"If they throw out major portions of the reform the most important thing for Dems to talk about right now is how Republicans and the Court are leaving us to the mercy of the private insurance companies," said Roger Hickey, co-director of the Campaign for America's Future, in a phone interview. "And that's not just the Supreme Court decision, but it's the Ryan budget. ... Republicans are trying to impose austerity because they say that Medicare is bankrupting the country, and Dems should point out that Republicans want to dismantle the one functioning part of our health care system -- Medicare -- that actually works for people, that actually controls cost. And what they're proposing is incredibly unpopular with the voters."
Hickey has been prescient in the past. In 2005, he influenced the strategy Democrats ultimately adopted to thwart President Bush's attempt to privatize Social Security. Then in 2009, in a break with single-payer backers, he joined the coalition supporting President Obama's push to overhaul the country's health care system.
If the Court throws out the Affordable Care Act, Hickey says Dems should -- and will have little choice but to -- support a move toward a Medicare For All-like system.
He acknowledges that expanding Medicare will be a heavy legislative lift. Moreover, he admits, "I don't think that the argument for single payer will be terribly effective in this election season."
But he distinguishes between immediate politics, and forward-looking policy-making.
"In the long term -- you know, next year -- Democrats should be pointing out that the only real way to control Medicare costs, is to go after costs of the health care system, which costs twice as much per capita as any other major industrial health care system," Hickey said. "We have to break the power of the insurance industry at least with a public option, and we have to control drug company costs, again using Medicare as a leverage. And we should be talking about a real comprehensive health care system that is closer to single payer."
Getting there will be slow going, but as time goes on, moderate Democrats who once believed in more conservative alternatives will recognize that, post-ACA, the only alternative to single-payer will be abandoning the idea of universal coverage altogether.
Buttressing that theory, retiring conservative Sen. Ben Nelson (D-NE) warned Wednesday that, "If they strike down the mandate, the Supreme Court will be paving the way to a single-payer system, or back to the old broken health care system - neither of which are good for Nebraskans."
Thus, wielding Medicare as a political cudgel would serve two purposes, according to Hickey. It would make a clear distinction between the parties -- particularly between Romney and Obama -- over the fate of one of the country's most popular programs; and it would unite liberals ahead of the difficult work of picking up the post-ACA pieces and moving toward a new, more straightforward approach.
"He doesn't actually have to go that far in order to be effective at winning votes this year," Hickey said. "At a minimum he really has to go after the Republican plans to dismantle Medicare."