By Julie Rovner December 3,
2019
The one
thing we know about health care in the 2020 Democratic presidential primary
race is that it’s a top issue for voters.
The latest Tracking Poll from
the Kaiser Family Foundation found 24% of Democrats and Democratic-leaning
independents said they want to hear the candidates discuss health care. That’s
twice the total for the next top issue, climate change; and four times the
total for immigration, the No. 3 issue. (Kaiser Health News is an editorially
independent program of the foundation.)
The big
question, though, is whether that interest will reward a candidate who backs a
sweeping, “Medicare for All”-type plan, or a more modest plan like a public
option, in which a person can voluntarily join a government health insurance
plan.
Polling
doesn’t make that clear. On the one hand, Democrats and Democratic-leaning
respondents in the KFF poll say when it comes to health care, the candidate
they trust most is Sen. Bernie Sanders of Vermont (who initially pushed a
Medicare for All plan).
Yet
those same people say they prefer a public option (of the sort supported by
former Vice President Joe Biden) to Sanders’ Medicare for All plan. That bears
out in a separate Quinnipiac poll released
last week, in which 36% of respondents say Medicare for All is a good idea
while 52% say it is a bad idea. An NBC/Wall Street Journal poll
from September found similar results: 67% of respondents said they would
support allowing people under age 65 to “buy their health coverage through the
Medicare program,” while only 41% favored “adopting Medicare for All, a single
payer health care system in which private health insurance would be
eliminated.”
So,
what the candidates now face is a question of strategy and tactics. Sanders
remains all-in on Medicare-for-All. “I wrote the damn bill,” he keeps reminding
reporters. Biden and the rising-in-the-polls Pete Buttigieg, the mayor of South
Bend, Ind., are firmly in favor of a more moderate approach. “We take a version
of Medicare. We let you access it if you want to. And if you prefer to stay on
your private plan, you can do that, too,” Buttigieg said at the Democrats’ October debate.
“That is what most Americans want.”
Sen.
Elizabeth Warren of Massachusetts looks like she is trying to have it both
ways. She has unveiled a far more detailed version of Medicare for All
than Sanders or other backers of the concept in Congress. And her campaign has
unveiled a “first-term” health plan
that could be implemented quickly, moving to a broader Medicare for All system
later in her first term. (Even Warren’s transitional plan is more expansive
than either Biden’s or Buttigieg’s plan.)
Who’s
right? There’s no good way to tell until voters go to the polls. But it might
surprise people that the last time a health overhaul was a major issue in the
Democratic presidential primary race ― in 2008 ― it wasn’t the candidate with
the most sweeping plan who emerged as the winner.
Then-Sen.
Hillary Clinton had a more sweeping plan for health care than her Senate
colleague Barack Obama did. Clinton called for a cap on out-of-pocket medical
expenses, and an “individual mandate,” the requirement (repealed by Republicans
in 2017) that people either prove they have coverage or pay a fine.
Obama
resisted many of those specifics, particularly the mandate. “In order for you
to force people to get health insurance, you’ve got to have a very harsh stiff
penalty,” he said at a debate in February 2008.
Eventually he called for a mandate that all children have
coverage. Obama did not fully embrace the mandate that would become
part of the Affordable Care Act until mid-2009, during the congressional
debate.
But
Democratic primary voters have moved significantly to the left
since 2008, Medicare for All proponents say.
That is
clearly the case. But if Democrats are to keep control of the House of
Representatives, they will need to keep the loyalty of those independent voters
in districts that are far more moderate than those represented by left-leaning
lawmakers like Alexandria Ocasio-Cortez (D-N.Y.) and Ilhan Omar (D-Minn.), who
are pressing for major changes including the passage of a Medicare for All
plan.
The key
to all this, of course, is threading the political needle in a way that keeps
the enthusiasm of the Democrats’ Medicare for All base, while not scaring away
voters in swing areas who fear such major changes. So far, not one of the
presidential candidates has found that perfect spot. The one who does could
well be the next president.
HealthBent,
a regular feature of Kaiser Health News, offers insight and analysis of
policies and politics from KHN’s chief Washington correspondent, Julie Rovner,
who has covered health care for more than 30 years.
Julie
Rovner: jrovner@kff.org,
@jrovner
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