Nixing private insurance divides 'Medicare for All' candidates

Some Democratic presidential candidates who say they support “Medicare for All” are walking a tightrope on whether to fully embrace a key portion of the proposal that calls for eliminating private insurance.

Only a few White House hopefuls raised their hands when asked at last week’s debates if they were willing to abolish private insurers, even though others who were on the stage have publicly backed legislation from Sen. Bernie SandersBernie SandersBloomberg: 'I'm going to stay right to the bitter end' of Democratic primary race The Memo: Biden seeks revival in South Carolina Sanders makes the case against Biden ahead of SC primary MORE (I-Vt.) which would do just that.

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Sen. Elizabeth WarrenElizabeth Ann WarrenBloomberg: 'I'm going to stay right to the bitter end' of Democratic primary race The Memo: Biden seeks revival in South Carolina Sanders holds 13-point lead in Fox News poll MORE (Mass.), Sen. Kamala HarrisKamala Devi HarrisThe Memo: Biden seeks revival in South Carolina Bloomberg campaign lobbied Yang for endorsement, possible VP offer: report Biden looks to shore up lead in SC MORE (Calif.) and Sanders all raised their hands, as did New York City Mayor Bill de BlasioBill de BlasioOcasio-Cortez cuts census ad with Lin-Manuel Miranda The Hill's Morning Report - Presented by Facebook - Trump on US coronavirus risks: 'We're very, very ready for this' De Blasio rips Bloomberg in Hannity interview: 'He's got no clue' MORE. But Harris later said she misunderstood the question, and clarified that she does not support eliminating private insurance.

“I am supportive of Medicare for All, and under Medicare for All policy, private insurance would certainly exist for supplemental coverage,” she said Friday morning on CBS News.

Sanders’s plan would cover every medically necessary service, including dental, vision and long-term care for people with disabilities.

That leaves little room for private insurers to cover anything except cosmetic surgery, Sanders has said.

Harris has seized on that exception to argue Medicare for All wouldn't eliminate private insurance, and that “supplemental coverage” would still exist.

Her comments, along with the discrepancy between those who have supported the Sanders bill on and off the debate stage, illustrate the delicate balance some Democrats are trying to achieve: They want to highlight their progressive chops by talking about Medicare for All, even though much of the voting public isn’t ready to give up their private insurance.

Harris has waffled on the issue of private insurance for months, despite being a co-sponsor of Sanders’s legislation. But she isn’t the only candidate in this situation.

Among the 2020 Democratic candidates, Sens. Cory BookerCory Anthony BookerThe Memo: Biden seeks revival in South Carolina Bloomberg campaign lobbied Yang for endorsement, possible VP offer: report Warren calls for changes to presidential pardon power, pledges to create clemency board MORE (N.J.) and Kirsten GillibrandKirsten GillibrandNow is the time for a US data protection agency The Hill's Campaign Report: Warren up, Bloomberg down after brutal debate Ginsburg, accepting lifetime achievement award, urges working fathers to take an active role in kids' lives MORE (N.Y.) are co-sponsors of Sanders’s bill, while Reps. Tulsi GabbardTulsi GabbardSteyer releases African American policy ahead of South Carolina primary Biden leads by 18 points in South Carolina: poll Buttigieg notes diversity on debate stage: We're '7 white people talking about racial justice' MORE (Hawaii), Tim RyanTimothy (Tim) RyanDemocrats tear into Trump's speech: It was a 'MAGA rally' Democrats walk out of Trump's address: 'It's like watching professional wrestling' Trump set to confront his impeachment foes MORE (Ohio) and Eric SwalwellEric Michael SwalwellRussian interference reports rock Capitol Hill California lawmakers mark Day of Remembrance for Japanese internment Chris Wallace: 'Just insane' Swalwell is talking impeaching Trump again MORE (Calif.) are co-sponsors of a similar House bill introduced by Rep. Pramila JayapalPramila JayapalCentrist Democrats insist Sanders would need delegate majority to win Democrats cancel surveillance vote over pushback to amendments 22 studies agree: 'Medicare for All' saves money MORE (D-Wash.), a co-chair of the Congressional Progressive Caucus.

