New York gubernatorial candidate Cynthia Nixon is the latest Democrat to fully endorse Medicare for All — meaning, she’s interested in turning today’s insurance patchwork into a single government-run health care system, or a single-payer system. Gubernatorial candidates from a dozen states are running on the policy, contrasting congressional races in which the Democratic Congressional Campaign Committee (DCCC) advised against using the two-word phrase in ads.
“Single payer health care in New York isn’t a pipe-dream,” said Nixon in what appears to be an ad shot on an iPhone. “It’s already passed the State Assembly four years in a row, but every time, it has been blocked in the Senate thanks to Governor Cuomo’s IDC [Independent Democratic Conference].”
Nixon is referring to the New York Health Act, a bill that passed the Assembly as recently as June 14, but failed to clear a Senate committee, as is the case with most progressive bills in Albany. The open secret among some New York progressives is that Gov. Andrew Cuomo (D) shoulders the blame. (Cuomo has called New York’s single-payer bill “a very exciting possibility,” but hasn’t endorsed it.)
“The governor could have used his veto power over districting maps in 2012, or used some of his vast campaign resources to elect a stronger Democratic majority in the upper chamber,” writes Susan King, associate professor of political science at John Jay College, City University of New York, for Jacobin. “Instead he has carefully maintained this structural barrier to the passage of progressive bills.”
This platform distinction within the Democratic party — in which one candidate appears noncommittal or resistant and another is a full-throated supporter of single-payer — is playing out across the country ahead of the November elections.
In Michigan, Democratic front-runner Gretchen Whitmer is in favor of universal coverage — which keeps private insurers but strives to get everyone covered — but she does not support single-payer, while one of two Democratic hopefuls, Abdul El-Sayed, has his own single-payer plan. The other candidate, Shri Thanedar, says he’s for single-payer insurance, but, in reality, he is actually more closely aligned with Whitmer’s vision. According to the polls, El-Sayed is currently in third place and the state primary is next month.
Few sitting Democratic governors favor single-payer, according to a Truthout anaylsis — just one governor, Mark Dayton of Minnesota, publicly supports it. So the wave of Democratic candidates running specifically on single-payer is notable. Ben Jealous in Maryland and Andrew Gillum in Florida are also running on the popular platform. Some governors want to implement the system at the state-level, while others endorse Medicare for All at the federal level.
But past races show that these candidates don’t always win. Illinois state senator and single-payer champion Daniel Biss in March lost to billionaire J.B. Pritzker, whose policy mirrors Whitmer’s and seeks to build off of Obamacare. Single-payer hopefuls in Ohio and Iowa also lost in the primaries.
This is not to say that all single-payer candidates are losing or that it’s a failing strategy. A significant win came in California, where Lieutenant Gov. and Democratic gubernatorial candidate Gavin Newsom, who endorses existing single-payer legislation that has stalled in the legislature, pulled ahead over Antonio Villaraigosa, who has said the idea of single-payer “forces seniors off Medicare” (that isn’t accurate). In Colorado, current member of Congress and gubernatorial candidate Jared Polis ran on single-payer and took the Democratic nomination — perhaps a surprising fact given that residents rejected the idea by way of ballot initiative in 2016.
Moreover, it’s important to recognize that single-payer has come along way, garnering more support from lawmakers and voters alike — thanks to Sen. Bernie Sanders (D-VT) and his supporters, who’ve successfully moved the “Overton window” on health care. The move was so significant that center-left and influential Washington D.C. think tank, Center for American Progress, reworked the mantra when it debuted its own, watered-down version of the health plan: Medicare Extra For All. (Editor’s note: ThinkProgress is an editorially-independent news site housed within CAP.) Currently, six in 10 people (59 percent) favor single-payer, according to a March 2018 Kaiser Family Foundation poll. That said, when broken down by party, Republican support for the idea holds at one-third.
The lesson of Vermont
Let’s turn to Vermont for a second — the inevitable elephant in the room, as the state came the closest to implementing a single government-run health care program, but ultimately failed. ThinkProgress asked the Nixon campaign about Vermont’s efforts, as the New York candidate not only endorses the concept at the federal level, but at the state level, too.
Nixon’s chief spokesperson Lauren Hitt said, “Vermont passed their legislation in 2010, but was required to wait until 2017 to apply for waivers from the [Affordable Care Act] to implement Green Mountain Care. Seven years was too long to keep leaping over the political hurdles, and so we need to make sure we pass the NY Health Act and implement it in a reasonable amount of time.”
“Medicare was implemented within one year and that was in the 60s without the technology we have today!” Hitt told ThinkProgress by email. She added that for New York to cover everyone, every employer and resident needs to pay the tax, and all sources of funding, including Medicare and Medicaid, need to divert to single-payer.
“Progressive states … should be leading the way to show the entire country that a better system is possible.”
While there were serious political impediments blocking single-payer in Vermont, Green Mountain Care was also economically unfeasible at the time, according to John E. McDonough, a professor of practice at the Harvard T. H. Chan School of Public Health. As McDonough explains for the New England Journal of Medicine, it was a combination of undershooting anticipated federal revenue and policy choices that added to the total projected cost.
New York or California could face a similar fate — or succeed with flying colors. The clear and perhaps largest obstacle is Trump.
When asked if the Nixon campaign believes the Trump administration would approve New York’s single-payer proposal and, if not, whether it makes sense to wait for a more supportive federal government, Hitt said, “In the age of Trump, Democrats can’t just sit back and wait for change to come from DC. At a time like this, progressive states like New York should be leading the way to show the entire country that a better system is possible. The voters are already there on single payer. Elected officials need to stop being scared of progressive policies, and make the dream of true universal health care a reality in New York state.”
Hitt’s rationale is, not surprisingly, similar to New York’s 14th congressional Democratic primary winner Alexandria Ocasio-Cortez, who stunned many political pundits when she beat incumbent Joe Crowley by running a purely progressive campaign. Ocasio-Cortez told Pod Save the People’s DeRay Mckesson last week that she promotes policies, like singe-payer, after asking herself “what is the most aggressive, ambitious move towards justice?” The idea is for Democrats to enter negotiations with bold ideas, not compromise before they even get to the table.
Such victories move the needle. But a governor’s ability to challenge mainstream policy ideas by running on and then trying to implement single-payer perhaps moves the needle faster, further conditioning Americans to the fact that, indeed, the policy isn’t a pipe-dream.