Medicare for All in Trump Country

The case that socialist ideas sunk Democrats in 2020 is undermined by the fact that every single cosponsor of House Progressive Caucus cochair Pramila Jayapal’s 2019 Medicare for All legislation won reelection this year, the only exceptions being lawmakers who retired, died, gave up their seats, or were unseated in primaries.

Seven of these Democratic incumbents were replaced this year by backers of Medicare for All, including the DSA-backed Cori Bush (MO-01) and Jamaal Bowman (NY-16), while four were replaced by Democrats who didn’t support it. One of those is Christy Smith, a self-described “centrist on issues of finance, business and economic issues” who opposes Medicare for All.

With 2 percent of the votes yet to be counted, Smith is currently trailing her GOP opponent by 0.04 points, in a district described by the Cook Political Report as evenly split on partisan lines, and which had been carried by her predecessor and Medicare for All cosponsor Katie Hill by nearly 9 points in 2018.

Critics would point out that most of those cosponsors reside in safe Democratic seats. But in fact, a number won reelection in competitive swing districts.

After flipping the seat in 2018, Matt Cartwright won reelection this year by 3.4 points in Pennsylvania’s 8^th district, which has been represented by a Republican for fourteen of the last twenty years, and has voted for Obama twice before voting for Trump in 2016. He did this despite not just cosponsoring Medicare for All, but going on Fox to make the case for it. Incidentally, the district is also the home of Scranton, the working-class town known as the former home of president-elect Joe Biden, who centered both his primary and general election candidacies on his opposition to the policy.

Likewise, after winning a 2018 special election for an open seat in Pennsylvania’s 7^th district, Susan Wild has now won reelection to the seat for the second time, in a district whose Republican-tilting voting patterns are nearly identical to Pennsylvania’s 8^th. Wild won in spite of being on the receiving end of exactly the kinds of GOP attacks that other Democratic supporters of Medicare for All have been subjected to.

Three of the bill’s cosponsors won reelection in Republican-leaning districts in California this year, too. Josh Harder (CA-10) won by nearly 11 points in a district that’s voted Republican six of the last ten years, Mike Levin (CA-49) won by 6 points in the seat that Republican Darrell Issa held from 2002 to 2018, and Katie Porter (CA-45) won reelection in an Orange County seat that she flipped in 2018 from unbroken Republican control since it was created thirty-seven years ago.

Similarly, their earlier support for the measure and cosponsorship of Jayapal’s bill didn’t doom Jared Golden in Maine’s 2^nd congressional district, which had flipped for Trump in 2016, and which he won again this year; Ann Kirkpatrick in Arizona’s 2^nd congressional district, which has historically voted Republican; nor Peter DeFazio in Oregon’s 4^th district, which Trump had narrowly lost in 2016. (Golden in 2020 backed away from his support for the bill, while Kirkpatrick didn’t run on the measure this year).

Of course, one can also point to steadfast Medicare for All backers who lost elections this year. Kara Eastman lost in Nebraska’s formerly Trump-supporting 2^nd congressional district, and Mike Siegel (TX-10), Julie Oliver (TX-25), and Donna Imam (TX-31) all lost in gerrymandered, Republican-held Texas districts.

But by that same token, one could point to the close but likely losses of Rita Hart (IA-02) and Ben McAdams (UT-04) in districts rated by the Cook Political Report as toss-ups despite their vocal rejection of the policy, as well as the defeat a parade of other Medicare for All–opposing Democrats in other Trump-voting seats, such as Collin Peterson (MN-07, unseated after nearly thirty years), Xochitl Torres Small (NM-02), and Kendra Horn (OK-05). We might also look at the Medicare for All–opposing Democrats who lost in safe Democratic seats this year, such as Donna Shalala and Debbie Mucarsel-Powell in Florida’s Miami-Dade county.

Of course, chalking these losses up to the candidates’ positions on Medicare for All would be absurd, given all the factors involved in any given election. The defeat of vulnerable Democrats in Trump country is hardly surprising in a year that saw massive pro-Trump turnout, while Shalala and Mucarsel-Powell were likely victims of Biden’s decision to ban door-knocking and his resulting underperformance in Miami-Dade — a factor that also hurt Seigel, Oliver, and Imam, as well as other, less progressive down-ballot candidates in Texas.

