There’s a good reason why the most in-depth policy discussion of the three-hour Democratic debate on Thursday night was about health care. It is the single most important issue of the campaign for Democratic and Democratic-leaning voters, as well as for voters overall. How do I know? They just told us.
The disagreements on health care among the Democratic candidates revolve largely around whether to institute Medicare for All, as Bernie Sanders and Elizabeth Warren have advocated, or to have, in Pete Buttigieg’s formulation, Medicare for All Who Want It. There’s a lot more to it, but in a nutshell, that’s the core difference.
Even centrist, moderate Joe Biden’s plan is significantly to the left of Obamacare. In 2009 Democrats tried but failed to include a public option in health care reform, but that one would have been available only to those shopping for their policy on an ACA exchange. Going far beyond that, Biden wants to make “a public health insurance option like Medicare” available to everyone, including those who get health insurance from their employer and don’t go through an exchange. Plus, Biden’s proposed public option would negotiate rates from providers, hospitals, etc. This would be a big improvement on the status quo.
Personally, I believe the Sanders/Warren Medicare for All plan would produce better results at lower costs for Americans (full disclosure: I announced nine months ago that I preferred Sen. Warren as our party’s nominee). Warren, including on Thursday night, has done a brilliant job explaining why that plan makes the most sense. Additionally, she has refused to fall into the trap of the “won’t you be raising middle-class taxes?” frame. She won’t provide video of a “yes” answer to that misleading and incomplete question—video that Republicans would use endlessly in all kinds of out of context ways.
At this week’s debate, just as she did at the previous three, Warren instead focused on costs to families. Moderator George Stephanopoulos set the trap with his initial question, and then this follow-up: “Direct question. You said middle-class families are going to pay less. Will middle-class taxes go up to pay for the program?” Warren wouldn’t take the bait.
Those at the very top, the richest individuals and the biggest corporations, are going to pay more. And middle-class families are going to pay less. That’s how this is going to work. What families have to deal with is cost, total cost. That’s what they have to deal with.
What we’re talking about here is what’s going to happen in families’ pockets, what’s going to happen in their budgets. And the answer is Medicare for All. Costs are going to go up for wealthier individuals, and costs are going to go up for giant corporations. But for hard-working families across this country, costs are going to go down, and that’s how it should work under Medicare for All in our health-care system.
Of course families will be better off paying less money in premiums to Medicare for All than the cost of premiums they now bear (and yes, even though their employer pays part of the premium in many cases, it’s still coming out of their salaries in the end). In addition, Americans will no longer have co-pays or deductibles. Who cares about having a choice of health insurance companies if you have 100% choice of doctors and hospitals, and 100% comprehensive coverage with no out of pocket costs?
Still, I don’t know whether the plan I prefer is the politically smart one for Democrats to be pushing. According to a recent Pew survey, even among Democrats, the plan I prefer only garners 44% support, compared to 34% who prefer something along the lines of Medicare for All Who Want It. Among all voters, about one-quarter prefer each of those paths, with the Warren/Sanders Medicare for All plan running three points stronger.
A Kaiser Family Foundation poll done earlier this month asked the question slightly differently, and found that Democratic voters favor “build[ing] on the ACA” vs. “replacing the ACA with Medicare-for-All” by a margin of 55% to 40%.
Here’s what I do know: Either of those approaches would improve on Obamacare (which all the Democratic candidates acknowledge was a tremendously positive step forward), and both of them stand in stark contrast to the health care “policy”—if one can call it that—of the Man Who Lost The Popular Vote.
The first part of that man’s plan is to repeal Obamacare, lock, stock and barrel. He is pushing for the Supreme Court to declare it unconstitutional specifically because the individual mandate no longer exists. Why does it no longer exist? Because Donald Trump, with the help of Mitch McConnell and then-Speaker Paul Ryan (wow, did he disappear completely once he left office), zeroed it out—although they didn’t actually repeal it, and it is still on the books even if defunded.
Trump says he will replace the ACA, but apparently his White House isn’t actually doing any work to come up with a replacement plan. Whatever they are doing, they have stated flatly that they will not “provide details about who is working on such a plan, what it might contain or when it might be ready.” In other words, the plan is as real as the Orange Julius Caesar is honest.
Beyond ACA repeal, Trump’s health care policy—along with the decision to curtail the Medicaid expansion provided for by Obamacare in states where Republicans have recently gained power—resulted in fewer Americans having health insurance coverage. This drop is the first one since the Affordable Care Act became law in 2010, and comes during a period of overall economic growth. That fact makes clear the degree to which Trump and Republicans are sabotaging the American health care system.
“It’s very frightening in that if this is happening now with unemployment at 3.7 percent, then what’s going to happen when the employer coverage situation gets worse?” said Eliot Fishman, a senior director at the consumer group Families USA and a top Medicaid official in the Obama administration. “There’s a fear we could see really dramatic increases in the uninsured rate if that happens.”
If we ended up with the Sanders/Warren plan, that would be a great thing for the American people. Other wealthy countries, as Sanders reminded us on Thursday night, pay one-half what the U.S. pays per person, and they cover everyone with similar or better results than Americans get. But you know what? If we ended up with Biden’s plan, it would still represent tremendous progress over the ACA as passed, and especially over the Trumpified version of it that exists currently thanks to the measures taken by President Individual 1 to undermine it.
By all means, let’s debate the merits of the various Democratic proposals now. And then, once we have our nominee, let’s come together behind the winning candidate’s plan and help the American people see the clear choice in front of them on health care. To start with, the Democrats will fight to expand access to health care, protect people with pre-existing conditions, and make sure that insurance actually covers people’s medical needs.
Trump? He’s fighting to destroy all the progress made under Obamacare and send us back to 2007, a time when if you lost your job, you lost your health insurance and possibly the ability to ever get new coverage if you or someone in your family had a pre-existing condition. Back then companies could sell you a junk insurance policy that, if you actually got sick, wouldn’t cover much more than a band-aid. Trump is trying to resurrect those zombie junk policies and make them legal once again. For the American people, the choice is that stark. If Democrats make that choice central to the 2020 election campaign, Americans will pick the right option.
Ian Reifowitz is the author of The Tribalization of Politics: How Rush Limbaugh's Race-Baiting Rhetoric on the Obama Presidency Paved the Way for Trump (Foreword by Markos Moulitsas)