Everyone Wants Health Care Reform. Industry Lobbying Won’t Let Them Have It.

It’s often said that politicians pander to polls. Not so for health care: despite repeated lopsided majorities in polls favoring a public system, leaders in both parties don’t seem to care.

President Joe Biden delivers remarks alongside Vice President Kamala Harris on the Senate's bipartisan infrastructure bill at the White House, 2021. (Kevin Dietsch / Getty Images)

Late last month, a poll conducted by Morning Consult and Politico gauged Americans’ opinions on several health care measures expected to be included in the Democrats’ forthcoming reconciliation bill. Its conclusions were striking: of the six proposed reforms put to respondents, each enjoyed majority support across the electorate with four even eliciting more than 50 percent from Republican voters.

A proposal to add dental, vision, and hearing coverage to Medicare, for example, scored 84 percent in favor (89 percent among Democrats; 79 percent among Republicans). Even less resoundingly popular items like lowering the eligibility age of Medicare to sixty still boasted high levels of support (61 percent overall, with 49 percent of Republican voters in favor).

In other words, there’s considerable buy-in for each proposal across the political spectrum. Why, then, does it seem so hard to imagine any actually passing into law?

At surface, the answer mostly has to do with the confusing and labyrinthine process now unfolding as the White House pursues a bipartisan infrastructure bill alongside another containing the few of things Democrats nominally promised to do if given a mandate. As is typically (and predictably) the case, proposals related to health care, education, and climate change have been relegated to the reconciliation bill even though many are quite popular. Almost by definition given the Democrats’ razor-thin majority and consistently demonstrated ambivalence about digging in around their own stated agenda, this means that measures like those recently polled by Morning Consult/Politico look vastly more precarious than those in the bipartisan infrastructure plan — ironic given their support among voters from both parties.

It’s a dynamic all too familiar to Washington, where the most popular and commonsensical policies tend to be given short shrift while things absolutely no one was asking for (see: “asset recycling”) are the basis for “consensus.”

Indeed, whatever the received wisdom might be about politicians putting polls over principle, it’s breathtaking how out of step with majority opinion the leaderships of the two parties often are. The most obvious and topical example is Medicare For All, which has enjoyed widespread support for years but was near-universally opposed by candidates in the 2020 Democratic primaries and can barely even get a hearing in DC.

The compromise was ostensibly a public option, the alternative embraced by Joe Biden which has tellingly received little mention since he actually took office. It’s now July, and the suite of proposals being discussed is mostly limited to a handful of Medicare reforms, packed into a reconciliation bill with an arguably negligible chance of success despite their overwhelming popularity among Democrats and Republicans alike.

The lesson in all of this is that the inner workings of Beltway lawmaking often operate independently of public opinion: the interests which shape and control the legislative process being able to do so without having to worry much about what the majority wants or thinks. Here, the Medicare reforms currently slated to appear in the Democrats’ reconciliation bill are a good case in point.

Having helped to push Biden’s proposed public option to the sidelines, and more recently spent unfathomable sums to defeat a local version of the idea in Colorado, the Partnership for America’s Health Care Future (PAHCF) — a front for various corporate health care interests including the private insurance racket and Big Pharma — is now working to stop Congress from lowering the age of eligibility for Medicare to sixty. To this end, it’s released a fearmongering report filled with deficit alarmism and taken out a seven-figure ad buy to discredit the idea. While the group, which has extensive ties to the Democratic Party, is not required to disclose donor information, an April report from the Intercept pegged the value of a single contribution from corporate leviathan CVS Health at $5 million.

It’s just one small illustration of the scale on which private interests operate, and the bottomless reserve of cash many have at their disposal to ensure that even modest and popular reforms stand little chance of success in Congress. By way of comparison, PAHCF’s official Facebook page has fewer than thirty-five hundred followers and its daily posts receive little to no engagement. Its Twitter feed is exactly the same, the few replies that it does receive consistently being from people hostile to its mission.

Though it’s admittedly a less than scientific way of measuring things, the spectacle of a multimillion dollar corporate lobbying effort unable to muster even the most perfunctory engagement on social media is a pretty potent metaphor about how America’s lawmaking process typically works. It’s pretty hard to fake grassroots enthusiasm or popular buy-in, especially when the objective is to prevent millions of people from getting things they both urgently want and desperately need.

The point is, with enough cash and lobbying power at your disposal, you don’t have to. Through astroturfed PR offensives, campaign donations, and the various privileges now afforded to dark money by America’s Wild West political financing regime, public opinion can be treated as basically irrelevant — even, and especially, when explicit promises have been made and a clear majority wants something that will imperil industry profiteers’ balance sheets.