by Shoshana Krilow
Vice President, Public Policy and Government Relations


It seems just like yesterday when then-presidential candidate George H.W. Bush uttered the infamous words, “Read my lips: no new taxes.”

What followed was President Bush doing something we rarely see these days – compromising with Congress and the other political party – to negotiate a budget that did, among other things, increase some taxes. Some analysts believe that his seeming failure to keep his word was partly to blame for losing his reelection bid.

That was 30 years ago. Let’s fast forward past many, many elections and many, many promises (both kept and un-kept). Let’s fast forward to bitter partisanship and increasingly less-collegial relationships on Capitol Hill and between the executive and legislative branches. Let’s focus on today’s campaign lip service of “Medicare for All.”

In our wonky, political circles of rhetoric we call this “Playing the granny card” ... both sides of the aisle have been and continue to be guilty of baiting voters with threats/opportunities to Medicare (depending on who you ask). This year’s election is no exception with, once again, both sides of the aisle using Medicare to scare/encourage voters.

Here’s a quick recap: Democrats are, once again, increasingly showing support for a concept called Medicare for All, oftentimes failing to describe how they would achieve it or how it would impact other sources of health insurance coverage but nonetheless showing their support for universal access to health care. Republicans are using the same slogan to stoke fear in grannies everywhere that their Medicare may be at risk and, to the non-grannies, that our country and its citizens' health insurance is being threatened. This isn’t the first time, nor will it be the last, that granny and Medicare are at the center of the health care debate.

So, who’s right? NEITHER.

Putting aside who may be right about policy (since when is it about the policy!?), let’s focus on the politics … which are increasingly, inextricably connected to policy.

Here’s another quick recap: While the tea leaves suggest that Democrats COULD retake the House, the chances of them retaking the Senate are low. Even if they did, however, it would not be by a considerable margin and there remains a Republican in the White House. Civics 101: both chambers of Congress need to pass the same bill before it can become law and the president must sign it (for the most part). If the president vetoes a bill, it can only be overridden by a two-thirds vote in both the House AND the Senate, a supermajority which Democrats most definitely will not have (although I should have learned by now to never say never). The chances of EITHER party having a supermajority of Congress anytime soon, and the White House aligning with that party, are about as likely my newborn starting to sleep through the night on a regular basis.

So – bottom line – like many, many, many pieces of legislation that are introduced, Medicare for All remains elusive. Lip service. No chance. AIN’T. GONNA. HAPPEN. At least not yet.  Maybe not ever. That may anger or excite you – but the fact remains that it’s difficult enough to enact seemingly small, non-controversial pieces of legislation into law, even during the best of times (4 percent of bills that are introduced actually become law), but something so divisive, so sweeping, and so wrought with uncertainties is NOT a reality. Although support and opposition for it have been around for a VERY long time, the focus on it now is merely a tactic to rev up the base – of both parties – to get out and VOTE. 

While I can certainly support the goal to encourage voting, I want to be clear that, Medicare for All is, for now, a political rallying cry – nothing more.

Before you get too excited or depressed, know that this will remain the case until, if, or when there are significant changes to the makeup of Congress and a new president is in the White House. And, even then, legislation that even remotely resembles the broad platitudes that currently describe Medicare for All would likely take a significant amount of time to develop, analyze, and debate.

While it may largely be a political talking point for both parties as of now, the underlying reasoning behind the message is still important. And that is, no matter how you feel about it, get to the polls and VOTE! Health care is too important to let partisan voices on either side dominate the conversation.

About the author. As vice president of public policy and government relations, Shoshana Krilow leads Vizient government relations, monitoring federal legislative and regulatory developments of importance to Vizient and its members. She has worked as a strategic advisor to health sector clients with a particular concentration on Medicare, the pharmaceutical and insurance industries, and the Affordable Care Act. Krilow also brings deep legislative expertise having spent several years on Capitol Hill, where she worked as a health policy advisor for Representative Marion Berry (D-Ark.) and Senator Joseph Lieberman (I-Conn.).

Published: October 17, 2018