In the first two debates, leading Democratic presidential candidates Kamala Harris, Elizabeth Warren and Bernie Sanders raised their hands when asked if they would abolish private health insurance in favor of a government-run health care plan.
This had conservatives baying for the hunt, and some centrist Democrats worried that the move to fix America’s health was too far, too fast. Will these candidates end up regretting staking this ground if they win their party’s nomination next year?
Sanders, it’s safe to say, regrets nothing. We’re only talking about Medicare for All because of his 2016 presidential run and insistence that taking for-profit actors out of the system is the only way to guarantee universal health care. The senator from Vermont is confident he can make the case to any voter that expanding Medicare is a simple way to fix American health problems. The concern is that half of Americans receive their health care from a private plan, and even if they’re dissatisfied with it, disruption can be scary.
Then there’s the tax-increases. The first question he received last night was whether his plan would raise taxes on middle-income Americans, and he was plainly uncomfortable delivering the answer, “yes.” It’s not that he doesn’t have an argument to make—many Americans would pay less on net for their health care if they received it from the government, even while paying higher taxes. It took him a few minutes to get to this point when pressed at the debate last night, but he might want to lead with it: “Yes, they will pay more in taxes but less in healthcare for what they get.”
You may have noticed all three of these candidates are lawmakers in the senate, and all three are signed on to Sanders’ Medicare for All bill there. That makes the hand-raising somewhat redundant; these candidates have already shown they are willing to endorse a single-payer system that leaves little if no room for private actors. In the primary, Warren in particular had little choice politically but to compete with Sanders for progressive voters who want to see the government take a bigger role in health care.
But it also resonates with the themes around which she has built her candidacy: “I spent a big chunk of my life studying why families go broke,” she said at the June 26 debate. “One of the No. 1 reasons is the cost of health care, medical bills. And that’s not just for people who don’t have insurance. It’s for people who have insurance.”
Still, Warren also has fans in the center of the party who respect her technocratic, policy-wonk style. They are going to be listening when Rep. John Delaney points out that Sanders’ bill doesn’t reimburse hospitals for care at the rates they would need to stay in business—”to some extent, we’re supporting a bill that will have every hospital closing.” He’s not wrong about this—a switch to single-payer would be complex, and Warren of all candidates will be asked to explain how it can be done without massive disruption during a general election.
The California senator might have the hardest time with her answer, if only because she’s fumbled this question before. At a January 2019 town hall meeting with voters, she seemed to endorse moving on from private insurance, but later had her staff walk the proposal back. And after raising her hand last night, she said in TV interviews this morning that she misheard the question and that private insurance would exist for supplemental coverage in her vision of Medicare for All, a fairly common combination in other countries with more public spending on health care. (To be fair to the senator, I also initially heard the question as whether the candidates would personally switch from private health care to a government plan.)
Harris’ lane in this primary is not as straightforward as Sanders’ political revolution or Warren’s narrative of plans. Her steely dissection of former Vice President Joe Biden’s record on bussing policy showed her strength as a former prosecutor. With her mixed record on criminal justice inspiring skepticism among progressives, her campaign wants to make clear that she can be trusted on a critical issue for the Democratic base.
Her back and forth on the issue bring to mind the health care battles of the 2008 Democratic primary, where Barack Obama and Hillary Clinton battled over whether Americans should be required to obtain health insurance. Obama rejected the individual mandate and Clinton embraced it; Obama would win the primary and the presidency, where he would embrace the individual mandate as central to the functioning of his health care reform.
Two other front-runners—Biden and South Bend mayor Pete Buttigieg—have offered a more moderate vision. They argue for a more gradual path away from the currents system, starting with a public option for health insurance akin to the one debated during the creation of Obamacare. Buttigieg calls this “Medicare for All who want it.” Improving Obamacare more modestly may be a better sell to the general public, who have come around to the law in recent years as the Trump administration has sought to eliminate it. Yet among many Democrats, there is frustration about the complicated system of health insurance subsidies and regulation. It undoubtedly increased insurance coverage and drove down costs nationally, but the cost of private insurance is still rising faster than inflation, drug-makers and insurers are still profiting from sickness, and the goal of universe access remains out of reach.
Whatever the Democrats propose on health care, Donald Trump and his party will cast it as both socialism and an attempt to cut government benefits. But Democrats still are more trusted than Republicans on the issue of health care, and some party strategists see any discussion of the issue as a road to victory. In their successful effort to reclaim the House in 2018, Democrats frequently made health care a signature issue, running and winning on Medicare for All even in historically conservative districts. Polling on health care shows that Americans are largely dissatisfied, anxious about costs, and skeptical of the existing system. About 56% of Americans favor a single-payer system, even though many don’t quite understand what Medicare for All might entail.
So, will swinging for the fences on health care today turn into a pop fly come 2020? The answer may depend less on Medicare for All itself, and more on whether voters trust the Democratic nominee more than Trump to explain it to them.