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 U.S. Senator Bernie Sanders has championed the ambitious goal known
as "Medicare for All," which would replace the current patchwork
healthcare structure with a single-payer system. The plan would
provide government coverage to everyone based on the existing
federal Medicare program for Americans 65 and older and would
effectively eliminate private insurance.
On the other side of the debate, candidates like former Vice
President Joe Biden, the current Democratic front-runner, have
criticized Medicare for All as unworkable. They have proposed a
public option, which would make a government plan available as an
alternative to, but not a replacement for, private insurance.
Others have tried to stake out a middle ground, expressing support
for Medicare for All as a long-term objective but endorsing steps
less far-reaching than a single-payer system that eliminates private
insurance.
The differences between the various proposals are often arcane and
difficult to explain, leaving voters watching the televised debates
unsure where each candidate stands.
"I think for the general public, the debate's been baffling," said
Tricia Neuman, the director of the Medicare policy program at the
nonprofit Kaiser Family Foundation. "There's been a lot of talk
about Medicare for All and a lot of these other proposals, but the
differences between them are fairly hard to decipher."
The distinctions pale in comparison to the gulf between the
Democratic plans and the priorities of the Trump administration,
which has sought to repeal the Obama-era Affordable Care Act in its
entirety.
Here is where each of the 10 Democrats who have qualified for this
week's debate in Houston stand on universal healthcare:
ALL IN FOR MEDICARE FOR ALL
Bernie Sanders
The U.S. senator from Vermont authored the Medicare for All
legislation that would revamp the entire healthcare system,
essentially abolishing 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 proposed higher taxes on employers and families to help
pay for the program but has argued that the typical middle-class
family would save more overall by cutting out health expenses.
The bill would transform Medicare 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 Biden, have criticized Sanders'
plan as unrealistic.
Elizabeth Warren
Warren, a U.S. senator from Massachusetts, is known for releasing
policy proposals on virtually every issue – but she has yet to
advance her own detailed healthcare proposal.
Instead, she has endorsed the Medicare for All legislation authored
by presidential rival Sanders, although she has also said there may
be "different ways" to reach universal coverage.
Warren raised her hand at a June presidential debate when asked
whether she favored eliminating private health insurance, unlike
some other candidates who had co-sponsored Sanders' plan, such as
U.S. Senator Cory Booker.
Like Sanders, Warren and other supporters of the pricey plan have
argued that families will save money overall by erasing medical
expenses.
IMPROVE OBAMACARE BY ADDING PUBLIC OPTION
Joe Biden
The No. 2 to former Democratic President Barack Obama has criticized
Medicare for All plans as efforts to dismantle the Affordable Care
Act, Obama's signature healthcare law.
Instead, Biden has vowed to "build on" the ACA, popularly known as
Obamacare after his former boss, 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.
Pete Buttigieg
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.
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He has criticized Medicare for All plans such as the legislation
championed by Sanders as unrealistic.
Amy Klobuchar
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 not released a detailed
healthcare plan. But she 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.
Julian Castro
The U.S. housing and urban development secretary under Obama has
said he would offer Medicare to all Americans as a public option. He
has also said individuals who prefer private insurance should be
permitted to choose that as an alternative.
He has not offered a detailed proposal of his own.
MIDDLE GROUND
Kamala Harris
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.
The 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.
Sanders' and Biden's campaigns criticized Harris' plan, with the
former accusing her of folding to the interests of the health
insurance industry and the latter saying she was undercutting the
Affordable Care Act.
Andrew Yang
Yang, an entrepreneur, supports Medicare for All, arguing that the
prevailing job-based insurance system discourages businesses from
hiring while forcing people to stay in jobs they dislike.
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. He has
not offered a detailed version of how he would achieve a
single-payer system.
Cory Booker
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.
Booker has not yet unveiled a detailed healthcare proposal.
Beto O'Rourke
The former congressman from Texas supports legislation in the Senate
known as "Medicare for America," which occupies a middle ground
between the "Medicare for All" bill led by Sanders and more moderate
proposals to create a public option.
Medicare for America would offer a government plan to all Americans,
including those covered by employer-provided insurance. The bill
would eliminate private insurance sold in the individual market but
would continue to allow private insurers to offer plans through the
Medicare Advantage system, as they do now.
Notably, the plan automatically enrolls newborns into the public
program, making it more likely that job-based plans would continue
shrinking in the future. O'Rourke has said the goal would eventually
be to reach a single-payer system in which everyone is covered by
Medicare.
(Reporting by Joseph Ax in New York; Editing by Colleen Jenkins and
Peter Cooney)
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