Health care has emerged as the issue of the Democratic primary. As Americans grow increasingly dissatisfied with their expensive health insurance, candidates have emerged with a broad spectrum of plans to increase access to care. The dividing line in the primary is over universal health care. Sens. Bernie Sanders and Elizabeth Warren, the top-tier candidates on the issue, have each proposed plans to eliminate private health insurance and replace it with a government-sponsored plan, while rivals like South Bend Mayor Pete Buttigieg and Vice President Joe Biden have criticized this approach as overly ambitious and expensive. Below, we’ve rounded up where the top candidates in the 2020 race stand on the issue of universal health care.
Sanders made the expansion of Medicare to cover all Americans a key plank of his policy platform when he ran in 2016, arguably bringing the issue to the Democratic mainstream for the first time. This election is no different: In April, the Vermont senator introduced his Medicare-for-All bill, which established a plan for the United States to transition to a single-payer health care system. At the time, his plan was co-sponsored by several of his current rivals in the race, including Warren, New Jersey Sen. Cory Booker, and California Sen. Kamala Harris.
Sanders’s plan would prevent employers from providing health care plans that compete with the government’s option, and it establishes a four-year timetable for Americans to switch over to the new universal Medicare. During those intervening years, people would be able to buy into a public option for health care. Under President Sanders, all Americans would be able to access a universal health care plan that would cover a wide array of services, including hospital visits, vision and dental benefits, maternity care, lab services, medical devices, and more; the only out-of-pocket spending would be on prescription drugs. Essentially, going to the doctor or the emergency room would become totally free. Because this plan would be paid for by taxes and automatically apply to all Americans, it can be referred to as universal.
As a co-sponsor of Sanders’s Medicare-for-All bill, Warren is another strong advocate for universal health care in the race. On a debate stage earlier this year, she and Sanders both raised their hands when asked if they would support eliminating private insurance entirely, a question that has tripped up some of their fellow candidates.
Warren wants to institute a system that reduces America’s rate of uninsured individuals down to 0% by making health care essentially free. Where she and Sanders differ, however, is how to pay for such a comprehensive overhaul. Both have proposed frameworks for covering the trillions of dollars that Medicare-for-All would cost, with Warren releasing hers last week after her critics had attacked her for being light on specifics. While both senators support increasing taxes on the super wealthy, they have differed on other measures: Sanders has proposed a payroll tax, which would raise taxes that employers pay on their taxes by 7.5 percent, while Warren’s plan would instead require that employers with more than 50 employees calculate how much they currently pay for health insurance and then give 98% of that amount to the government’s Medicare-for-All fund.
Sanders recently attacked Warren’s payment plan, describing his own as “far more, I think, progressive, because it’ll not impact employers of low-wage workers but hit significantly employers of upper-income people.”
In a riff on Sanders’ proposal, the South Bend mayor has proposed a so-called “Medicare For All Who Want It” plan. In other words, the government would provide a low-cost health care option that people could buy into if they aren’t satisfied with their employer-provided insurance — but they wouldn't have to opt in. “Everyone should have the option of getting coverage through a public insurance alternative,” Buttigieg’s campaign said in a statement. “This way, if a private insurance plan from your employer or the marketplace isn’t affordable, you can get a plan that is.” Buttigieg’s plan is more of an expansion on the Affordable Care Act than it is a truly universal plan — people could still choose not to pay for health care if they can’t afford it.
Buttigieg criticized universal health care at the Democratic debate in September. “The problem, Senator Sanders, with that 'damn bill' that you wrote and that Senator Warren backs, is that it doesn’t trust the American people,” he said. “I trust you to choose what makes the most sense for you, not my way or the highway.” He again attacked the merits of Medicare-for-All at the October debate, challenging Warren over how she'd pay for her plan and saying that his idea was "just better than Medicare-for-All."
Like Buttigieg, the former vice president has proposed a public option that would be available as a hypothetically low-cost alternative to employer-sponsored healthcare. Biden is explicitly portraying his plan as an expansion of the ACA, which he helped make into law during his work in the Obama administration, but 2020 rivals like Harris point out that while his plan may insure 97% of Americans, that still leaves about 10 million people without coverage.
That's because the Biden plan says a family could spend no more than 8.5% of their income on insurance, which still might be too much for lower-income families. In a video announcing his health care plan, though, Biden argued that “adding a public option to Obamacare is the best way to lower costs and cover everyone.”
He has explicitly rejected Medicare-for-All, describing it as an Obamacare repeal that undoes the progress he helped Obama make when the ACA was passed. And he has criticized the plans of his rivals as too expensive, additionally claiming they'd take too long to enact. "I think we should be in a position of taking a look at what costs are,” he said in September. “My plan for health care costs a lot of money. It costs $740 billion. It doesn't cost $30 trillion, $3.4 trillion a year.”
Attempting to thread the needle between Biden and Sanders, Harris released her own more moderate take on Medicare-for-All earlier this year. Her version of the plan would not eliminate private insurance; instead, it would require that all private plans abide by a set of requirements comparable to Medicare. “Medicare will set the rules of the road for these plans, including price and quality, and private insurance companies will play by those rules, not the other way around,” Harris wrote.
Her plan would take far longer than the Sanders plan to implement: Where the Vermont senator proposed a transition period of four years, Harris has offered a period of 10 years in which Americans could buy into a government option. Other candidates, like Booker and entrepreneur Andrew Yang, have offered similar mash-up plans to Harris's.