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Will Health Care Be a Major Issue in 2024?
Why the candidates hoping to beat Trump to the GOP presidential nod aren’t talking about health care—and why Joe Biden is.
DESPITE WHAT THE CAMPAIGN CONSULTANTS and analysts on TV would have you believe, politics is not all that complicated. The clichés have it basically right: More often than not, success comes from showing a personality that is likable, coming up with ideas that people think will put more money in their wallets, kissing babies, praising God when appropriate, and—above all else—telling the voters why you are better than whomever you are running against. Voters may not want a fire-breathing dragon running for office, but they do want a candidate who shows some passion.
I mention these political basics not because you are unaware of them but because this year’s Republican presidential contenders seem to be. I’ve never seen a group of seasoned politicians—those who have gone through the campaign grind many times—acting so mealy-mouthed and passionless in their approach to getting votes, because they are so scared to go after Donald Trump. It’s like Trump is holding the paddle at a frat pledge meeting and they keep saying to him, “Thank you, sir, may I have another.”
Heading into the first GOP debate this week, there are a few exceptions. Most notably, Chris Christie has focused on attacking Trump, and has seen his own numbers inch up in a few polls. Mike Pence has criticized Trump on matters related to the 2020 election aftermath, but there are limits to how much the former VP can criticize the former P for whom he so long carried water. Vivek Ramaswamy, Nikki Haley, and Tim Scott usually just try to change the subject when asked about Trump, preferring to speak only about the need for younger leaders.
Ron DeSantis has been elliptical, timid, and bumbling in his criticism of Trump. In an interview last week, after awkwardly criticizing Trump for not “upending that swamp” in Washington (can one upend a swamp?), DeSantis took aim not at Trump but at Trump’s voters: “A movement can’t be about the personality of one individual. . . . If all we are is listless vessels that [are] just supposed to follow, you know, whatever happens to come down the pike on Truth Social every morning, that’s not going to be a durable movement.” This lame effort followed the “leak” of a DeSantis PAC debate-prep memo last week that desperately sought ways the Florida governor could avoid talking about Trump.
Here’s the thing: There is a way that an opponent could go after Trump, a way that focuses on substance. It relates to an issue that voters consistently place on the top of their lists of concerns, one that older and conservative voters are always worried about. And it’s an issue that Trump repeatedly screwed up while president.
The issue is health care. Nearly two-thirds of the respondents in a massive Pew poll from June called “the affordability of health care” a “very big problem in this country today.” It virtually tied with inflation at the top of the list of concerns.
An issue that the public places high on the “very big problem” hit list is one that candidates would usually be bringing up nonstop. But the 2024 GOP contenders aren’t really talking much about health care—and it’s worth looking at why.
What voters care most about in health care is easy enough to understand. People want better care, access to doctors they like, and ways to keep their children healthy and grandma alive—all without going broke. But health care costs keep going up faster than most other goods and services. At the moment, there are big rises in the costs of care for people who have diabetes and are obese (not to mention the astronomical price of Ozempic). Meanwhile, polls show that many people are intimidated not only by the high costs but by the complexity of the health care system: there is confusion about private insurance, about the various Medicare payments and copays, about who should get Medicaid and who shouldn’t, about how to get coverage for mental health treatment.
And Trump’s record is abysmal.
“When in office, Trump advocated unsuccessfully to repeal and replace the ACA, including proposals that would have eliminated the expansion of Medicaid,” wrote Larry Levitt, a policy expert at KFF (the group formerly known as the Kaiser Family Foundation), in a recent JAMA article. Trump pushed for policies that would have “increased the number of people uninsured, and weakened protections for people with preexisting conditions.”
Hammering Trump from that direction would likely work for a Democrat opposing him in the general election, since the latest stats say that the ACA (Obamacare) is favored 59–40 percent by the American public, with women coming in at 61–38, men at 57–43, independent voters (the key to any election) at 62–38, black voters at 75–24, and Hispanic voters at 66–33. The same goes across all ages and income levels.
But among Republicans, the numbers on Obamacare are underwater: 26–73. So in theory it might be possible to feed GOP primary voters with messaging that Obamacare is a failure. And, as Levitt details, several of the participants in this week’s primary debate are already on record as having supported repeal of the ACA and not expanding Medicaid, which were fairly mainstream GOP policy positions over the last decade. (Interestingly, Chris Christie, who was a critic of Obamacare early on but did expand Medicaid and came around to opposing some of the Obamacare-repeal bills, has made a point of attacking Trump for having “said he was going to repeal and replace Obamacare” but then not “get[ting] it done when he had a Republican Congress.”) But again, it would be hard to take an anti-Obamacare message out of the primary season and into the general election campaign.
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Likewise, attacking Trump on his miserable record on COVID—from hundreds of thousands of excess deaths to advocating quack therapies—will not be easy for the GOP candidates who themselves are eager to pander to the paranoia of their party’s base regarding Anthony Fauci and pandemic lockdowns and what DeSantis calls “the jab.” Trump can justly take credit for his administration having sped the creation of the COVID vaccines. But Republicans are now so anti-vax that they are disproportionately dying off, so there is little political room for Trump’s primary opponents to maneuver.
WHILE THE GOP CANDIDATES aren’t going after Trump on health care, Biden certainly is. In early July, when announcing new plans—to lower health care costs, get better treatments for veterans, cap prescription prices, boost cancer research, and strengthen programs for mental health and opioid overdoses—he took on Trump without naming him.
When talking about his lowering of prescription drug prices, Biden said “The last guy increased it.” He then added:
We’ll also stand up to MAGA Republicans who have been trying for years to get rid of the Affordable Care Act. They’ve tried 70,000 times, I think. . . . On my watch, healthcare is not a privilege in this country. It should be a right.
It’s possible that this could change. A Republican could “come up with some messaging around health care reforms and do something that might distinguish them a bit,” said Jim Merrill, a GOP consultant in New Hampshire. “I think given the amount of time we have left and some months ahead here, there’s an opportunity to do that.” But don’t hold your breath: “For now, what you’re seeing is a reflection of where the base electorate is.”
Daniel McGraw is a freelance writer and author in Lakewood, Ohio. Twitter: @danmcgraw1.