Here's Where Elizabeth Warren, Kamala Harris, and Joe Biden Stand on Healthcare
One of the most striking moments in each night of the first Democratic primary debates occurred when moderator Lester Holt asked the candidates to raise their hands if they supported eliminating private healthcare insurance in favor of a government-run plan. On the first night, only Senator Elizabeth Warren and Mayor Bill de Blasio raised their hands, and on the second, only Sens. Kamala Harris and Bernie Sanders did. (After scanning his competitors, former Vice President Joe Biden lifted a cautious finger.)
Sanders has led the charge to eliminate private insurance with his vision for Medicare-for-all. Medicare currently provides health insurance to Americans over 65 and people with disabilities, and Sanders' plan would create a supercharged version of the program, expanded not just to cover the entire country but to insure more medical services and end deductibles and copays. This kind of tax-funded government insurance system is also called single-payer health care.
Medicare-for-all is still controversial among Democrats, but achieving universal healthcare-which would mean that every American has affordable access to the care they need-is a popular goal. Universal coverage could be enacted in a variety of ways, including government-run single-payer healthcare or a mix of private and public insurance options.
All the major Democratic candidates have endorsed broadening access to healthcare through some form of government intervention-every one of them indicated agreement in a Washington Post questionnaire that asked whether they supported "creating a public option to expand health care, such as allowing people to buy into a state Medicaid program regardless of income."
But candidates disagree on what that expansion should look like. Sanders has led the charge for a single-payer system that would abolish private insurance. But critics of his Medicare-for-all plan point out that nations like Canada and the UK have both government-run universal health care while also leaving citizens the option of holding private coverage. "Everybody who says Medicare for all and every person in politics who allows that phrase to escape their lips has a responsibility to explain how you are supposed to get from here to there," said South Bend Mayor Pete Buttigieg during Thursday's debate. "In countries that have outright socialized medicine like England, there is still a private sector."
Supporters of eliminating private insurance point out that any plan that allows for independent insurers would also have to leave room for those companies to earn profits. In countries like the UK, private insurance can act as a ticket to the head of the line for non-emergency care. In Canada, private insurance covers care that the government does not, like drugs and dental, and in France, insurers cover the deductibles and copays that are part of that nation’s government healthcare service.
"The only way to make room for a significant role for private insurance in the American context is to make the public system paltrier or skimpier, to impose onerous co-pays and deductibles, or to let the rich preferentially displace working-class people from hospital beds and doctors’ offices," wrote physician and researcher Adam Gaffney in The Nation in February. "But it doesn’t seem to make sense to punch holes in your own floor just to create work for a carpenter."
Here’s a guide to what the 2020 Democratic contenders are saying about how they’d ensure that every American has high-quality healthcare.
Joe Biden
Biden, in keeping with his less-is-more campaign so far, hasn’t gotten into the details of his healthcare vision. But he’s said he supports expanding Medicare as an option for all Americans, telling a Pittsburgh audience in April that, “whether you're covered through your employer or on your own or not, you all should have a choice to be able to buy into a public option plan for Medicare.” When WaPo asked outright if he supports some version of single payer, however, the frontrunner issued no response.
Bernie Sanders
No single candidate has had more of an impact on the Democratic healthcare debate than the Senator from Vermont. If elected president, he’d push for a single-payer plan that would eliminate private insurance, be free of copays and deductibles and give Americans the right to chose their doctor and hospital. He’s proposed paying for it with new taxes on the wealthy, but conceded during Thursday’s debate that middle-class Americans would probably also face a tax hike, though he argues it would be offset by healthcare savings.
Elizabeth Warren
"I’m with Bernie on Medicare-for-all," said Warren during Wednesday's debate. She was also among the candidates to raise their hands to end private insurance, which marks an evolution on the issue-earlier this year, she seemed to dodge the question. "Look at the business model of an insurance company. It's to bring in as many dollars as they can in premiums and to pay out as few dollars as possible for your health care," she said Thursday night. "That leaves families with rising premiums, rising copays, and fighting with insurance companies to try to get the health care that their doctors say that they and their children need. Medicare for all solves that problem."
