When U.S. Sen. Elizabeth Warren rolled out details of her Medicare for All plan at the beginning of November, she didn’t merely answer her fellow Democratic presidential contenders, who were clamoring to know how she proposed to pay for it. Warren also handed a few pages from her playbook to her plan’s real opposition, the Partnership for America’s Health Care Future, a consortium of sometimes disparate health-industry heavyweights, from insurance companies to private hospitals to Big Pharma.
Since 2018, the deeply funded and well organized Partnership, which is headed by Lauren Crawford Shaver, a former Hillary Clinton presidential campaign aide, has spearheaded a wide-ranging media and lobbying effort to defeat any movement toward either a single-payer or public-option health-care system. (Under single-payer, the government would provide health insurance for every person in the U.S.; a public option means adding a federally based plan to compete with private insurers.) Its methodology includes mass media scare ads, “earned media” editorials, directed think-tank studies and inside-the-Beltway persuasion.
“They’ve really powered ahead. We’re seeing them ramp up more and more,” said Eagan Kemp, a health policy advocate with Public Citizen. “And they are putting effective pressure on the polling [data] regarding Medicare for All” by, among other things, spending vast amounts of money across media platforms to raise concerns about tax increases or long wait times to see a doctor.
The health care industry expects any Democratic candidate that emerges in 2020 to be a threat to the existing system, and it is pushing aggressively against that threat – both publicly and privately. But although the industry’s current war against universal health care is one of 21st-century America’s biggest political fights, its unforgiving rhetoric and tactics are rooted in legislative conflicts that stretch into the distant past.
Going back to the tortured path that eventually led to the creation of Medicare in 1965, medical industry giants have moved to defeat or delay almost every development they viewed as an incursion on their profits and prerogatives. That includes the Clinton administration’s attempted reforms in the 1990s and the Affordable Care Act, which, under intense lobbying, scrapped a heavily debated public option on its way to becoming law under President Barack Obama.
“It’s a long period of consistency not only in opposition, but also in messaging,” said Anthony Wright, executive director of Health Access, a California-based consumer advocacy coalition. “It’s striking how they’ve come out not against a specific plan, but against the whole range of plans.”
But with opinion polls indicating that a majority of Americans favor either full public health care or a public option, private insurers may now be facing an existential crisis. And while House Speaker Nancy Pelosi has expressed doubts about the political viability of a straight Medicare for All proposal, two of the leading candidates for her party’s nomination, Warren and Sen. Bernie Sanders, are pushing for exactly that.
“Today, in 2019, in the United States of America, the wealthiest nation in the history of the world, inadequate health coverage is crushing the finances and ruining the lives of tens of millions of American families,” Warren wrote in the introduction to her proposal.
Following the 2010 passage of the ACA, with its legal requirements for individual coverage, the number of uninsured Americans began to fall. But those figures were on the rise again in 2018. And when adding those who are considered underinsured (meaning they pay out-of-pocket or deductible costs that equal five to 10 percent of their income), some 87 million adults are affected, with the poorest Americans faring the worst.
That rigid view may be one of the primary reasons the Partnership lost one of its co-founders this past summer, when the AMA announced it was no longer affiliated with the group.
The AMA said it remains opposed to Medicare for All. But in June, a resolution to reverse the organization’s opposition to single-payer was defeated in its policy-setting House of Delegates by a surprisingly narrow margin, and its national gathering was met by demonstrations that included doctors, nurses and medical students urging it to extend Medicare coverage to all Americans.
Today, however, it is the next election cycle that matters (“We are all focused on 2020,” Forbes-Tate’s Crawford Shaver said in a recent podcast), and the lobbying money reflects that reality. Between the first quarter of 2018 and the first quarter of 2019, the number of firms hiring lobbyists to work on Medicare for All increased nearly sevenfold – almost all of them attempting to defeat the idea.
When Bernie Sanders campaigned on his plan in 2016, he was seen as a disruptor but not necessarily a threat. That much, very clearly, has changed.
“The more that this issue has gained visibility, the more they want to counter the messaging,” said Health Access director Wright. The concept of health care as a human right is now in the political mainstream, and if it’s in the mainstream, then it has a chance to breathe – something the U.S. private health insurance industry has no interest in seeing happen.