said their vote was intended to express opposition to the president, 52 percent thought the president’s policies were hurting the country, and an incredible 73 percent of voters were dissatisfied with the federal government. Perhaps most significantly, the Tea Party, a radical right wing group which hadn’t even existed two years before, was supported by over 40 percent of voters.

Once again, this immense loss cannot be attributed entirely to health care legislation; but it is impossible to overstate the influence the Affordable Care Act had over this election. Nearly half of voters in the 2010 midterms supported repealing the ACA, while a measly 16 percent supported leaving it as it was. More importantly, the ACA was an especially effective motivator for the older, wealthier electorate the Republicans relied on: while the approval rating for Obamacare hovered just below 50 percent throughout 2010, those making over ninety thousand dollars a year overwhelmingly opposed the law from its inception, and by September of 2010, 60 percent of them disapproved of it. In fact, a joint study by the University of Denver and North Carolina State University concluded that the ACA alone cost at least thirteen Democratic seats.

But perhaps the greatest effect the ACA had on the 2010 midterms is less tangible. Between 2008 and 2010, the country experienced a profound reversal in its view on the role of government: in 2008, 51 percent of voters said that the government should do more to solve problems while 43 percent said it should do less; in 2010, 56 percent said the government should do less while 38 percent said it should do more. While it is difficult to know how much of this dramatic shift was a result of Obamacare, given that the ACA was by far the most significant law passed in that two-year span, it was undeniably a major factor in the anti-government sentiment that fueled this transformation.

When one thinks of polarizing issues in American politics, social policies like abortion, gun control, and same-sex marriage are often considered to be at the top of the list; but if the 1994 and 2010 midterms reveal anything, it is that healthcare reform can be just as if not more divisive and devastating than these contentious issues. The United States of 2016 is very different from the United States of 2010 and 1994. But if Clinton’s relatively moderate Health Security Act and the even more centrist Affordable Care Act prompted two of the greatest Democratic defeats in congressional history, it is fair to assume that Bernie Sanders’ radical “Medicare for All” plan would prompt a similar backlash. For a candidate who intends to reform the tax code, expand social security, and make college tuition free, losing more seats in the House would be a catastrophic blow.

Indeed, “Medicare for All” poses a risk even greater than unfulfilled campaign promises. As President Obama said in his most recent State of the Union address, one of the greatest regrets of his presidency is that the “rancor and suspicion between the parties has gotten worse instead of better.” The deterioration of political discourse over the past decade is the result of many different factors, but as Burnham observed in 1994, health reform has a unique ability to polarize the political climate. By re-opening the healthcare debate with partisan tensions at an all-time high, Sanders risks leaving a legacy of heightened political turmoil. Whether he wins or loses, and whether “Medicare for All” passes or fails, one thing is definite: as Burnham wrote more than two decades ago, “we are in for explosively polarizing times.”

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