Health care does not look to be as central to the 2024 campaign as it was in 2020, when the issue thoroughly dominated the Democratic primary before COVID upended the political world, or in 2016, when the long Republican plot to overturn the Affordable Care Act was centerstage right next to the world-historic issue of Hillary Clinton's private emails. But one thing is for certain—Democrats still have total issue ownership of health care, and the idea that it is going to be a strength next year for former President Donald Trump and the Republicans is so impossible that not even the most delusional person on Earth could believe it before breakfast.
Republicans care about health care like MLB commissioner Rob Manfred cares about keeping baseball in the city of Oakland. They might talk a good game, but ultimately, they are going to follow the money trail straight to the headquarters of the insurance companies who have created this country's mind-numbingly stupid health care system. You don't have to go very far back in history to see that this is the case—under Trump, the GOP got the keys to the health care debate in 2017 and decided not to drive the car anywhere except into a deep ditch they dug for themselves.
During the 2016 campaign, Trump made big, vague promises on health care that predictably went nowhere. "Everybody's going to be taken care of much better than they're taken care of now," he would say while promising to "repeal and replace" the Affordable Care Act. Yet neither Trump nor his congressional allies, despite having years to plan for it, had any earthly idea of what they would replace the ACA with other than a hodgepodge of half-baked ideas and some limp tinkering around the margins, and it turned out that the public was uninterested in returning to the pre-Obama regulatory environment. After several legendary and humiliating attempts to repeal Obamacare, Republicans simply gave up and moved on to other things, like convincing several hundred thousand of their most devoted followers to die needlessly of COVID rather than get a free vaccine.
"We're going make it legal to discriminate against sick people again! USA! USA!" wasn't quite the stirring battle cry they thought it would be. And it's a steep hill to climb, but health policy is probably the least serious intellectual redoubt of conservatism, an area that MAGA dittoheads won't touch because it requires hard-earned expertise and seriousness rather than media stunts and name-calling. It's also a policy area where traditional Republican nostrums about the magic of the free market are a particularly tough sell.
More to the point, we can be certain that health care isn't a top priority because that's what Trump and his rivals are telling us in word and deed. There are five lines about health care on Trump's campaign website, including this masterpiece which represents the sum total of his promises: "He will stop all COVID mandates and restore medical freedom, end surprise medical billing, increase fairness through price transparency, and further reduce the cost of prescription drugs and health insurance premiums."
As always with Trump, this is a combination of things that Democrats already want to do (like ending surprise billing) and ill-defined goals in search of a policy plan. How does one "restore medical freedom?" Is there something they could bomb that would achieve this lofty goal, or a book about it that Ron DeSantis could ban in Florida? There isn't even a rudimentary outline of what Republicans would do if they scored the presidency and both chambers of Congress next year. They are literally leaving it to voters' imaginations and hoping that they fill in that blank slate with vibes. Even DeSantis, Trump's leading rival, has nothing about health care on his web site and never talks about it except in the context of banning gender-affirming care.
This continues a long historical trend of Democrats being the only one of our two major parties to ever be interested in or do anything about health care. Democrats created Medicare and Medicaid. Under Bill Clinton, Democrats created the Child Health Insurance Program (CHIP). Under Barack Obama, Democrats passed a sweeping health reform law that banned discrimination against people with pre-existing conditions, expanded Medicaid coverage, placed caps on out-of-pocket expenses, offered new coverage options for young adults and created marketplaces for lower-cost health insurance. The list of Republican legislative achievements related to health care could fit on the top fifth of a single piece of paper and even that would be a stretch since only a single word is required: "nothing."
Were these Democratic ideas perfect? No, they were not. Do today's Democrats agree on exactly what should be done to rein in health care costs? Also no. President Biden campaigned on and continues to support a public health insurance option and lowering the Medicare eligibility age, which fits best with the landscape of public opinion that wants the federal government to guarantee health insurance for individuals without necessarily staging a complete takeover of the system. Other leading Democrats want to pursue more foundational reform under the rubric of "Medicare for All."
Either way, Democrats are the only ones seriously debating health care, and that's not going to change heading into next year, especially when GOP elites are thoroughly consumed with their culture war hysteria and rank-and-file Republicans are more interested in keeping vaccines out of their children than in keeping people alive. Good news for Republicans though: if they like their health policy incoherence, they can keep it, and by all accounts they will.
David Faris is an associate professor of political science at Roosevelt University and the author of It's Time to Fight Dirty: How Democrats Can Build a Lasting Majority in American Politics. His writing has appeared in The Week, The Washington Post, The New Republic, Washington Monthly and more. You can find him on Twitter @davidmfaris.
The views expressed in this article are the writer's own.
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
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21.11.2023
Health care does not look to be as central to the 2024 campaign as it was in 2020, when the issue thoroughly dominated the Democratic primary before COVID upended the political world, or in 2016, when the long Republican plot to overturn the Affordable Care Act was centerstage right next to the world-historic issue of Hillary Clinton's private emails. But one thing is for certain—Democrats still have total issue ownership of health care, and the idea that it is going to be a strength next year for former President Donald Trump and the Republicans is so impossible that not even the most delusional person on Earth could believe it before breakfast.
Republicans care about health care like MLB commissioner Rob Manfred cares about keeping baseball in the city of Oakland. They might talk a good game, but ultimately, they are going to follow the money trail straight to the headquarters of the insurance companies who have created this country's mind-numbingly stupid health care system. You don't have to go very far back in history to see that this is the case—under Trump, the GOP got the keys to the health care debate in 2017 and decided not to drive the car anywhere except into a deep ditch they dug for themselves.
During the 2016 campaign, Trump made big, vague promises on health care that predictably went nowhere. "Everybody's going to be taken care of much better than they're taken care of now," he would say while promising to "repeal and replace" the Affordable Care Act. Yet neither Trump nor his congressional allies, despite having years........
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