As more Democrats propose moving beyond the Affordable Care Act, the party may be steaming toward the same iceberg that sank Republican efforts to repeal the law.
The GOP’s drive to rescind the ACA ran aground in part because it pitted the party’s predominant ideology against the material interests of its changing electoral coalition. The growing liberal discussion about replacing the ACA with a government-run, single-payer health-care system—an idea that received a powerful boost when Senator Kamala Harris embraced it at a CNN town hall this week—could present Democrats with a mirror image of the same problem.
During the ACA debate, Republicans failed to recognize the degree to which their traditional priority of minimizing government involvement in health care could threaten the financial security of the older and working-class whites now central to their electoral fortunes. Similarly, Democrats may be underestimating how much of their new coalition—which increasingly relies on well-educated whites in major metropolitan areas—may resist entrusting the health-care system entirely to government control.
Like the debate over taxes, the one over single-payer health care, often described as Medicare for All, could become one of the principal crucibles in which the Democratic Party confronts its changing identity. It will test how a party increasingly drawn toward populist economics confronts the challenge of managing a political coalition growingly reliant on voters who are thriving financially and attracted to the party largely on cultural grounds. The Medicare for All debate sharpens that tension because the college-educated voters moving away from the GOP in the Donald Trump era overwhelmingly receive insurance through their employers—and polls show that the vast majority of them are satisfied with that coverage.