The latest CNN poll is out (1-10-20) and shows a change in the rankings of the top four Democratic primary candidates, not surprising. Certainly, rankings will change yet again.

  Among the four, healthcare will be a big issue, maybe the major issue, in both the primaries (and the general election when facing Trump). Democratic primary voters … most left of center … are facing a major dilemma: vote for real change candidates (Warren, Sanders) supporting Medicare for All or for possibly more electable moderate candidates saying just expand Obamacare /ACA (Biden, Mayor Pete, other moderates).

  Obama once stated (as an Illinois State Senator) that Medicare for All was the optimum solution. He was correct for many reasons, including universal coverage. Private insurance has 12% overhead versus Medicare’s 2%; savings could go to direct patient care. Plus, hospitals and physicians’ offices waste time and money fooling with dozens of private insurance companies, all with different reimbursement policies.

  In 2009, President Obama faced a perplexing decision: push single payer … or try something else covering less than half of the uninsured, leaving tens of millions without coverage. But, even with the Dems controlling Congress and the Presidency, getting single payer past Dem conservatives (like Lieberman with financial ties to the insurance lobby) would have been nearly impossible.

  So, Obama went for second place (the ACA, the sure win) versus going for a gold medal (Medicare for All). He purposefully based the ACA on the conservative Heritage Institute inspired Romneycare in Mass., thinking that by using private insurance and a Republican expansion model, the GOP would support it.

  He was ridiculously naive; the GOP was dedicated to voting against Obama, no matter what he presented. And, then lie to the public, making Obamacare “the” 2010 campaign issue.

  Obamacare lost the Dems their majority, due to both: a. an impressive GOP opposition strategy and b. extremely poor marketing of the ACA concept and implementation by the party and the government. However, the ACA has made an amazing comeback as people eventually figured out its considerable benefits. The American people now widely support it.

  The same could happen with Medicare for All if the Dems win the Presidency, the House and the Senate in 2020. The GOP will continue to lie, saying Medicare for All is “socialism” and people with private insurance will lose their physicians and hospitals to “government-controlled healthcare.” Unless the Dems could unite and sell single payer, which they still seem reluctant to do, they could again lose the House and Senate in 2022.

  Because of the lack of a coherent healthcare stand, the percentage of all Americans supporting healthcare for all Americans has already dropped to 53% from 60% a year ago (Pew, 7-26-19). The Democrats must show a united front now on Medicare for All if they want change.

  Democrats still believe in government, with 78% saying it’s government’s responsibility to cover everyone. (Note that a large proportion, 34% of 78%, of these Dems still believe in a mixed public/private system, as in current Medicare).

  The majority of Democrats under 50 do believe in Medicare for All, single payer. So do 57% of liberals, as opposed to just 33% of conservatives/moderates. Motivated liberals could win elections, or stay home, as they did with corporate candidate Hillary.

  GOP supporters (76%) clearly don’t want government making sure that everyone has insurance, but 64% of the 76% do support Medicare/Medicaid.

  The Dems will not get these voters anyway, although with single payer there will still be the same private delivery system that currently exists. High deductible plans (increasingly used to lower employer costs) will be gone, helping the average citizen. Thirty million people, most working now but without healthcare benefits, would get insurance. As in the case with the ACA, the public would come around once these benefits were realized. The Dems would eventually end up on top, much stronger than they are currently.

  So, that’s the Dem dilemma. Vote for progressive folks who will do the right thing for the long term but might hurt the Democratic Party in the short term. Or, vote for the moderates who might have a better chance of getting elected via swing state wins, but will do little to obtain needed change, hurting the Party in the longer term. We will just have to wait and see.