No Simple Narrative

But, centrists would no doubt reply, what about all the Democrats who won in competitive districts this year after distancing themselves from, or outright disavowing, their earlier support for Medicare for All? That includes Colin Allred (TX-32), Haley Stevens (MI-11), and Golden (ME-02). Surely this points to the political efficacy of dropping the policy, doesn’t it?

It’s a claim that sits in tension with the fact that Allred, Stevens, and Golden all backed the measure in 2018, when they each won their races. It’s also hard to square with the Democrats in competitive seats who backed off their earlier support for the measure and lost this year, such as Jill Schupp (MO-02), T. J. Cox (CA-21), Harley Rouda (CA-48), Gina Ortiz Jones (TX-23), Mitsch Bush (CO-03), Carolyn Long (WA-03), and Cameron Webb (VA-05), whose defeat and Republican ads bashing his support for the program was specifically cited by former CIA spy Abigail Spanberger (VA-07) in her case against progressive politics.

How, if at all, these reversals factored into the candidates’ losses this time is up for debate. Did dropping the policy plank reduce grassroots enthusiasm for the campaigns? Did the flip-flop engender voter resentment for appearing phony or waffly, as with Webb, who as late as June this year called Medicare for All “the most equitable and just version of health care” before opposing it? Or were there other problems with the candidates themselves?

The latter was certainly the case with Sri Kulkarni, who lost the race for Texas’ 22^nd district by 7 points as of the time of writing. Kulkarni had dropped Medicare for All as an issue since first running in 2018, but perhaps more importantly for some voters in his district, his arrest for possession of cocaine when he was eighteen and more recent attendance at the Burning Man festival became an issue in the campaign.

Kulkarni also alienated some crucial constituencies thanks to his ties to Hindu nationalists. Perhaps this explains why the more progressive, Medicare for All–supporting Siegel performed about the same (ever so slightly better, in fact) in his Texas race, despite spending half of what Kulkarni had.

Centrists can blame GOP attack ads that falsely tied Democrats to progressive policies they didn’t actually support. But then why didn’t such attacks work to sink anti–Medicare for All Democrats like Stevens, Spanberger, Dean Phillips (MI-03), Cindy Axne (IA-03), and Elaine Luria (VA-02), all of whom were reelected? In fact, if we’re supposed to believe Republicans managed to fool voters that the candidates who lost backed Medicare for All, then why shouldn’t we believe that voters reelected other centrists after being tricked into believing they actually backed the popular policy?

Resisting their Constituents

For all the claims that Democrats in swing districts were forced to fend off enraged constituents demanding their representatives deny them health care, there’s significant evidence that the opposite was in fact the case.

Abby Finkenauer (IA-01), who was unseated this year, resisted a grassroots pressure campaign pushing her to embrace Medicare for All. In New York’s 11^th district, now-former Rep. Max Rose faced questioning from residents at a town hall over his refusal to back the policy, and even faced a primary challenge from a constituent who had worked to get him elected in 2018 and was now disappointed he refused to back progressive legislation.

Joe Cunningham, who lost by 1.2 points in his South Carolina district this year, repeatedly faced challenge from constituents drowning in the country’s abysmal health care system, including a teenager with cystic fibrosis, and a father spending $20,000 on his family’s health care. (“I don’t want insurance, I want health care,” one of his constituents told him. “The money goes from working peoples’ pockets into corporations’ pockets”).

These Democratic incumbents didn’t always lose. Rep. Andy Kim (NJ-03) won reelection with a nearly 9-point lead, despite repeatedly rebuffing pressure from constituents and pressure groups to back Medicare for All, including protests demanding his support.

Ron Kind (WI-03) similarly faced pressure from local unions as well as constituents calling for single-payer who filled his listening sessions. One told him about a $30,000 bill he got after suffering a concussion from falling on ice, while several local doctors tried to explain to Kind the superiority of such a system, and another pointed to the fact that insurers made up some of Kind’s top donors.

