The most hotly debated policy in the Democratic presidential primary is “Medicare for All” ― a plan to move all Americans onto a single, government-run health insurance plan.
But while proponents of single-payer health care like presidential hopefuls Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) have had the chance to make their case on the debate stage, the opponents of the idea are vastly outspending them on the airwaves in early caucus and primary states.
The Partnership for America’s Health Care Future ― an industry front group representing private health insurers, hospitals and pharmaceutical companies ― has spent at least $1 million in television advertisements blasting the policy in Iowa alone. (It is also ghost-writing anti-Medicare for All op-eds for state lawmakers, according to a Washington Post report.)
A typical 30-second spot, “Same Thing,” depicts a diverse group of ordinary Americans musing about how they prefer to pick their own health insurance plan ― and dismissing the idea of even a public health insurance option.
“Politicians may call it ‘Medicare for All,’ ‘Medicare buy-in,’ or even a public option,” a male actor walking down the street says.
“But they mean the same thing: higher taxes or higher premiums,” a woman carrying bags of groceries adds.
Republican allies of the private health care industry have rushed in to supplement big business’ direct spending.
In June, One Nation, a super PAC tied to Senate Majority Leader Mitch McConnell, announced a $4-million TV, radio and digital advertising campaign blasting Medicare for All. A 30-second TV ad produced by the group features Americans holding signs with the length of hypothetical wait times for medical procedures under a single-payer system as a narrator intones ominously about the bleak future awaiting the country if Medicare for All proponents succeed.
One Nation’s president, former McConnell chief of staff Steven Law, has said that he plans to ramp up the group’s spending as the election progresses. Law confirmed to HuffPost by email that the ad campaign is national, but noted that the super PAC also aired state-specific ads in Iowa, Arizona and North Carolina in August.
The spending against Medicare for All has not been matched by any progressive outside groups, according to a Democratic operative tracking national and state-level media ad buys.
“Someone needs to go into Iowa and answer those ads.”
- Progressive member of Congress
“Someone needs to go into Iowa and answer those ads,” said a progressive member of Congress who requested anonymity to speak freely. “We win the argument when we talk about people dying and people going bankrupt because of the insurance greed and pharmaceuticals.”
Advocates of Medicare for All can take heart in the fact that the advertisements, thus far, appear to have had a limited impact on national public opinion. Notwithstanding the assault on the policy, Medicare for All maintains net favorability in national polling, even when voters learn that it entails giving up their private health insurance. (The creation of a public option ― a policy backed by former Vice President Joe Biden, South Bend, Indiana, Mayor Pete Buttigieg, Sens. Amy Klobuchar of Minnesota and Michael Bennet of Colorado ― is even more popular.)
But some progressives worry that the ad spending is making Medicare for All less appealing to voters in the early primary states, which could diminish its political brand for years to come.
The progressive member of Congress called it a “one-sided assault.”
The independent spending gap is particularly worrisome for progressives because some of the moderate Democratic presidential candidates are also marshaling their resources to blast Medicare for All.
Buttigieg has funded at least three advertisements that highlight his opposition to the policy and make the case for preserving “choice” in the health care system.
The campaign spent just over $200,000 to air one of those ads ― a 30-second spot called “Refreshing” ― 639 times in Iowa in the last two weeks of November, according to data obtained by FiveThirtyEight.
“We have to have people have the choice to keep their private health insurance or to go on to the Medicare plan,” a voter named Michelle says.
Since he began going on the air in a significant way in August, Buttigieg has spent over $7.5 million on TV ads in Iowa and another $1.4 million in New Hampshire, according to data obtained by HuffPost.
Given the available information, it is not clear how much of that money was spent on ads depicting Medicare for All unfavorably. But if he spent a similar amount on that ad and one or two of the others over the course of December, the total could easily top $1 million.
Meanwhile Warren and Sanders, the latter of whom discusses Medicare for All at length on the stump, have mostly chosen to highlight other themes in their paid advertisements. Sanders mentions Medicare for All briefly in an ad about his history fighting for progressive policies, and another about his plans to fight corruption.
A 1-minute spot that Warren ran in Iowa touting her commitment to rooting out corruption does not mention Medicare for All. Another Warren ad in Iowa publicizes her plan to increase monthly Social Security benefits by $200.
But rivaling the anti-Medicare for All forces’ presence on the airwaves is a tall order, not least because the universe of organizations actively lobbying for the policy is small and financially limited.
Business for Medicare for All, a small nonprofit founded by insurance industry whistleblower-turned-single payer activist Wendell Potter and backed by sympathetic business-people, engages in public education about the business benefits of Medicare for All.
Over the summer, Potter formed an affiliated political action arm called Medicare for All Now, and subsequently tapped former Delaware Senate candidate Kerri Harris to lead it. The group, which is structured to spend major sums in elections, is still in the process of building up its email fundraising list. The group’s small research team nonetheless performed public records requests that enabled the Washington Post to report on the Partnership for America’s Health Care Future’s ghostwriting scheme.
Another pillar of the single-payer community, Physicians for a National Health Program, serves a similar role to Business for Medicare for All as a source of research and public advocacy.
And the Democratic Socialists of America, a decentralized organization whose priorities and tactics vary from chapter to chapter, conducts local canvassing to mobilize people behind Medicare for All and elect a select number of politicians who support it.
But in a world where the health care industry and its Republican allies are blanketing the airwaves with advertising lambasting Medicare for All, there is clearly room for a televised message defending it.
The one pro-single-payer group with the resources to spend money on television is the National Nurses United labor union. The progressive union, which, per public records, has over 140,000 dues-paying members and annual revenues over $15 million, is consistently the loudest and most deep-pocketed proponent of Medicare for All.
In the 2016 election, the union unsuccessfully invested over $800,000 in independent spending in the hopes of making Sanders the Democratic presidential nominee.
But while the union endorsed Sanders in mid-November, it has not given any indication that it will spend money on his behalf.
When HuffPost asked for details about NNU’s Medicare for All strategy, union spokesman Chuck Idelson pointed to the power of NNU’s membership and field operation.
“Literally, people power, tens of thousands of boots on the ground, having deep conversations with everyday people about how our broken health care system has failed them and their families, garnering their support for Medicare for All and getting them to join us in our fight ― that is our philosophy of organizing for social change to take on the enormity of the challenges we face as a society,” Idelson said in a statement.
Of course, canvassing has its limits, particularly for a union heavily concentrated in California, rather than Iowa and other states that have been barraged by industry advertising. The union boasted in late June that it had knocked on 20,000 doors nationwide to spread the gospel of Medicare for All. For a point of comparison, the Sanders campaign knocked on 32,000 doors in Iowa alone on a single, snowy weekend in mid-December.
Pressed on what kind of money NNU was prepared to spend in its pro-Medicare for All efforts, and whether those efforts might include TV advertising, Idelson stuck to a broad description of their work.
“The national grassroots campaign is fueled by all volunteers across the country,” he said. “The patients, the nurses and our allies are our resources.”