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Booker said he thinks there is a role for private insurance, and told The New York Times in a recent candidate survey that he would pursue a public option.

During the debate, Booker was less clear about his plans.

“We have to do the things immediately that provide better care,” he said. “We can do this better, and every single day I will fight to give people more access and affordable cost until we get to every American having health care.”

In a statement after last week’s debates, Sanders said there can be no middle ground, and his campaign called on all the candidates to unequivocally say where they stand on Medicare for All. 

"If you support Medicare for All, you have to be willing to end the greed of the health insurance and pharmaceutical industries. That means boldly transforming our dysfunctional system by ending the use of private health insurance, except to cover non-essential care like cosmetic surgeries," Sanders said. "And it means guaranteeing health care to everyone through Medicare with no premiums, no deductibles and no copays."

Democrats are trying to coalesce around a single health care message, much like they did in 2018 to take back the House.

Some on the left maintain that backing Medicare for All legislation is a must for anyone who wants to secure the Democratic presidential nomination next year, but moderate candidates are wary of giving President TrumpDonald John TrumpThe Memo: Biden seeks revival in South Carolina Congress eyes billion to billion to combat coronavirus Sanders makes the case against Biden ahead of SC primary MORE and Republicans an opening to accuse Democrats of pushing for a “socialist” takeover of health care.

Polls show that voters like the idea of Medicare for All, though most don’t know that the legislation would eliminate private insurance.

June survey by the Kaiser Family Foundation found that despite what the authors of two Medicare for All bills in Congress have said, a majority of poll respondents thought they would still be paying premiums, deductibles and co-pays.

A similar Kaiser poll from January found that support for Medicare for All dropped from 56 percent to 37 percent when respondents were told it would eliminate private health insurance.

Robert Blendon, a health policy professor at Harvard University, said most candidates will be deliberately vague about Medicare for All, even the ones who are co-sponsors of the Sanders bill.

“I think many candidates signed onto the principle,” Blendon said. “They want a Medicare dominated system but didn’t fully understand that today’s Medicare … has a private alternative which is very popular. I just don’t think they are aware of that.”

Candidates like Sanders, who has been advocating for single-payer for years, understand the nuances, Blendon said, but most others are new to the debate.

“They wanted to show they are committed to moving the country … and now this issue has surfaced in the primary, and it will definitely surface in the general election about a private alternative if you want one,” Blendon said.

Before last week’s debate, Warren had drawn some criticism from the left for equivocating about her health care policy. But on Wednesday, she left no doubt about her position, and made an aggressive play for the progressive vote.

“I’m with Bernie on Medicare for All,” Warren said on the debate stage. She added that politicians who say Medicare for All isn’t feasible just aren’t willing to fight for it.

Warren’s shift puts pressure on Sanders, and was praised by progressive groups.

“When it mattered most, and with millions of people watching, she made the strongest case yet,” said Adam Green, co-founder of the Progressive Change Campaign Committee.

“There’s a huge difference between checking a box on a position, versus actually making the case for the public and persuading them you are right,” Green added. “If all you do is check a box, you aren’t prepared with strong rebuttals to the obvious Republican attacks.”

But Warren’s embrace of Medicare for All also makes her a prime target for attacks from Trump and his GOP allies. Trump has relished attacking Medicare for All, and brought it up again last week, unprompted, as he signed an executive order about health cost transparency.

“More than 120 Democrats in Congress support Bernie Sanders’s socialist takeover of American healthcare. It’s very dangerous,” Trump said. “The Democrat plan would terminate the private health insurance of over 180 million Americans who are really happy with what they have.”

Democratic candidate Sen. Amy KlobucharAmy Jean KlobucharSanders holds 13-point lead in Fox News poll Centrist Democrats insist Sanders would need delegate majority to win Bloomberg outspends field in Facebook ads ahead of Super Tuesday MORE (Minn.) touched on those attacks during the debate. She supports a Medicare public option, but is not a co-sponsor of the Medicare for All bill.

“I am just simply concerned about kicking half of America off their health insurance in four years, which is what this bill says,” Klobuchar said.