The Great, Missing Middle

So, this afternoon I’m writing a story about single payer healthcare at the state level.

Since losing the 2016 election, Medicare for all has picked up steam on the Democratic left. This started as a bumper sticker among those who take it on faith that Bernie Sanders would have defeated Donald Trump, but increasingly it’s showing up in the more normalized corridors of power.

Case in point: California and New York have both put forth legislation testing the waters of single payer systems statewide.

Now, as I explain in my article (look for it next week on The Street!), they’ve got a pretty steep hill to climb. This will cost a lot of money and they’re trying a pretty radical state-level experiment in a very nationally-integrated system. It’s going to be tough.

But that said, I expect that single payer healthcare will become a huge political issue for one, very important, reason:

It’s the only version of health care reform pitched to the middle class.

Both Obamacare and Ryancare* focus on the polar extremes. Obamacare expanded health insurance to the poor while Paul Ryan built his system around overwhelming top-end tax cuts.

Neither law has much to offer someone making $70,000 per year. At least, not on a gut-impact level.

Single payer does. It offers to replace our overwhelming, highly complex system with one card. It offers to disentangle medicine from employer. It offers an end to what is approaching ten years of vitriolic debate on the same subject.

In other words, single payer offers simplicity.

If I’m a middle class voter, it’s easy to see the problems this would solve. I can listen to this pitch and think “okay, I get what I’d get out of this.” And just as importantly, unlike the ACA or AHCA debates, this is probably the first proposal on health care reform that would solve any problems in my life.

Now, that doesn’t necessarily make single payer good policy. Medicare for all may not be as impossible as its opponents claim, but there’s also absolutely no reason to believe it would be as easy as its advocates believe. Getting into that would take a much longer article and probably a few books to discuss.

But as a political message, I expect us to start hearing a lot more about this in the coming years. After all, middle class voters outnumber millionaires and vote in much larger numbers than the poor. I expect a campaign targeted at them to have some legs.

*This is not Donald Trump’s bill. He will sign it, but I have seen no indication that he played any role in drafting it or establishing policy priorities. As far as I can tell, Paul Ryan is the architect of the AHCA.