This week’s second round of Presidential-primary debates were yet another marker of just how thoroughly Bernie Sanders’s Medicare for All advocacy has transformed the Democratic Party. Perhaps even more notable than the stridency of Sanders’s and Warren’s defenses of the plan were the barbs from moderates who have been forced by widespread enthusiasm for Medicare for All to put forward plans that are well left of the Affordable Care Act.
“Folks, we have a choice,” John Delaney said during his opening statement, on Tuesday. “We can go down the road that Senator Sanders and Senator Warren want to take us—with bad policies like Medicare for All, free everything, and impossible promises that’ll turn off independent voters and get Trump reëlected. That’s what happened with McGovern, that’s what happened with Mondale, that’s what happened with Dukakis. Or we can nominate someone with new ideas to create universal health care for every American, with choice.”
Delaney himself would replace the current health-care system with a universal, Medicare-like program that individuals and employers could supplement with private plans. This puts him further to the left than candidates such as Joe Biden, John Hickenlooper, Beto O’Rourke, and Pete Buttigieg, who would preserve the current system while creating a Medicare-like public option, which, unlike the public option ultimately dropped in the crafting of Obamacare, would be open to all Americans.
In his remarks on Tuesday night, Buttigieg argued that a robust public option could grow in popularity over time, to the point that most Americans might wind up with a government plan. “That’s the concept of my Medicare-for-all-who-want-it proposal,” he said. “If people like me are right, that the public alternative is going to be not only more comprehensive but more affordable than any of the corporate options around there, we’ll see Americans walk away from the corporate options into that Medicare option and it will become Medicare for All.”
In the lead-up to her appearance in Wednesday night’s debate, Kamala Harris released her own version of Medicare for All, seemingly aimed at pleasing everyone. In sum, Harris is offering a plan that would give every American government insurance within ten years—as opposed to Sanders’s four-year transition—while retaining a private insurance market. But her effort to split the difference has made her proposal vulnerable to criticisms from both sides. The Harris plan gives up the administrative cost savings and simplicity of a wholly government-run system. Moderates, on the other hand, have called Harris’s plan, like Sanders’s, too expensive and too disruptive.
“If you noticed, there’s no talk about the fact that the plan in ten years will cost three trillion” a year, Biden said on Wednesday night. “You will lose your employer-based insurance. You know, this is the single most important issue facing the public, and, to be very blunt and to be very straightforward, you can’t beat President Trump with doubletalk on this plan.”
A majority of voters generally support the idea of Medicare for All, but polling numbers vary according to how you describe the program. A recent Morning Consult poll found that fifty-three per cent of voters support Medicare for All, but that number drops to forty-six per cent when voters are told that such a system would “diminish the role of private insurers.” It rises back to fifty-five per cent, though, when voters are also told that Medicare for All would allow Americans to keep their preferred hospitals and doctors.
This suggests that the reluctance to ditch private insurance is largely about reliability—voters might become more open to Medicare for All it if they could be assured that it would preserve their access to all the services and providers they use now. “It’s not like people love their private insurance plans,” Larry Levitt, the executive vice-president of the Kaiser Family Foundation, told me. “I think people are particularly nervous about being asked to give up the insurance they have today for something that might be better. But you’re asking people to take that on faith.”
When you look at Sanders’s plan in theory, he continued, “there’s nothing not to like for people. You can go to any doctor and any hospital, you have no deductibles, co-pays, or premiums, and it’s much more comprehensive than any current private insurance plans. There’s absolutely nothing not to like about that. But, you know, that’s how it exists on paper.”
Ultimately, though, Levitt argues that neither Sanders’s plan nor any of the plans that have been described as more pragmatic and politically feasible stand a chance of being enacted as written.
“A bill that could pass Congress would look nothing like any of these current proposals,” he said. “None of these plans have gotten very specific about exactly how they would be paid for. And, inevitably, once you’re forced to pay for an ambitious health plan, compromise becomes necessary to lower the costs.”
In this respect, Levitt suggested, the prominence of the debate, and not the specifics of the plans, is what is most significant. “I think the bigger question is whether an incoming Democratic President would prioritize health care over other issues,” he said. “Candidates have plans for all kinds of issues. But once they get into office, they can usually only focus on one or two things. I think that the big question is which issue these candidates will take on.”
