On July 30 and 31, the Democratic presidential hopefuls will face off in the second round of debates in this election cycle, and Medicare for All may once again be a theme of the night.
Support for single-payer Medicare for All, a program that would eliminate private health insurance by expanding Medicare to cover all Americans, has become something of a litmus test for the 2020 Democrats. Medicare for All is an incredibly popular position across the political spectrum. Many candidates, however, have attempted to stake out a position somewhere between opposing it and wholly endorsing it.
All 20 candidates at the June debates were asked to raise their hands if they supported a Medicare for All plan that would eliminate private health insurance. Only four of them did: Bernie Sanders, Elizabeth Warren, Kamala Harris and Bill de Blasio. The next day, Harris backtracked, claiming to have misunderstood the question.
The candidates who kept their hands down rushed to explain and stipulate. Pete Buttigieg expressed his support for “Medicare for All who want it,” a plan which would allow Americans to buy into a program with, as he called it, the “flavor” of Medicare. Joe Biden echoed Buttigieg’s support for a public option that would include a “Medicare-like” plan. When Beto O’Rourke said that he, too, prefers a public option to a single-payer program, de Blasio cut in. “Why,” he demanded, “are you defending private insurance?”
It’s a question worth asking. Over half of Americans support single-payer healthcare — one poll even cites a 70% approval rating for Medicare for All. In 2018, a Gallup poll found that healthcare is among the most important issues for voters, a statistic that indicates widespread dissatisfaction with America’s current healthcare system. With demand for Medicare for All so high, Democratic hopefuls are loath to stick to the status quo on healthcare. So why are candidates, including several who co-sponsored Sanders’ Medicare for All bill in the Senate, hesitant to endorse true single-payer healthcare? Of course, there may be a factor besides personal conviction and constituent opinion: money. Several big-donor industries have a lot to lose from Medicare for All.
The health insurance and pharmaceutical industries spend large amounts to ensure political influence. During the 2016 election cycle, healthcare insurance giant Blue Cross Blue Shield shelled out over $25 million on lobbying and more than $9.6 million on political contributions (about $8.2 million from their PACs and other affiliated organizations, and $1.4 million from company employees). Pfizer, one of the world’s largest pharmaceutical companies, spent nearly $9.9 million on lobbying and $2.9 million on contributions ($1.98 million from PACs and organizations, and $892K from employees). For both companies, the top two recipients of political contributions were Hillary Clinton’s presidential campaign and House Speaker Paul Ryan’s congressional reelection.
Both industries have been central to the fight against Medicare for All. Last summer, health insurers, pharmaceutical companies and private hospitals teamed up to create the Partnership for America’s Healthcare Future (PAHCF), an organization dedicated almost entirely to killing Medicare for All. Over the past year, members of PAHCF have lobbied Congress members and spent thousands on online ads to reduce support for Medicare for All among voters and politicians. According to data from the Center for Responsive Politics, the members of PAHCF spent a total of over $143 million on lobbying in 2018.
But it appears that even before PAHCF was founded, the health insurance industry was alarmed by the growing momentum of Medicare for All. In 2017, MapLight and Pacific Standard revealed that Senators who opposed Sanders’ bill received, on average, double the amount of money from the health insurance industry as did those who supported the bill.
Sanders seems to believe that healthcare industry money may be influencing his 2020 opponents as well. At the end of a speech on July 17th about Medicare For All, he pledged to reject all contributions over $200 from the pharmaceutical and health insurance industries, and called on his opponents to do the same. His pledge encompasses donations from PACs, lobbyists, and high-ranking executives. The healthcare industry, he argued, has been “able to control the political process.”
Earlier this month, OpenSecrets investigated which 2020 candidates received the most money from health insurance and pharmaceutical companies. In These Times also teamed up with researchers from The People’s Lobby’s Fair Elections Task Force, a community organization fighting for campaign finance reform in Chicago, to gather more specific data on individual contributions. For now, health insurance and pharmaceutical PACs have steered clear of the 2020 Democratic field, but many of the industry’s high-ranking employees have already begun to chip in. According to OpenSecrets’ research, the leading candidates who oppose eliminating private insurance have received larger contributions from health insurance and pharmaceutical executives than the candidates who fully support single-payer healthcare.
OpenSecrets’ research shows that of the candidates polling in the top five (Biden, Sanders, Warren, Harris, and Buttigieg), Biden has received the most money from health insurance and pharma employees, and Sanders has received the least. At $97,453, Joe Biden accepted almost three times more money than Bernie Sanders ($36,728). Pete Buttigieg, a close runner-up, received $93,954. Harris took home around 1.5 times more money than Sanders, at $55,359. Warren accepted $43,680, less than 1.2 times more than Sanders.
Though she is not quite a leading candidate, polling between 1% and 2%, Amy Klobuchar notably accepted $65,304 from health insurance and pharmaceutical employees, making her the third-largest recipient overall (after Biden and Buttigieg). In These Times found that she received the maximum donation of $2,800 from Kara J. Walter, a UnitedHealth executive, and $1,000 from David Abelman, Executive VP of DentaQuest. Klobuchar is skeptical of Medicare for All, which in last month’s debate she claimed would kick “half of Americans off their health insurance.”
