Running for office in 2012, Massachusetts U.S. Sen. Elizabeth Warren did not want to talk about single-payer health care.
Asked multiple times whether she supported single-payer, Warren responded that she was focused on keeping the Affordable Care Act in place.
Fast forward to 2017. Warren, a leader in progressive Democratic politics, recently emailed supporters announcing her intention to co-sponsor a single-payer bill introduced by U.S. Sen. Bernie Sanders, I-Vt.
“Medicare for All is one way that we can give every single person in the country access to high quality health care,” Warren wrote.
Warren is not alone. A growing number of progressive Democrats have recently thrown their support behind single-payer health care, in what appears to be a major shift in Democratic Party orthodoxy.
“It appears there’s more of a sense, particularly among the Democratic officeholders looking to run for higher office, that this is where the base of the Democratic Party is at now, and it’s important to stay in step if they want to move forward,” said John McDonough, professor of public health practice at the Harvard T.H. Chan School of Public Health. McDonough worked on developing the Affordable Care Act as a senior adviser to a U.S. Senate committee and helped pass the 2006 health care overhaul in Massachusetts.
The idea of single-payer care — essentially a national health system run by government — has been around for decades. Sanders has introduced his bill many times before, and the late U.S. Sen. Ted Kennedy, D-Mass., also advocated for single-payer health care.
But never before has Sanders had 16 of his Senate colleagues introducing the bill with him — including high-profile Democrats and potential 2020 presidential contenders such as Warren, New Jersey Sen. Cory Booker and New York Sen. Kirsten Gillibrand. U.S. Sen. Ed Markey, D-Mass., also signed on.
There is also growing support for single-payer health care among Massachusetts Democrats. In the state Legislature, bills to establish “Medicare for All” this session have support from 11 senators and more than 40 representatives. A similar bill in the 2011-12 session had 32 cosponsors between both branches.
State Sen. Jamie Eldridge, D-Acton, the bill’s lead sponsor, credited a liberal group of newly elected lawmakers as well as more grassroots advocacy from Sanders supporters and progressive groups like the Berkshire Democratic Brigades.
“When Bernie Sanders ran for president and rolled out his ‘Medicare for All’ bill, that’s added a lot of attention,” Eldridge said. “People are seeing what’s happening at a national level and pushing for state legislation as well.”
Eldridge said despite the passage of health care reforms that expanded coverage in Massachusetts in 2006 and nationally in 2010, a lot of people are still “deeply dissatisfied” with the private health insurance system due to high out-of-pocket costs and denials of coverage for treatment. People are also worried about the potential repeal of the Affordable Care Act.
“The Democratic Party, especially those who are more progressive, are saying we can’t just oppose Donald Trump or oppose Republican ideas, we need to put out positive ideas,” Eldridge said. “I think single-payer is one of those big ideas.”
In interviews, all three of the Democratic candidates who hope to challenge Gov. Charlie Baker in 2018 — Jay Gonzalez, Setti Warren and Bob Massie — said they support single-payer health care.
Gonzalez, the former CEO of health insurer CeltiCare, said he believes a single-payer system would be “simpler and cheaper and better,” citing the “waste and inefficiency” of hospitals having different contracts with multiple insurers.
McDonough said he thinks enthusiasm for Sanders’ presidential campaign contributed to the growing support for single-payer health care among Democrats. Meanwhile, the failure of Republican efforts to repeal and replace the Affordable Care Act may have emboldened liberals.
MIT health economist Jonathan Gruber, an architect of the Affordable Care Act and Massachusetts’ reforms, said Sanders’ presidential campaign focused on big ideas, and he went further than expected challenging Hillary Clinton in the Democratic primary.
“Democrats are saying maybe we need to think bigger than we’ve been thinking,” Gruber said.
Gruber said Democrats are frustrated that Republicans seem unwilling to compromise on health care, so some are moving in a more partisan direction.
There is also a shift in public opinion. A June 2017 poll by the Kaiser Family Foundation found 65 percent of Democrats and 55 percent of independents support single-payer health care — up from 62 percent and 42 percent in 2008-09. Support remains low among Republicans.
But support for single-payer heath care comes with risks.
When single-payer health care appeared on ballots in Colorado and Oregon, voters rejected it. Vermont tried to implement it but failed. Congress will almost certainly be unable to pass single-payer health care given opposition from Republicans and division among Democrats. Discussions of single-payer tend to fall apart around the issue of how to pay for it.
According to Kaiser Family Foundation polling, public support for single-payer shrinks when people are told about the increased taxes needed to pay for it or about criticism that it would give government too much control over health care.
While talk of single-payer could excite the progressive Democratic base, it could also hurt centrists. If single-payer becomes a litmus test for party candidates, some political observers say that could prevent Democrats from building the larger coalition they need to win in swing districts.
U.S. Rep. Richard Neal, D-Springfield, has gotten numerous questions about the topic at events in his district. He continues to say he wants to see how single-payer health care does in individual states before implementing it federally.
McDonough said a focus on single-payer could distract from the work of improving the Affordable Care act, and could create deep divisions in the Democratic Party. “It would be an awfully polarizing issue if there were a serious effort to try to do it in Congress,” McDonough said.
Gruber said the idea of single-payer is “easily attacked” and takes the focus off the failure of the Trump administration to carry out aspects of the Affordable Care Act.