AOC says the quiet part out loud about Medicare for All: It has virtually no chance of becoming law right away

AP Images / Alex Brandon

Democratic Rep. Alexandria Ocasio-Cortez of New York conceded in an interview with the Huffington Post published Thursday that Medicare for All may not become law right away – and appeared open to compromise on a plan she’s consistently championed.

“The worst-case scenario? We compromise deeply and we end up getting a public option. Is that a nightmare? I don’t think so,” the progressive lawmaker and key surrogate for Sen. Bernie Sanders said, while noting she still intended to fight for universal healthcare.

Her comments highlight a possible pivot available to Sanders as he becomes the frontrunner for the Democratic presidential nomination: Fight for sweeping change, but take what you can get from a polarised Congress.

Medicare for All is at the heart of the Vermont senator’s unabashedly progressive campaign. The proposal would enroll everyone into the United States into a government-run insurance system and provide comprehensive health benefits. It would also virtually eliminate private insurers.

Most Democratic primary voters support it, but the Sanders plan has virtually no chance of passing Congress.

“He’s not gonna get that,” Democratic Sen. Joe Manchin of West Virginia told Axios.

It reflects the reality that many voters still chafe at Medicare for All once they learn of the possible trade-offs – like losing their private coverage or paying additional taxes. Though 56% of the public supports Medicare for All, but that figure flips and becomes strong opposition (60%) when people are told it would eliminate private insurance, for example.

In stark contrast, the middle-of-the-road proposal known as the public option – which centrists like former Mayor Pete Buttigieg and former Vice President Joe Biden are pursuing – has broad backing among Democrats and independents. That would create an optional government health plan and allow people keep their private insurance.

However, much of the fierce ideological battle to reform the nation’s healthcare system among Democrats has been squarely focused on the feasibility of implementing Medicare for All.

Topher Spiro, the vice president for health policy at the Centre for American Progress, tweeted the Democratic primary was “dominated by a policy everyone acknowledges has no chance of passing.”

And he drew a parallel between Ocasio-Cortez and a prominent Democratic presidential candidate who recognised the difficulty of enacting a law that would reconfigure almost a fifth of the American economy.

“Warren was realistic but also honest about it – and she was thrashed for it,” Spiro said in another tweet, referring to Sen. Elizabeth Warren.

Why health reform is difficult to achieve

The Massachussetts senator said in early 2019 she supported Sanders’s plan for universal coverage, but moved towards the centre later in the year as polls showed voters uneasy with losing their private insurance.

She rolled out a two-step plan in November to initially push for the public option and vowed to pursue Medicare for All in the third year of her term. However, she was hammered by liberal activists who viewed it as a betrayal, and suffered a drop in the polls.

Her campaign didn’t respond to a request for comment.

Warren’s approach factored in how even moderate policy reforms on healthcare have become a huge lift in Congress. Despite overwhelming public support for legislation to end “surprise billing” for hospital patients, Republicans and Democrats have failed so far to end exorbitant costs people incur for being treated by doctors and specialists they didn’t know were considered out-of-network.

A big reason for the continuing gridlock is an onslaught of lobbying dollars from health insurers and providers.

There’s also a crystallizing example from the Democratic-led fight to pass President Obama’s signature healthcare law a decade ago.

In 2009, the House passed a version of the Affordable Care Act that included a public option. But it was later killed in in the Senate Finance Committee with several moderate Democrats joining every Republican in opposition.

Though it’s now considered a cautious pathway to reform, a public option would still significantly disrupt the health industry, depending on the plan’s structure and ability to negotiate lower prices. Shepherding it through a likely Republican-led Senate would be very difficult, and even more so for Medicare for All.

Adam Jentleson, a past deputy chief of staff to the former Democratic Sen. Harry Reid, said the GOP would seek to embarass Sanders if he won the White House and bring his signature plan up for a vote to reveal lingering Democratic divisions.

“If Republicans control the Senate, they will immediately bring it up for a vote, and it will fail in embarrassing fashion for President Bernie,” Jentleson wrote on Twitter. “Not exactly a strong opening bid!