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- The key question Democrats are confronted with is whether to overhaul the nation’s healthcare system, which makes up around 18% of the American economy.
- In the run-up to the second Democratic primary debates where 20 candidates are taking the stage, the battle lines are being drawn on healthcare reform.
- Perhaps no element of the intense healthcare debate has been scrutinized more so far than the role of private insurers, forming an ideological faultline along Democrats’ policy proposals.
- "This really comes down to a debate about how disruptive to be in a health reform plan," Executive Vice President Larry Levitt of the Kaiser Family Foundation told INSIDER.
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To overhaul or not to overhaul?
That’s the key question Democrats are confronted with when it comes to dealing with the nation’s healthcare system, a behemoth of a sector that makes up around 18% of the American economy. In the run-up to the second Democratic primary debates where 20 candidates are taking the stage, the battle lines are being drawn on healthcare reform.
Perhaps no element of the intensifying healthcare debate has been scrutinized further in the primary so far than the role of private insurers, forming an ideological faultline along Democrats’ policy proposals.
Some progressives are calling to eliminate private insurance, arguing they are incentivized to maximize profits at the expense of patients. Revenues for the top five health insurers are projected to reach $787 billion, larger than the five preeminent tech companies, according to Axios.
Those progressives have found champions in Sens. Bernie Sanders and Elizabeth Warren, both proponents of "Medicare-for-All," a plan that would expand Medicare and enroll all Americans in a single-payer system on a government plan — and virtually eliminate private insurance. On the opposite end of the spectrum is former Vice President Joe Biden, an advocate of the Affordable Care Act who wants to keep private insurance while adding a government-run option, a far more incremental approach.
Others like Sen. Kamala Harris are straddling the middle: She wants to expand Medicare with the aid of private insurers to achieve universal healthcare, but phasing it in over a decade. Her plan is a stark contrast to Sanders, who’s proposed to enroll every American within four years.
"This really comes down to a debate about how disruptive to be in a health reform plan," Executive Vice President Larry Levitt of the nonpartisan Kaiser Family Foundation told INSIDER.
‘A lightning rod’
The debate, however, isn’t anything new. Healthcare reform has been an underlying current within Democratic politics stretching back to the immediate post-World War II era, when President Harry Truman proposed a "universal" national health insurance program. In an attack line that echoes today, powerful healthcare groups tore into Truman’s proposal as "socialized medicine" and the bill died in Congress.
Five decades later, the Clinton administration undertook a similar ill-fated crusade for healthcare reform in the early 1990s, undone by charges it represented a government takeover of healthcare. Former President Barack Obama faced similar opposition when he signed the Affordable Care Act into law in 2010.
The dynamic is still very alive, Levitt says, noting that "a plan that goes too far in eliminating private and employer-based insurance is open to attack." And with healthcare a top issue for voters around the country anxious about rising costs, the candidates are unloading the cannons.
When Harris rolled out her middle-ground plan on Monday, Sanders immediately blasted it. He said in a CNN interview that Harris’s plan is "not ‘Medicare for All’" and he believed a purer form of it recognizes "health care is a human right and that the function of a sane health care system is not to make sure that insurance companies and drug companies make tens of billions of dollars in profit."
It’s a confrontation that pits the hearts and heads of voters and candidates alike. At a Michigan campaign stop last week, Biden reportedly derided the sweeping plan endorsed by his rivals: "Come on, what is this, a fantasy world?" Meanwhile, Sanders charged earlier this month that Biden was behaving like a Republican on healthcare, and the two sparred over the issue.
Rhetorical barrages aside, a new poll from the Kaiser Family Foundation shows about half the public supports the broad idea of "Medicare for All," which Sanders helped push to the mainstream during his 2016 presidential campaign. But support plunges when voters are told the plan could raise their taxes or lead to delays in getting their care.
Depending on the trajectory of the debate around Medicare for All, Levitt says the taxes needed to support the sweeping proposals could be its "most controversial element," given the plan envisions getting rid of premiums and deductibles. "Americans tend to be allergic to tax increases," he says.
The Sanders Medicare for All plan includes a list of financial options to cover its cost, including a tax on the wealthiest Americans. But Americans would have to pay more in taxes to cover its price tag, with similar proposals estimated to cost from $28 trillion to $32 trillion.
With the "detente" between moderate Democrats and progressives now broken on healthcare, Levitt told INSIDER, the primary field is set to undergo a bruising fight as what’s within the four corners of their healthcare proposals becomes clearer.
"The history of health reform is that it works very well on the level of a bumper sticker but as soon as you start filling in the details, it becomes a lightning rod," Levitt said.
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