Kirsten Gillibrand is another favorite of the healthcare industry — at $39,546, she is the sixth-largest recipient of money from health insurance and pharma employees, above Sanders. Pfizer Executive Vice President Sally Susman, who donated the maximum $2,800 to her campaign according to In These Times’ research, hosted a fundraiser for Gillibrand earlier this year, which Gillibrand defended by claiming that Susman is “a friend” and that she “supports LGBTQ equality.” Perhaps Gillibrand’s relationship to the healthcare industry factored into her choice not to raise her hand in the June debates, and to argue instead that Medicare for All should not touch private insurance companies because competition will drive them out naturally.
It is no surprise that Joe Biden and Pete Buttigieg are the healthcare industry’s top picks. Biden recently denounced a potential switch to single-payer healthcare as “a sin,” and has made absurd claims that Medicare for All would mean existing Medicare “goes away as you know it.” According to In These Times’ research, his contributions include $2,800 from Independence Blue Cross CEO Daniel Hilferty, and $2,800 from Steven Collis, CEO of AmerisourceBergen. Buttigieg, meanwhile, has managed to appeal to both progressive Democrats and healthcare executives with his “Medicare for All Who Want It” proposal. In These Times found that his top donors include Wade Rakes, a Centene vice president who donated $4,300, and Joshua Smiley, CFO of Eli Lilly, who gave $2,800.
According to In These Times, Kamala Harris’ donations from high-ranking executives include $2,800 from Danielle C. Gray, Senior Vice President of Blue Cross NC, and $2,700 from Osi Esue, Marketing Director of Abbvie Pharmalytics. Like Buttigieg, she has attempted to play both sides of the debate around single-payer healthcare. On Monday, a month after walking back her support for eliminating private insurance at the June debates, she finally released a healthcare proposal dubiously titled “My Plan for Medicare for All.” Her plan would take ten years to phase in and would allow private insurance companies to compete with Medicare. “You can’t call this Medicare for All,” said Sanders’ campaign manager in a statement about Harris’ plan. Along with Harris’ new plan came a statement that her campaign does not take any money from pharmaceutical executives, but she has not yet returned most of the money she received from them.
For his part, before Bernie Sanders announced his pledge to reject health insurance and pharma donations over $200, he accepted donations that would have broken it. For instance, In These Times found that he took at least $920 from Lynn McRoy, a medical director at Pfizer who may or may not count as a “high-ranking executive.” OpenSecrets also reported that he took home $2,000 from the CEO of Ironwood Pharmaceuticals. Bernie’s campaign has announced that it will return all previously accepted donations that violate the new pledge.
Like Sanders, Warren received a relatively small amount of money from the healthcare industry. In These Times found few high-ranking executives on her list of contributors, though she did accept some significant contributions, such as $1,010 from Robert Cuddihy, Amgen’s Vice President of U.S. Medical Affairs. Before the June debate, she was criticized for her silence on Medicare for All, but she has since come out in full support of single-payer healthcare, including for undocumented immigrants.
While all but two of the leading 2020 Democrats equivocate on single-payer healthcare, organizers around the country continue to fight for Medicare for All and for the campaign finance reform that may be necessary to make progressive policies like single-payer a reality. For these organizers, contributions from the health insurance and pharmaceutical industries are more than just numbers.
Morgan Oliver, an organizer from the Fair Elections Task Force, believes that without big money in politics, a universal healthcare system would be far more politically possible. “People’s constituents want that,” she added. “We see how many people have struggled with the health insurance industry in many different ways, even people in very conservative communities.” This struggle is personal for Oliver as well — she told In These Times that even with private insurance, she has struggled to afford a medication that she needs because it cost nearly $4,000.
Oliver is working to pass a Fair Elections Ordinance in Chicago that would create a donor match program for small individual contributions. She believes that fighting for campaign finance reform locally is a crucial step to winning it nationally. She envisions a federal public campaign financing law that would restrict big money in politics while boosting the power of small donations through vouchers or donor matching.
Sheilah Garland, a political organizer with National Nurses United, which has long fought for Medical for All and endorsed Sanders in 2016, says that nurses around the country viscerally understand the necessity of divorcing healthcare from profit. She cited the Partnership for America’s Healthcare Future as a major obstacle in the union’s fight for single-payer healthcare, alongside general lobbying and contributions from health insurers and Big Pharma.
Garland says her experience working with nurses has demonstrated the importance of eliminating private insurance through Medicare for All. Almost every nurse in the country, she says, has watched a patient struggle to access a life-saving treatment that isn’t covered by their insurance company’s policy.
“When you’ve spent time with [a patient],” Garland said, “you know their story. You see them, you see their family, you see their struggle to regain their health … and to see all of that literally washed away because of some sort of policy … it’s absolutely devastating.”
Nathan Whitmore, a researcher from The People’s Lobby’s Fair Elections Task Force, contributed research to this article.
Anna Attie is a writer, community organizer, former In These Times intern and a University of Chicago graduate.