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November 15, 2019

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Where Democratic presidential candidates stand on health care reform

Health care continues to be a major issue on Americans' minds, and as Democratic presidential candidates launch their campaigns, it's also a policy priority for them. Lisa Desjardins reports on the contenders' various proposals and talks to Dylan Scott of Vox about terminology and branding, political calculations and how Americans view an expanded government role in health care.

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  • Judy Woodruff:

    Next, we return to a new series we're launching on the policy positions of the 2020 presidential candidates.

    Tonight, Lisa Desjardins explores the various approaches to reforming health care coverage that some prominent contenders are advocating.

    First, some background.

  • Lisa Desjardins:

    In the big-name, big-field Democratic race for president, health care is the biggest issue.

  • Sen. Kirsten Gillibrand, D-N.Y.:

    We want health care as a right, and not a privilege.

  • Lisa Desjardins:

    Much of it echoing one candidate.

  • Sen. Bernie Sanders, I-Vt.:

    Is health care a human right, or is it not?

  • Lisa Desjardins:

    Vermont Senator Bernie Sanders' Medicare for all legislation is co-sponsored by no less than four other senators and one congresswoman for president. The Sanders bill would create one government-run health care system, ending private health insurance.

    Medicare and Medicaid enrollees would transition into the new system. It wouldn't impact the Veterans Affairs or Indian Health Services coverage. But even as the most Democratic contenders so far seem to agree, look carefully. There is divide over how far to go and how fast.

    The day he announced his presidential run, New Jersey Senator Cory Booker, when asked, said he wouldn't end private health insurance.

  • Sen. Cory Booker, D-N.J.:

    Even countries that have vast access to publicly offered health care still have private health care, so, no.

  • Lisa Desjardins:

    Also in favor of keeping private health insurance are Senators Kirsten Gillibrand of New York and Elizabeth Warren of Massachusetts, that vs. California Senator Kamala Harris, who told a CNN town hall in January she does want to end private insurance.

  • Sen. Kamala Harris, D-Calif.:

    I believe the solution — and I actually feel very strongly about this — is that we need to have Medicare for all. That's just the bottom line

    (CHEERING AND APPLAUSE)

  • Lisa Desjardins:

    Later, her communications team walked that back, saying she is open to other plans as well.

    Fully government-run health care is the broadest idea, but many Democratic candidates also support smaller takes on that, like expanding Medicare to start 10 years earlier, at age 55, or offering a so-called public option, which would be a government-run health insurance plan, possibly like Medicare.

    South Bend Mayor Pete Buttigieg told "NewsHour"'s Judy Woodruff he likes a government option now as a first step.

  • Pete Buttigieg:

    Take a version of Medicare or something like it, make it available as a public option on the exchange. Then this will be a very natural glide path to a single-payer environment.

  • Lisa Desjardins:

    Meanwhile, polling shows this is good political territory for Democrats. A Kaiser Family Foundation survey last month showed a majority, 56 percent, of Americans they surveyed favor a Medicare-for-all style national health plan, while 42 percent oppose.

    A whopping 77 percent support lowering the Medicare buy-in age to 50. Put Minnesota Senator Amy Klobachar in the camp of too soon for full-blown government run health care.

  • Sen. Amy Klobuchar, D-Minn.:

    I think it's something that we actually wanted to do back when we were looking at the Affordable Care Act, and we were stopped, was trying to get a public option in there.

  • Lisa Desjardins:

    All of this is a shift left from recent years. For example, the Affordable Care Act passed in 2010 after Democrats dropped the idea of a public option.

    For much of the country, it's also changed from last year, when most Democrats running for Congress focused on saving the Affordable Care Act and its protections for sick people.

    Now the conversation on the Democratic presidential trail is about expanding past, sometimes far past, the Affordable Care Act.

    The candidates have some different takes on health care.

    And to talk about that, Dylan Scott joins us. He covers health care and domestic policy for Vox.

    Let's jump right into the terminology, which I think could become an issue for the next year.

    We hear Medicare for all. We hear universal health care. Is it clear that those terms mean the same things to all of these candidates?

  • Dylan Scott:

    Well, I think it is important to be clear that there is a bill in the United States Senate called the Expand and Improve Medicare for All Act that Bernie Sanders has put forward.

    And that would institute a single-payer national health insurance program that every American would be covered under. So that is the legislation that, when Bernie Sanders talks about Medicare for all, that's what he means.

    But Medicare for all has also taken on a bit of a life of its own. It's become a slogan that I think signifies that we want to expand health care access, we want more people to be able to join Medicare if they want to.

    But, for some people, the not — maybe the people who aren't true believers in single-payer health care, it's become more of an effective branding to talk about universal health care, as opposed to a specific policy proposal that's been written into legislative text.

  • Lisa Desjardins:

    That leads exactly to my next question. We have almost every candidate from Congress who's a Democrat backing Bernie Sanders' plan, technically.

    Do we know, if president, if these people would actually enact that? It seems like it might not be their first choice. How do you break down what they really want to do?

  • Dylan Scott:

    So I think of the Democratic candidates in a couple different buckets.

    You have the true believers, the Bernie Sanders, who say Medicare for all, single-payer is where we need to go, and that's the bill we should be putting up on the — up in Congress in 2021, if we get control of the White House and the Senate and the House.

    But there's another bucket of Democrats who are a little more flexible, let's say. They — they have endorsed the Bernie Sanders bill. They say their goal is to get to a Medicare for all system. But in the near term, they will talk about shoring up the Affordable Care Act, tackling prescription drug prices.

    And then over a little longer-term time horizon, they're more willing to take incremental steps to get to a Medicare for all system. Then, you do have a third bucket of Democrats who don't want anything to do with this. They're aware of some of the attacks that will be made against the Medicare for all program, like it'll lead to higher taxes, less access, the socialist takeover of the medical system.

    For Democratic voters, the interesting question will be, is it important to have a kind of absolutist approach, where we must have single-payer? Or do they like hearing that your goal is to expand health care access, but they're not as caught up on the details of how you get there?

  • Lisa Desjardins:

    There's also some political calculation here, right? If someone goes too far to the left in the primary, can they win in the general?

    What do we know about the overall population and what the Americans in general want for health care?

  • Dylan Scott:

    Voters are comfortable with a pretty robust government role in providing health care access to our population.

    Now, whether that means they're really interested in a single-payer program, I think, is the great undetermined question. When you talk to pollsters, they will actually say, I don't think Americans really know what they think about single-payer yet.

    We do like the idea of everybody having access to health care, and we're comfortable with the government having a big role in providing it. But people get a little antsy if they — if they hear that, well, everybody is going to be forced into this government insurance program. They like the idea of choice.

    Now, whether that choice is, can I choose the insurance carrier and the insurance card that I keep in my wallet, or whether the more important choice is about what doctor I can go see and what hospital will take my insurance, I think that's one of the things that we're still figuring out.

    Americans like the idea of universal health care, but higher taxes obviously make Americans nervous. The idea that they might lose some choice makes Americans nervous. And so I think what remains to be seen is whether they're as committed as the Bernie Sanders of the world to a national health insurance program that's comparable to something like Canada, or whether they would be OK with more incremental steps.

    But the idea of disrupting a system that's mostly working for them makes them more nervous than anything else.

  • Lisa Desjardins:

    And we're also waiting to see in some cases how these candidates would pay for their plans, right?

  • Dylan Scott:

    Yes.

    That's the issue nobody really wants to touch.

  • Lisa Desjardins:

    Dylan Scott, we will ask you about it hopefully in the future. Thank you for joining us.

  • Dylan Scott:

    Thank you.

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