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Since the collapse of the GOP effort to repeal and replace the Affordable Care Act, single payer has gained new life on the left. Sen. Bernie Sanders released his “Medicare for all" plan yesterday, and a majority of House Democrats have signed on to another version proposed by Rep. John Conyers.

Expand chart
Data: Kaiser Family Foundation Polls; Note: 2008-09 is an average of 7 polls; Chart: Andrew Witherspoon / Axios

The big picture: Politically, single payer — the idea of having the government pay for health care rather than private insurers — can help rally the left much like the prospect of repealing the ACA rallied the right. But it could also help Republicans, who own the problems in health care now, switch the target to the Democrats and their sweeping new health reform plan.

The pros for Democrats:

  • As the chart shows, single payer is popular among Democrats, with about two thirds in favor. But it has also gained popularity among independents in recent years, with over half supporting it. Republicans, not surprisingly, aren't so crazy about it.
  • Single payer is a big idea many Democrats can rally around. It excites the base and party activists by establishing health care as a right, achieving universal coverage, and eliminating insurance companies. This analysis is about politics, but most advocates of single payer advance the idea because they believe in it, not as a political calculation.

The cons for Democrats:

  • They could lose a one-time opportunity to tar Republicans with the damage their ACA replacement plan would have done to millions of people, according to the multiple analyses that showed lost coverage and higher premiums for vulnerable people.
  • By campaigning on their own sweeping health reform plan, Democrats could give Republicans a fighting chance to change the subject.
  • More targeted policy ideas, such as Medicaid buy-in options for the ACA marketplaces and a Medicare buy-in for 50-64 year olds, could also be popular on the left and the center, while offering far smaller targets than a sweeping single-payer plan would.

Reality check: Single payer is popular, but polling today doesn't tell us much about where the public will be if there is a national debate about actual single-payer legislation in the Congress. ACA repeal had the support of about half the public in Kaiser Family Foundation polling in late 2016 and early 2017, but fell to closer to 30 percent once there was an replacement plan under the microscope.

Support for single-payer falls by 10 to 20 percentage points when people are read common criticisms, such as that it will increase taxes or give the government too much control over health care. Arguments in favor, including that single payer will make health a basic right or reduce administrative costs, increase support by similar amounts.

We cannot simulate what will happen in a real debate, which depends on the actual details of the legislation and the power of the arguments made.

Be smart: This is more than just a health policy debate. It is also a proxy debate about the future of the Democratic Party. The party can swing left trying to build energy in the base, or it can move to the center, trying to capture the votes of many of the more conservative working people who voted for President Trump.

Don't forget: Most Americans are far less focused on sweeping health policy ideas than they are on lowering their out-of-pocket costs. Health reformers – left, right, or center – who make the connection between their policy ideas and these pocketbook concerns may capture the most voters.

Go deeper

School principals are not OK

Principal Alice Hom (purple jacket) of New York's Yung Wing School P.S. 124 near a vaccination van in November. Photo: Michael Loccisano/Getty Images

The overwhelming majority of secondary school principals experienced frequent stress last school year, according to a RAND Corporation report out Wednesday.

The big picture: The stress levels among female principals and principals of color were especially stark, with nearly 40% in these groups reporting constant job-related stress, compared to about 24% of male principals and 26% of white principals.

It's official: Stock market having worst start to year ever

Data: FactSet; Chart: Axios Visuals

It's been a decidedly ugly start to the year for the stock market, with particular pain in the tech trade.

State of play: As of the end of trading Tuesday — the 16th session of the year — 2022 is now, officially, the worst-ever start in the history of the S&P 500, according to data from Ned Davis Research, a stock market research shop.

Surprising pandemic side effect: Soaring trade deficits

Source: Census Bureau and Bureau of Economic Analysis; Chart: Axios Visuals

Inflation and jobs may get all the economic headlines, but meanwhile a big shift is taking place in the underpinnings of the world economy: The U.S. trade deficit is soaring.

What's happening: Americans' spending on imported physical goods has gone through the roof, while exports are growing slowly, making the U.S. the world's consumer of last resort.