Democratic candidates running for president are in the middle of a heated debate about health care, one that will only intensify under the glare of television cameras as they take the stage in Detroit, Michigan, for the second presidential debate this week.
But even with the fierce sniping about Medicare for All, which has become a litmus test in the 2020 race for the Democratic nomination, the candidates have yet to explain how any version of the proposal would pass in a sharply divided Senate ― even if Sen. Mitch McConnell (R-Ky.) finds himself the minority leader once again.
The problem for advocates of “Medicare for All” isn’t simply the Republicans in the Senate, who have called it “socialism” and pledged to fight it tooth and nail. A number of more conservative and centrist-minded Democratic senators remain uncomfortable with the idea, preferring instead more immediate measures that would bolster the insurance market under Obamacare.
“I think it’s been an interesting idea to generate conversation about how we best provide health care to people,” Sen. Jeanne Shaheen (D-N.H.) said on Tuesday when asked if she could support a version of Medicare for All. “I’m interested in doing everything we can as quickly as possible to give as many people access to health care as we can, and I don’t think that will do it ... I think there are other ways to cover people faster.”
Sen. Kamala Harris (D-Calif.) on Monday released her version of Medicare for All, a plan to create a new, government-run insurance plan designed to cover all Americans and pay for nearly all their medical expenses. The proposal would likely eliminate existing employer-sponsored plans, over the course of a decadelong transition, but allow private insurers to offer an alternative form of coverage, much as they do today for seniors on Medicare.
Harris’ plan takes a middle-of-road approach, falling short of Sen. Bernie Sanders (I-Vt.) sweeping plan to completely overhaul the nation’s health insurance system, yet offering a bigger transformation to the nation’s health care system than the reforms supported by former Vice President Joe Biden.
Unsurprisingly, it immediately received flak from both Sanders’ and Biden’s campaigns, who criticized it for going too far, and not far enough.
“This new, have-it-every-which-way approach pushes the extremely challenging implementation of the Medicare for All part of this plan ten years into the future, meaning it would not occur on the watch of even a two-term administration,” Biden deputy campaign manager Kate Bedingfield said in a statement. “The result? A Bernie Sanders-lite Medicare for All and a refusal to be straight with the American middle class, who would have a large tax increase forced on them with this plan.”
Faiz Shakir, Sanders’ campaign manager, also panned the measure.
“You call that whatever the heck you want to call it ― it’s not Medicare for All,” he said Tuesday in an interview on CNN.
Public opinion data suggests why some Democrats remain hesitant about embracing an entirely government-run health care program. Polls have shown repeatedly that Medicare for All’s support drops if voters think it means displacing their private insurance altogether. When asked in a Henry J. Kaiser Family Foundation health tracking poll to choose between Medicare for All and proposals that augment the Affordable Care Act, for example, 36% of Democrats chose Medicare for All and 57% preferred plans that build upon Obamacare.
That’s why both health care plans put forward by Biden and Harris leave some form of a private insurance system largely in place. Sanders, meanwhile, has no qualms about eliminating the private insurance system altogether. He argues that not doing so would leave too many Americans at the mercy of for-profit insurers while driving up costs for everybody.
Polls have shown repeatedly that Medicare for All’s support drops if voters think it means displacing their private insurance altogether.
The divisions between the candidates will likely be on display on Tuesday and Wednesday in Detroit for the second presidential debate. Sanders and his fellow progressive Sen. Elizabeth Warren (D-Mass.) take the stage the first night, while Harris and Biden will get a chance to square off against each other on the second night.
Granted, building coalitions around ambitious proposals takes time and building movements around them on the campaign trail only helps. But as heated as the debate over Medicare for All has been so far, the presidential candidates who support implementing some permeation of it will have to convince more of their Democratic colleagues in the Senate to support it if it has any chance of becoming law in the near future.
“We can’t even pay for Medicare for some. We need to solidify that. We need to fix the Affordable Care Act,” Sen. Joe Manchin (D-W.Va.) said Tuesday when asked about Medicare for All.
Sen. Bob Casey (D-Pa.), meanwhile, said he believes “the better approach” is relying on more incremental proposals like “Medicare at 50,” which would allow Americans 50 and older to buy into the Medicare program, to expand the health insurance market.
“I think the important thing is that people have a choice in their selection of a plan,” added Sen. Dianne Feinstein (D-Calif.)