The progressive activists who put the public option at the heart of the health care reform debate in 2009 and 2010 will return in 2012 to press Democrats to back a single-payer system if the Supreme Court throws out the Affordable Care Act on Thursday.
For progressives, Medicare for all — or a similar approach — was always the ideal way to address the soaring costs and widespread un- and underinsurance that defined the country’s broken health care system. But Democratic leaders believed an approach along the lines of Mitt Romney’s reforms in Massachusetts would stand a better chance of attracting Republican and conservative Democratic support in Congress, and foreclosed on the single-payer model without giving it any legislative consideration.
To keep single-payer supporters in their coalition, though, Democrats pledged to fight for a Medicare-like public option that would allow consumers the opportunity to buy insurance directly from the government. They ultimately abandoned that idea as well.
That’s why the same disappointed activists aren’t sweating Thursday’s Supreme Court ruling. If the health care law fails, they believe it will open up a whole new set of political and substantive opportunities for liberals.
“The right fought [the Affordable Care Act] just as bitterly as they would have fought if it was single payer,” said Chuck Idelson, spokesman for National Nurses United — a union and trade association of registered nurses that has consistently supported Medicare for all.
“Medicare continues to be an extremely popular reform — it’s one of the most popular reforms in U.S. history,” said Idelson.
NNU will host medical screenings and town halls and other events in the run up to the Court’s decision to push single payer as a preferable alternative to the health care law.
Expanding Medicare to all Americans would be an enormously heavy legislative lift. But supporters of the approach believe President Obama and Democrats will have an immediate political incentive to turn to the idea if the Court wipes their signature achievement off the books.
“Medicare For All was the right solution in 2009, is the right solution now, and is the ultimate destiny at which our nation will arrive. The only question is whether Democratic leaders are strategic enough to start the process of marching through that door as it opens,” said Adam Green, co-founder of the Progressive Change Campaign Committee. “If the Supreme Court is so political that it overturns the Affordable Care Act despite clear legal precedent, that illegitimate ruling would call for outrage — but it also would blow the door to Medicare For All wide open. The march to Medicare For All would be a marathon, not a sprint, but an absurd ruling this Thursday would be the opportunity for Democrats to start marching.”
Moreover, the argument goes, it would create for Democrats a useful tool to bring Mitt Romney’s radical plans for Medicare into sharper focus.
“If the Supreme Court opens the door for Democrats to campaign in 2012 on Medicare For All and Republicans are left campaigning on Paul Ryan’s plan to end Medicare, that clean contrast could be the game changer that gives Democrats a clean sweep in November,” Green said.
Obama kept these more aggressive reformers at arms length during the year-long fight over the Affordable Care Act. But in the run up to an election, and if the conservative Supreme Court deals a death blow to Obama’s signature legislation, the calculus could change.
“We would certainly encourage him … to say, ‘OK the court didn’t like the way this law was drawn up, ok then let’s go back to square one, let’s do a law that has no constitutional problem — Medicare,’” Idelson said. “And they could probably do this in one page.”
Brian Beutler is TPM's senior congressional reporter. Since 2009, he's led coverage of health care reform, Wall Street reform, taxes, the GOP budget, the government shutdown fight, and the debt limit fight. He can be reached at email@example.com.