The decision by several of Sen. Bernie Sanders’ rivals for the 2020 Democratic presidential nomination to endorse his healthcare proposal is turning into a colossal blunder.
Healthcare policy professor and author Aaron Carroll observed on Tuesday, “It’s somewhat baffling to me that the debate [amongst] Democrats has devolved into a discussion about whether we’d ‘completely ban private insurance’ under Medicare for All. Almost no universal systems in the world have completely banned private insurance.”
But there’s a very simple explanation for this.
When Sanders unveiled his “Medicare for All” plan in 2017 and updated it this April, four of his colleagues and 2020 contenders joined him both times: Sens. Kamala Harris, Elizabeth Warren, Cory Booker, and Kirsten Gillibrand. At the time, they wanted to co-opt an idea that seemed to have a strong following, and to not allow room on their Left on a central issue of the campaign.
But by taking this approach, not only did they unnecessarily associate themselves with the most extreme position on healthcare, but they gave themselves significantly less flexibility to articulate their own vision on the issue during the campaign. Specifically, it meant that they endorsed a plan that would effectively eliminate private insurance by: 1) transferring all Americans onto a single government plan within four years; 2) outlawing all private plans that cover any of the same benefits as the government plan; and 3) offering such a wide range of benefits on the government plan, that it would effectively leave nothing for private plans to cover. Meanwhile, Sanders, the lead author of the bill, has repeatedly argued that it would get rid of private insurance except for cosmetic surgery coverage, which Margot Sanger-Katz helpfully points out at the New York Times, doesn’t even exist.
There was no reason for these candidates to make Sanders their healthcare guru.
Had they not endorsed the Sanders plan itself, Harris and Warren (the co-sponsors with the highest odds of taking the nomination) would have been free to explore a number of different approaches. One would have been to design a plan that offered a government option to all without explicitly requiring that everybody give up their private insurance to join it. There’s nothing to suggest it would have considerably hurt them. People who support the abstract concept of “Medicare for All” aren’t necessarily demanding the Sanders version or bust. A June Kaiser Family Foundation poll found that among those who supported a national health plan, 89% described it as “very important” that the plan offered coverage to everybody, compared with just 38% who said it was “very important” that it eliminated private insurance.
Even if Harris and Warren ultimately decided to migrate everybody to a government-run plan, they still had options open to them other than the Sanders approach.
Harris has spent the primaries vacillating on the role of private insurance, before coming to her current untenable position that she supports the Sanders bill that effectively eliminate private insurance while at the same time emphasizing that there would be a role for private “supplemental” coverage. Which, as shown above, would effectively be nonexistent.
If that’s the position she wants to take, however, she could have advocated a system similar to Canada’s, in which everybody has the government plan for their primary coverage, but about two-thirds of the public also has private coverage for vision, dental, prescription drugs, and other services not covered by the national plan. That at least would have given some meat to her argument about “supplemental” coverage. But under the Sanders plan that she’s stuck endorsing, such coverage would not be possible, because his plan promises to cover all of those services and bars private insurers from offering duplicating coverage.
There are some liberals who argued early on that by endorsing the Sanders plan, in addition to others, Democratic candidates would leave the door open to various approaches. Warren, in March, argued that there were multiple pathways to get to universal coverage. But this argument did not require endorsing the Sanders plan.
When the Sanders plan came out, instead of joining as a co-sponsor, Warren could have said something to the effect of, “I support the idea of ‘Medicare for All,’ but I will be releasing my own plan outlining my own vision on healthcare.”
Instead, once she went down the road of becoming a co-sponsor, the cost of walking away and proposing something else became greater. So in the first debate, she found herself boxed into to embracing the elimination of private insurance that currently covers nearly 180 million, and declaring “I’m with Bernie.” So the die has been cast even if she subsequently releases a different plan.
Sure, in a general election matchup against Trump, anything is possible. But by letting Sanders set the terms of debate on healthcare, his rivals created an unnecessary liability for themselves by ensuring that the fight over universal healthcare would be fought on the terms least favorable to them.
