By Paige Winfield Cunningham / The Washington Post
Medicare-for-all activists won’t be pleased if Wednesday’s debate amounts to another health insurance wonkfest.
In the previous four Democratic presidential debates, the candidates spent considerable time deep in the policy weeds, forcing one another to answer a raft of difficult questions such as how to transition tens of millions of Americans onto public benefits, what to do with the existing private insurance complex and how to pay for a universal health-care system. Those are all important considerations if Congress ever moves in the direction of Medicare-for-all or a public option.
But progressives pushing hard for single-payer argue it’s the big, broad arguments — not minor differences among the candidates’ positions — that will make the case to voters to embrace Medicare-for-all. It’s the prospect of a generous set of benefits protecting everyone that attracts people to the approach, they say, and those broad principles are what they want the candidates to especially stress tonight rather than getting mired down in the mechanics.
“We think candidates have spent too much time digging in on weedy issues which are not the issue most Americans care about,” Lisa Gilbert, vice president of legislative affairs for Public Citizen, told reporters yesterday. “Those that support it should be doubling down and talking about why it matters to regular Americans.”
Yet if the candidates want to get wonky tonight, there will be more than enough opportunity.
In the weeks since the October debate, Sen. Elizabeth Warren, D-Mass., has released two specific proposals on how to pay for Medicare-for-all and how to move the country there more gradually. She wrote those plans after she was criticized for ducking the hardest questions about whether Medicare-for-all would mean higher taxes and no more private coverage.
For that reason — and because she’s trying to regain her former lead in Iowa caucus polls — Warren probably will be front and center in any Medicare-for-all discussions. Right now, she’s neck-and-neck with Sen. Bernie Sanders, I-Vt. — the original Medicare-for-all evangelist — and former vice president Joe Biden, who has already gone aggressively after Warren and Sanders on the topic and prefers a public option approach.
Leading everyone is South Bend, Indiana, Mayor Pete Buttigieg, who has done his own balancing act on Medicare-for-all. Buttigieg was originally an enthusiastic supporter of the Sanders approach but has since majorly qualified his stance, now saying people should be allowed to buy a Medicare-type plan but also be able to keep private coverage if they prefer.
Celinda Lake, a pollster for Biden, said “that horse is already out of the barn” when it comes to whether the candidates will argue details.
“There is no question that the way to sell any of these health-care plans to the public is to have a broader conversation, but I don’t think the opponents will let each other do that,” she told me.
To progressive activists, the danger for Democrats is aggressively highlighting their differences on Medicare-for-all instead of stressing their broad, mutual goals of achieving universal affordable coverage are lost in the shuffle.
Adam Green, co-founder of the Progressive Change Institute, recalled an interview between MSNBC host Chris Matthews and Warren after the debate in Detroit. In that interview, Matthews drilled Warren over and over on whether Medicare-for-all would require more taxes:
Warren has countered those questions by arguing that American families would pay less in health-care costs overall, even if their tax bill is higher. Green said that’s what Americans care about fundamentally: their own bottom line.
“It is absurd to get so in the weeds that we’re getting past voters and really talking to the Chris Matthews of the world,” Green said.
Public Citizen says it has online polling showing support for Medicare-for-all changes little among voters, even when it is described in different ways. That underscores the group’s argument that the candidates shouldn’t worry as much about details as about getting their message of universal health coverage across.
This much is clear: The Democrats can’t not debate health care tonight. One in 4 respondents to a Kaiser Family Foundation poll released today said health care is their top issue — far surpassing the 12 percent of respondents who cited the environment and climate change as No. 1. And it is legitimate to argue that the costs of transitioning to a single-payer system is hardly a weedy issue, as well as questions about how and whether private insurance will be eliminated.
Democratic-leaning voters indicated they do want to hear more from the candidates about the fate of their health-care plans under a sweeping new system, according to the Kaiser poll. Some of the poll’s specific findings:
• Fifty percent of Democrats and Democratic-leaning independents say the candidates are spending too little time talking about how their plans will affect seniors on Medicare.
• Forty-seven percent want to hear more about how to pay for the proposed changes.
• Forty-five percent want to hear more about whether their plans would increase taxes on the middle class.
• Forty-five percent want to hear more about how the candidates will work with Congress to enact their plans.
Brian Fallon, press secretary for Hillary Clinton’s 2016 presidential campaign, said what’s important is that candidates come across as “authentic” in whatever arguments they make. He’s not worried they’re hurting the party’s chances with all their Medicare-for-all jousting.
“I feel fairly confident in predicting on the day of the election … the Democratic nominee will be more trusted on health care,” Fallon said.