The Democrats' Demolition Derby.

• Author: Longman, Phillip

The fight over Medicare for All is destroying the party's 2020 chances. "Medicare Prices for All" is the way out.

The issue of health care ought to provide Democrats a smooth limousine ride to the White House. Polling shows that health care is tied for first, along with the economy, as the leading political issue for Americans, and among voters in the upper Midwest swing states likely to decide the election, Donald Trump gets worse marks for his handling of health care than for any other issue.

Yet in recent months, health care has been more like a demolition derby--a spectacle in which Democratic candidates bash each other over policy differences in ways that weaken the whole field. This past fall, Elizabeth Warren saw her lead in Iowa and New Hampshire polls collapse after she struggled to explain how she would pay for her single-payer "Medicare for All" plan without raising taxes on the middle class. She has also lost support among likely Democrat ic primary voters who have become increasingly concerned about polls showing that single-payer would be a political loser in the general election--because, in addition to higher taxes, it would require 157 million Americans to give up the employer-provided health coverage they currently rely on. Similarly, Kamala Harris dropped out of the race in December in part because of her embrace--and then rejection--of Medicare for All.

Joe Biden and Pete Buttigieg have done somewhat better by eschewing single-payer in favor a "public option"-essentially, building on Obamacare by letting the uninsured and others buy into Medicare or some other government-run health insurance program, with subsidies for those who need them. But these more moderate candidates have not been able to close the deal with the many left-leaning Democratic voters who think America's flawed health care system needs more fundamental change.

And those voters have a point. America needs change beyond what any extension of Obamacare can offer because Obamacare can't solve health care's most pressing and electorally salient issue: rising costs. For the typical mediumincome family of four with health insurance, annual health care costs have risen by more than $10,000 in the decade since the passage of the Affordable Care Act. Since 2008, deductibles for covered workers have increased eight times as fast as wages. The rising cost of premiums nominally paid by employers is a major reason why so many of us haven't gotten a raise in decades. Money that might go to increased wages goes instead to cover the cost of unrelenting health care inflation.

Champions of Medicare for All claim that their plan would attack this crisis by giving the government bargaining power to demand lower prices from doctors, hospitals, and drug companies. But even if that's true in theory, it doesn't change the fact that Medicare for All is electorally toxic. Its abstract promise of cost control doesn't overcome voters' aversion to higher taxes or losing their insurance. Warren and Sanders's plans' most-likely outcome isn't cheaper care. It's four more years of Donald Trump.

Biden's and Buttigieg's plans are far more politically salable, and they claim that the public option, as it grows, could also be used by the government to extract lower prices. That's also true--for those who choose the public option. But for those who stick with their private insurance (that is, most people in the short and medium term), health care costs will likely skyrocket as hospitals and doctor groups raise prices on employer-provided plans to make up the loss of revenue from the public option. In other words, Democrats might be able to win with the public option in 2020, only to get crushed in 2022 or 2024 as millions of angry voters who were promised health care cost savings wind up experiencing the opposite.

Democrats desperately need an alternative health care plan--one that has broad political appeal and won't cost the Democrats the next election, yet also gives progressives the structural changes they want. Most important of all, they need a plan for solving the health care cost problem that an overwhelming number of voters say they want addressed.

Fortunately, there is such a plan. With coauthor Paul Hewitt, a former Social Security commissioner and health economist, I first sketched it out in these pages nearly two years ago. (See "The Case for Single-Price Health Care," April/ May/June 2018.) The core idea is straightforward: Have the federal government mandate that the prices Medicare pays for health care apply to everyone's health care plan. Call it "Medicare Prices for All."

If implemented today, it would, in one stroke, dramatically restructure health care markets while dramatically cutting medical costs for most working families, and all without...