By Joseph Ax
(Reuters) – Perhaps no issue has divided the field of Democratic 2020 presidential hopefuls more than the debate over “Medicare for All.”
Progressive candidates favor the sweeping proposal, which would replace private health insurance with a single government-run plan. More moderate candidates have embraced less drastic measures they say would achieve universal healthcare coverage while allowing individuals to choose their plan.
Here is where each of the 10 Democrats who have qualified for Wednesday’s debate in Atlanta stand on Medicare for All:
MEDICARE FOR ALL OR BUST
The U.S. senator from Vermont authored Medicare for All legislation that would essentially abolish private insurance in favor of a single government-run plan that covers every American. The ambitious proposal would cost more than $30 trillion over 10 years, according to independent analyses.
Sanders has acknowledged he would impose higher taxes on families to help pay for the program, but has argued that the typical middle-class family would save overall by eliminating virtually all health expenses.
The bill would transform Medicare – now primarily for Americans aged 65 and over – into a universal system and ban employers from offering healthcare plans to compete with the government. Aside from prescription drugs, patients would face no out-of-pocket costs when accessing medical services.
Several Democratic rivals, including former Vice President Joe Biden, have criticized Sanders’ plan as unrealistic.
Warren, a U.S. senator from Massachusetts, has endorsed Sanders’ proposal. Unlike Sanders, who has not explained specifically how he would pay for the plan, Warren has released a detailed financing proposal.
Warren has estimated Medicare for All would cost $20.5 trillion in additional government spending over 10 years. That is lower than what independent analyses have found, but Warren has argued that she would achieve savings by lowering administrative costs and reducing drug prices, among other changes.
She would rely on tax increases for corporations and the wealthy, most notably billionaires, and said the plan would not raise taxes for middle-class families “one penny.”
The proposal was met with skepticism by several of her Democratic rivals, including Biden, whose campaign accused her of engaging in dishonest “mathematical gymnastics.”
Warren said she would transition to Medicare for All gradually over three years, including initial legislation to make Medicare available to all Americans while preserving existing employer-based insurance at first.
PREFERRING A PUBLIC OPTION
The No. 2 to former Democratic President Barack Obama has criticized Medicare for All as an effort to dismantle the Affordable Care Act (ACA), Obama’s signature healthcare law.
Instead, Biden has vowed to “build on” the ACA, popularly known as Obamacare, by adding a public option that would leave the current private insurance system in place.
His healthcare plan, estimated to cost $750 billion over 10 years and paid for partly by higher taxes on the wealthy, would let people enroll in a paid government healthcare plan as an alternative to private insurance. The government plan would be modeled on Medicare and available even to workers with employer-provided policies.
The proposal would also expand the ACA’s subsidies for private policies, making them more generous and extending them to more people.
Like Biden, Buttigieg, the mayor of South Bend, Indiana, favors a public option, which would allow individuals to opt into a government plan but would preserve the existing role for private insurers. Buttigieg, who has coined the phrase “Medicare for all who want it” to describe the concept, has argued that a public option will eventually lead to a single-payer system, because individuals will find that Medicare is more cost-efficient than private policies.
Unlike other fellow senators seeking the Democratic presidential nomination, Klobuchar did not co-sponsor Sanders’ Medicare for All legislation.
Klobuchar, a moderate from Minnesota, has said she would improve on the Affordable Care Act by adding a public option, giving people the chance to choose a government-backed plan. She has criticized Medicare for All as a “pipe dream.”
Steyer, a billionaire-turned-Democratic mega-donor who entered the race in July, has said he favors a public option that would allow Americans to choose a government-backed plan.
STAKING OUT A MIDDLE GROUND
For months, the U.S. senator from California – an original co-sponsor of Sanders’ Medicare for All legislation – struggled to clarify whether she would eliminate private insurance in favor of a single-payer health plan, as the Sanders bill envisions. On at least two occasions, she appeared to answer in the affirmative before walking back her statements.
Harris has since released her own Medicare for All plan, which stands somewhere between the sweeping Sanders proposal and more moderate alternatives.
Under Harris’ proposal, all Americans would be covered by Medicare, but private insurers would continue to play a role by offering plans within the Medicare system similar to the current Medicare Advantage program that allows recipients to choose private insurance plans that offer extra benefits.
Her plan sets out a 10-year period to phase in the new system, unlike Sanders’ goal of four years. Harris has said she would use a mix of new taxes on the wealthy and corporations to finance her plan, although she has not offered a precise price tag.
Yang, an entrepreneur, supports the concept of Medicare for All, arguing that the prevailing job-based insurance system discourages businesses from hiring due to ever-rising costs, while forcing people to stay in jobs they dislike for fear of losing their healthcare coverage.
He has said he would not ban private insurers but does not believe they would be able to compete with a no-cost government plan.
Booker, a senator from New Jersey, was one of the co-sponsors of Sanders’ Medicare for All legislation and has repeatedly affirmed his support for that bill.
But he has also said “pragmatism” may require a more incremental approach, such as a public option, that would eventually lead to a true single-payer system.
Like Harris, he has signed onto several alternative Democratic-backed healthcare bills in the Senate that would create a public option and lower the Medicare eligibility age from 65.
The Hawaii congresswoman has said she supports Medicare for All, and she is a co-sponsor of a version of Sanders’ bill in the U.S. House of Representatives.
However, Gabbard has also said she would prefer to allow people who are happy with their employer-sponsored or union healthcare plan to keep it, and she did not raise her hand in June at a debate when the candidates were asked whether they favored eliminating private insurance.
(Reporting by Joseph Ax in New York; Editing by Soyoung Kim and Bill Berkrot)