Health care has emerged as a fault line for Democrats in the 2020 presidential campaign, dividing candidates over the viability of “Medicare for All,” a single-payer, government-run program that would cover all U.S. citizens.
Their proposals range from eliminating all private insurers and providing only public coverage, to giving Americans a choice between private insurance and a public option.
Here’s where the seven candidates participating in the PBS Newshour/POLITICO Democratic debate stand on the issue.
Joe Biden: Wants to build on Obamacare
Biden has not endorsed Medicare for All, questioning the enthusiasm Democratic voters have for the plan. As Vice President, Biden fought for the passage of the Affordable Care Act. When Republicans attempted to repeal the legislation in 2017, Biden published an op-ed in The Washington Post listing the achievements of the health care law, including improvements in emergency care, addressing the opioid crisis and expanding Medicaid.
His campaign website says he wants to “defend and build upon” the ACA by offering a public option like Medicare while maintaining private insurance. In states that have rejected Medicaid expansion, Biden also wants to offer free access to a public option for qualifying residents. He proposes increasing the value of tax credits to lower premiums and extend coverage.
“Whether you’re covered through your employer, buying your insurance on your own, or going without coverage altogether, the Biden Plan will give you the choice to purchase a public health insurance option like Medicare,” his website says.
Pete Buttigieg: Wants ‘Medicare for all who want it’
Buttigieg has called the country’s current system “unjust and insufficient.” The mayor of South Bend, Indiana, endorses a “Medicare for all who want it” plan that he says would provide a public health care option, while allowing people to keep private insurance. The proposal would be open to everyone. In states that have not expanded Medicaid, low-income residents would be automatically enrolled.
Buttigieg’s plan would implement an “all-payer” rate setting that sets one price for any given medical procedure. “We make sure that everybody can afford [public health insurance], but we don’t require you to take it. And partly I think that’s just the right policy, because I think people should be able to choose,” he told NPR.
Amy Klobuchar: ‘There’s a better way’ than Medicare for All
Klobuchar believes in universal health care, but does not endorse Medicare for All, telling CNN she thinks “there’s a better way.” Klobuchar says her approach will “insure more people and bring premiums down with a nonprofit public option” that “builds on Obamacare.” Her public option would expand Medicare and Medicaid, according to her website.
Lowering drug prices has also been a policy focus for Klobuchar. She introduced a bill to allow Medicare to directly negotiate prices, and co-authored a bill with Sen. Chuck Grassley, R-Iowa, to speed up the availability of low-cost generic versions of high-cost drugs.
Bernie Sanders: Endorses Medicare for All
Sanders was one of the first lawmakers in the race to propose a government-run health care system for all Americans. He was the lead Senate sponsor of the 2017 “Medicare For All” bill, which would launch universal health care and end employer-provided health insurance.
A report released by the Urban Institute in October found that his single-payer approach would cost $34 trillion dollars over 10 years, more than the total cost of Social Security, Medicare and Medicaid combined.
“Look, I am not denying that we’re going to spend a lot of money,” Sanders told PBS NewsHour in response to criticism about the potential costs of his plans. “But [critics] cannot deny that we’re saving people substantial sums of money by eliminating all premiums.”
The Vermont senator would fund the plan through multiple sources: a 6.2-percent charge on employers, a 2.2-percent fee on most families, increased marginal tax rates for incomes $250,000 and higher, increased taxes on capital gains, and a larger estate tax for the wealthiest. Under the plan, the top individual income tax rate would be 52 percent.
Tom Steyer: Create a public option
Steyer’s plan is another centrist approach that proposes expanding health care access through more Obamacare funding and a public option. He envisions a system where the federal government negotiates health care costs with providers and medical groups. Steyer says this would operate separately from Medicaid and Medicare, but that providers that want to serve Medicare or Medicaid patients also would be required to participate in the public option. He says the plan would cost $1.5 trillion over a decade.
In his campaign announcement, Steyer criticized pharmaceutical companies for profiting off of drug sales and helping spur the deadly opioid crisis. In 2017, he supported a California bill that would require drug manufacturers to provide notification of price increases.
Elizabeth Warren: Support Medicare for All with wealth tax
Warren, a staunch supporter of the Affordable Care Act, currently promotes a Medicare for All plan. In November, Warren unveiled a $20.5 trillion plan that would, among other things, implement a billionaire wealth tax, increase taxes for corporations, as well as require employers, state and local governments to make payments to the federal government to pay for universal health care.
“Medicare for All is the best way to cover every person in America at the lowest possible cost because it eliminates profiteering from our health care and leverages the power of the federal government to rein in spending,” Warren says on her website.
Andrew Yang: Medicare for All with private insurance option
Yang has called the Affordable Care Act a good first step but believes the law didn’t do enough to reform the nation’s health care system. He supports a Medicare for All plan that would retain the option of private insurance. His website criticizes the country’s current model, and calls for a system that focuses on salaried physicians, holistic medicine and mental health.
“We have a system that’s not designed to maximize health and well-being, we have a system designed to maximize revenue,” Yang told NBC.
The entrepreneur has also proposed funding artificial intelligence efforts that could improve mental health services and would create a “White House psychologist corps” that would evaluate and screen administration staff.