And while Haley Stevens backed away from her earlier support for Medicare for All, her stance contradicted her own state party, 98 percent of whose delegates voted in September to make Medicare for All part of their platform.

But perhaps most glaring is recently reelected Rep. Conor Lamb (PA-17), who has become something of a figurehead for the party conservatives’ media campaign against progressives. Despite telling the New York Times last week that “people are not clamoring for” single-payer health care, Lamb has repeatedly faced pressure from constituents to support such a policy. At a 2019 town hall, he was met with “call after call for a single-payer health care or Medicare-for-all system,” according to a local report, fending them off by claiming it would be impossible to afford and refusing to “support a big middle-class tax increase.”

A few months later, Lamb again braved challenge from irate constituents, many of them the kind of liberal suburbanites not known for typically agitating for left-wing causes, disappointed with Congress’ lack of movement on progressive priorities. When a nurse urged him to sign on to the Medicare for All bill, Lamb insisted most people in the district were “pretty happy” with their insurance. (Lamb’s second biggest donor is the University of Pittsburgh Medical Center, a notoriously abusive and powerful health care monopoly that dominates Pittsburgh and Allegheny County, parts of which are located in his district).

It’s also difficult to know how having a candidate at the top of the ticket who spent the past two years launching dishonest broadsides against Medicare for All and other progressive policies hurt candidates down-ballot who ran on such platforms. Both pro-single-payer candidates — like Dana Balter (NY-24), Jon Hoadley (MI-06), and Eastman — and anti-single-payer candidates — like Mucarsel-Powell and Schupp — had Biden’s misleading attacks on Medicare for All recycled by their Republican challengers in attack ads and campaign rhetoric. Meanwhile, as Mike Siegel told Ryan Grim:

Imagine we had a candidate for president who for 10-12 months is talking nonstop about fundamental economic change. That’s what it takes. And that’s where the Democratic establishment, which to some extent supported me, although not as strongly as they could have, they’re not talking about that, because we’re too invested in conservative donors who don’t want us to say that.

And if centrists are going to chalk the 2020 electoral failure up to one policy, it’s hard to see why it makes more sense to point the finger at one that polls consistently well versus one that has been consistently unpopular, like trying to impeach and remove Trump over what came to be known as “Ukrainegate.”

At the time, both anecdotal evidence and numerous polls showed impeachment could be, as CNN put it, “an electoral loser for Democrats” in swing states. It may very well be that the party’s push for it proved particularly harmful to incumbents in Trump-friendly districts.

Ironically, that divisive policy was pushed at the time by the same party members, like Spanberger and fellow CIA alum Elissa Slotkin (MI-08), who have spent the aftermath of the election blaming the Left for Democrats’ losses.

In a high-profile, public relations press release at the time, Slotkin, Spanberger, and three other conservatives took credit for launching the impeachment inquiry against Trump, nicknaming themselves “the Badasses” in an attempt to brand themselves as a right-wing version of the better-known “Squad.” When the impeachment they pushed proved a political miscalculation, sending Trump’s approval rating to an all-time high, their role and the entire branding exercise was swiftly memory-holed.

Was impeachment the ultimate factor that decided this year’s election results? Certainly not. Yet it is telling what parts of recent political history the Democratic Party’s corporate wing chooses to forget, and which it chooses to stress.

The Blame Game

An analysis of the Democrats’ down-ballot performance neither proves Medicare for All was the electoral poison its opponents claim it was, nor that it was an automatic electoral slam dunk. There is enough evidence to craft whatever narrative one wants.

For Democratic centrists, that’s meant the familiar act of blaming anyone else, particularly the Left, for the failure of a campaign crafted and led by the party’s conservative members, and one that provides an excuse to shift further right in response.

Since the Obama era, the party has been decimated at the state level, lost control of Congress, and run the same style of presidential campaign twice against the same corrupt, buffoonish monster, with very nearly the same failed result both times. Somehow, none of it has ever been the fault of the people actually in charge of the party.

There is no evidence Medicare for All and other class-based, bread-and-butter policies advocated for by the Left dragged down the party’s performance this election. But Democratic centrists have never let evidence stand in the way of blaming the Left for their own failures.