Keeping the Democratic party honest on health care

The Democratic party establishment tries to walk a tightrope. Their party base favors a whole slew of progressive measures. But the party hierarchy consists of either members of the oligarchy or people who are beholden and enamored of it. So they end up saying one thing publicly and another privately to their wealthy donors. We are seeing this now with the idea of Medicare For All as a means of providing universal health coverage. What was portrayed as utterly radical when Bernie Sanders proposed it during the 2016 campaign has caught fire within the party within an incredibly short time, so much so that every single Democrat who has announced a run for the presidency this year has expressed support for it, a remarkable turnaround.

But Ryan Grim says that the The Intercept has obtained slides from a presentation that a top aide to Nancy Pelosi gave to health insurance executives from Blue Cross Blue Shield on December 4th, an industry that would be hugely affected by Medicare For All.

LESS THAN A month after Democrats — many of them running on “Medicare for All” — won back control of the House of Representatives in November, the top health policy aide to then-prospective House Speaker Nancy Pelosi met with Blue Cross Blue Shield executives and assured them that party leadership had strong reservations about single-payer health care and was more focused on lowering drug prices, according to sources familiar with the meeting.

Pelosi adviser Wendell Primus detailed five objections to Medicare for All and said that Democrats would be allies to the insurance industry in the fight against single-payer health care. Primus pitched the insurers on supporting Democrats on efforts to shrink drug prices, specifically by backing a number of measures that the pharmaceutical lobby is opposing.

Primus, in a slide presentation obtained by The Intercept, criticized single payer on the basis of cost (“Monies are needed for other priorities”), opposition (“Stakeholders are against; Creates winners and losers”), and “implementation challenges.”

Grim shows the slides that they recreated so that source of the leak would be protected. Grim says that the Pelosi strategy seems to be to try and work with the health insurance industry against Big Pharma to reduce drug prices, something that they can agree on.

At the briefing, Primus mentioned three avenues that Pelosi, a California Democrat, sees toward lower drug prices, sources said. The first, the CREATES Act, is bipartisan legislation, strongly opposed by Big Pharma, that would make it easier for generic drug companies to get access to a sufficient quantity of medications needed to produce generics.

The second measure addresses what’s known as “pay for delay,” in which a drug company pays a generic manufacturer to not produce a generic version of an expensive drug. Democratic leadership wants to ban that practice. The third revolves around the issue of “evergreening,” which is a pharmaceutical industry practice of extending patent protection for a particular drug through a variety of practices. Democrats want to restrict evergreening to encourage cheaper generics make it to the market faster.

Primus’s approach has a strong political logic to it, as taking on every health care stakeholder at once is arguably more difficult than singling out one industry and hammering away, even if the effort is out of step with where progressive energy is at the moment.

But such short-term tactics should never sacrifice the long-term goal of getting a single payer system. One hopes that the new batch of aggressive young progressive congresspersons who were elected in November will keep the party honest on this issue.


  1. DonDueed says

    It seems to me that the Medicare for All model has a built-in role for the existing insurance industry. Actual Medicare (as opposed to a true single-payer system) has coverage gaps, copays, and deductibles that are currently covered through “Medicare Advantage” and “Medicare Supplement” plans from those very insurance companies.

    As a bridge to a more comprehensive single-payer system, Congress could literally extend Medicare to all citizens, along with its existing gaps, leaving a role for the insurance companies and for employers to offer such plans as hiring incentives. While it wouldn’t provide true socialized health care, it would be a far easier sell to lawmakers and the insurance industry (though still a major challenge).

  2. Don F says

    I was lucky enough to marry a woman who served in the National Guard long enough that she was eligible to sign up for Tri Care when she retired, and to declare me as her dependent. Now I have Medicare and with the Tri Care as supplemental, I have the best healthcare coverage I’ve ever had. I see NO reason why everyone in the US, regardless of age or military service shouldn’t be under the same umbrella.

  3. Dunc says

    Grim says that the Pelosi strategy seems to be to try and work with the health insurance industry against Big Pharma to reduce drug prices, something that they can agree on.

    Possibly, but I wouldn’t rule out the possibility that they’re saying something different again to the pharma industry…

  4. Kevin Dugan says

    One of the biggest attractions and advantages of a single-payer system is that is streamlines away all the forms, interfaces, copays, insurers, insurance law, billing, collections and other expensive hassle of dealing with a very complex multi-insurer system, both for the consumers and the health-care providers. Let the health insurance industry die, or at least be constrained to policies that cover un-health-related cosmetic or pseudoscientific treatment modalities. Settling for anything less than full single-payer feels to me like shooting myself in the foot and drenching it with salty alcohol.

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