Health 202: Medicare for all is new Democratic mantra in congressional races

When Kara Eastman, a social worker and professed progressive advocate, decided to run for Congress in a lean-red district in a deep-red state, she was driven by her mother's exorbitant medical bills for her cancer treatment.

Her mother died before she could see her 46-year-old daughter canvass Nebraska's 2nd Congressional District advocating for "Medicare for all," the latest catchall term for government-provided health care that is catching on in congressional races across the country, dividing Democrats from each other but also shaping the terms of a new health-care debate for 2018.

In her race, Eastman pressed for a single-payer system in which everyone would get health care paid for by the government, while her opponent, Brad Ashford, D, a well-known former congressman who lost his seat in 2016 and was trying to win it back, called that impractical and said the more politically reasonable approach was a public option in which Americans could opt to buy in to Medicare.

With her Bernie Sanders-esque platform, Eastman ultimately overtook party establishment-pick Ashford in a shocking upset and in November will face incumbent Rep. Don Bacon, R, who is slightly favored in a tough race.

Successes such as Eastman's are occurring in Democratic primaries across the country. And unlike Alexandria Ocasio-Cortez, the overnight political sensation who bested 10-term incumbent Rep. Joe Crowley in last month's Democratic primary in New York - which basically secured her a seat in Congress in the solidly blue district - progressives are winning in conservative parts of the country, too.

They're motivated by Sanders's insurgent run against Hillary Clinton in 2016. They're motivated to be as diametrically opposed to President Donald Trump as possible. They're even motivated by the tea party.

"I think there's still a divide on the way back to power, the way back to a majority, but I think we are seeing a push to the left and a thinking that drawing a sharp contrast with the GOP is a better strategy than trying to beat them in the middle with a moderate message,"said Nathan Gonzales, a longtime elections analyst. "I think there could also be some envy of the tea party in pulling the party to the right by not compromising and standing on their principle and seeing the GOP still gain power."

Using the popular Medicare program to sell a more expansive government-health care system is a newer strategy and hasn't yet been road tested in a general election. But it's received so much traction on Capitol Hill and the campaign trail that Buzzfeed put it best when describing it as having "the potential to become a new litmus test for the Democratic Party."

Of the 57 Democrats, like Eastman, who have won primaries and will challenge GOP incumbents in swing districts this fall, 33 support some form of Medicare for all, according to data from the Progressive Change Campaign Committee (PCCC). Nearly two-thirds of that group use the term in their campaign materials and just over a quarter are running in districts that Trump won.

For Adam Green, co-founder of the PCCC, there is no Medicare for all purity test. There are many Democrats who aren't the entire way there on a single-payer system, and use the term Medicare for all to mean a public option, where Americans of all ages can buy into the program that is now limited to people over 65.

"Right now, we very much see a Medicare-for-all option as the floor and Medicare-for-all single payer as the ceiling," Green said. "We want to make clear every Democrat can support some version and not shoot themselves in the foot by forfeiting that golden language."

Public polling on some form of Medicare for everyone has already shown widespread support. A whooping 75 percent of Americans support Medicare becoming an option for any American who wants it, according to a Kaiser Family Foundation survey, and more than half are in support of a single government health-care program.

High-profile Democrats, including several likely to make a bid for the White House in 2020, are signing on to the various Medicare-for-all bills being introduced in Congress. Unsurprisingly, Sanders, I-Vt., has the most ambitious version, which would essentially turn Medicare into America's national health-care system. Possible presidential hopefuls, Democratic Sens. Elizabeth Warren of Massachusetts, Kirsten Gillibrand of New York, Cory Booker of New Jersey and Kamala Harris of California, have signed on as co-sponsors.

Other senators have versions that make Medicare available as an alternative to private insurance. Sens. Chris Murphy, D-Conn., and Jeff Merkley, D-Ore., have a bill to allow anyone, regardless of age, to choose Medicare coverage. Sens. Tim Kaine, D-Va., and Michael Bennet, D-Colo., have one called "MedicareX" that would roll out such a program slowly in areas without many insurance options. Bennet recently referred to such an effort as "more doable."

Eric Patashnik, a professor of public policy at Brown University and the editor of the Journal of Health Politics, Policy and Law, told me in an email that the political viability of Medicare for all will ultimately depend on its details.

"Some Medicare for all proposals would shift all Americans into a single, government-financed program and eliminate the private-insurance system," he said. "These proposals would require a massive increase in taxes. Many people would be fearful of giving up their existing coverage, and conservatives will inevitably argue that a federally financed plan will lead to rationing."

To Patashnik's point, GOP Sen. Bill Cassidy of Louisiana responded to Bennet's proposal to expand Medicare by simply saying, "Medicare for all would be Medicare for none."

Democrats have long been plagued by their inability to succinctly sell their policies. While Republicans can distill their platform to a few repeated words without offering more specifics, such as "repeal and replace Obamacare," Democrats tend to get lost in the weeds. (Everyone remembers former President Bill Clinton's winding lecture on health policy at the 2012 DNC convention that earned him the moniker "Secretary of Explaining Stuff.")

Wrapping the Democrats' health-care message into a simple "Medicare-for-all" package is an effort to play that game, and Green hopes candidates don't get bogged down in wonky semantics.

"There's no more popular brand in American politics than Medicare. Republican grandparents like their Medicare as much as Democrats do," Green said. "It's political gold."