Kamala Harris
Harris has signed onto the’ Medicare-for-all bill, and like Sanders, de Blasio, and Warren, she raised her hand Thursday night to indicate she was in favor of doing away with private insurance. But during a Friday appearance on Morning Joe, Harris said she’d misunderstood the question, and that she doesn’t support getting rid of private insurers.
This is the second time Harris has endorsed the idea before walking it back. In January, she’d dismissed private insurance, saying during a CNN town hall, "Let’s eliminate all that, let’s move on." Her team lated retreated from the statement, saying that Harris would be open to plans that kept some private insurance role.
Pete Buttigieg
Mayor Pete supports "Medicare for all who want it," he's said. "We take some flavor of Medicare, you make it available on the exchange as a public option," said the candidate during his March CNN town hall, "And you invite people to buy into it." Like most of the 2020 Democrats, Buttigieg doesn't support eliminating private insurance.
Cory Booker
Booker is a co-sponsor of Sanders’ Medicare-for-all bill, which would decrease the private insurance market, but his critics from the left remain doubtful of his commitment to progressive healthcare polices. In 2017, Booker voted against a bill that would have cut drug prices by importing medications from Canada, though he now supports efforts to curb pharmaceutical prices. He’d also keep private insurance. "We're not going to pull health insurance from 150 million Americans who have private insurance that like their insurance," Booker said in a CNN appearance last month.
Amy Klobuchar
The Minnesota Senator has come out in support of permitting states to expand Medicaid and placing caps on on premiums. Critics of leaving the issue to states point out, however, that the Affordable Care Act offered a Medicaid expansion, and 13 states have rejected it. In Wednesday’s debate, Klobuchar pledged to "do something about pharma, to take them on, to allow negotiation under Medicare, to bring in less expensive drugs from other countries.
Julián Castro
"I believe that we need universal health care," the former HUD secretary said in January, coming out in support of Medicare-for-all. Like Sanders, he’s endorsed paying for a single-payer system with a tax on the very wealthiest Americans.
Bill de Blasio
The New York mayor introduced a plan that would guarantee healthcare to all of those in his city in January, and he’s backed a single-payer national plan as well as the abolition of private insurance. "We need a universal healthcare system," he told The New York Times, "I think Medicare-for-all model is the pathway that gets us there."
Jay Inslee
Among all the candidates, Washington governor Inslee has one of the most impressive healthcare achievements under his belt. In May, he signed a law creating the country’s first state-run insurance plan that competes with private companies. Though it’s a landmark accomplishment, the measure was significantly watered down in order to pass the legislature, and premiums are only five to 10 percent cheaper than those offered by private insurers. As president, Inslee says he’d expand Medicare to cover “all who want it,” but that he wouldn’t eliminate the private insurance market.
Beto O'Rourke
Though he supported Sanders’ Medicare-for-all vision during his Senate race against Ted Cruz, by March of this year, former Congressman O'Rourke said he was “no longer sure” that single-payer was “the fastest way” to guarantee healthcare coverage for all Americans. These days, he supports expanding Medicare while maintaining employer-based insurance through a bill called Medicare for America.
Kirsten Gillibrand
"I do believe Medicare for All is the right solution for health care," Gillibrand said in May. "I think the quickest way to get there, to get to single-payer, to get to health care as a right and not a privilege, is to let people buy in over a four- or five-year transition period." She’s endorsed keeping private insurance for now, but says that it will likely eventually be replaced by the government plan.
John Hickenlooper
The former Colorado governor was famously booed by a Democratic crowed in San Francisco after he chided that “socialism is not the answer,” so it’s not surprising that he’s expressed skepticism about Medicare-for all. Republicans, he warned The Washington Post this month, would call single payer "‘socialism,’ and they're going to say this is taking away the freedom and independence of the individual.” But he's vowed that if elected he’d “work as President to get universal healthcare for all Americans."
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