A Los Angeles rally supporting Medicare for all. Eighty-one percent of Democrats approve of the idea, according to a recent poll.CreditRonen Tivony/NurPhoto, via Getty Images
NY TIMES
The debate unfolded over a period of days, on multiple televised stages in different states. There were no direct clashes between the candidates, no traces of personal animus — but a debate it was, the first vivid disputation over policy in the 2020 Democratic presidential primary.
The subject, perhaps predictably, was health care. At issue was just how drastically to transform the American system, and how comprehensive the role of government should be.
/cdn.vox-cdn.com/uploads/chorus_image/image/63075789/1097370070.jpg.0.jpg)
In one camp were a pair of blunt-speaking Midwesterners, Senators Amy Klobuchar of Minnesota and Sherrod Brown of Ohio — both beloved by many liberals, yet both dismissive of fellow Democrats’ promises to create a vast new apparatus of government-backed health care. They endorsed incremental policy changes, like lowering the age of eligibility for Medicare.On the other side was the party’s most uncompromising economic populist, Senator Bernie Sanders of Vermont, a self-described democratic socialist who promised nothing short of a revolution in health care with his proposal for “Medicare for all.” He held up Canada and Western Europe as working models for the United States.
“If our friends in Scandinavia can provide quality health care to all of their people as a right, for far less than we spend, you tell me why we can’t do it,” Mr. Sanders said in a CBS interview, broadcast on Tuesday morning after he declared his candidacy for president.
The political and policy fault lines were familiar ones, but the scale and clarity of the disagreement was new to the 2020 presidential primary, an affair that has thus far unfolded as a contest of splashy campaign rollouts, forceful personalities and overlapping policy wish lists. While the party’s most prominent candidates have differed in their rhetoric and most distinctive legislative proposals — Senator Elizabeth Warren’s wealth tax, or Senator Kamala Harris’s middle-class tax cut — at this early stage they have declined to engage the submerged philosophical rifts between them.
The political and policy fault lines were familiar ones, but the scale and clarity of the disagreement was new to the 2020 presidential primary, an affair that has thus far unfolded as a contest of splashy campaign rollouts, forceful personalities and overlapping policy wish lists. While the party’s most prominent candidates have differed in their rhetoric and most distinctive legislative proposals — Senator Elizabeth Warren’s wealth tax, or Senator Kamala Harris’s middle-class tax cut — at this early stage they have declined to engage the submerged philosophical rifts between them.
Yet the exchanges over health care hinted that those ideological divisions may not stay buried for long: As the Democratic primary field develops and grows, the party is headed for a fuller public conversation about the role of government and the scale of their own ambitions.
Even before Mr. Sanders entered the race, other candidates drew unsubtle lines separating themselves from his brand of politics: Ms. Warren has branded herself a proud capitalist, and Ms. Harris said emphatically on Monday, “I am not a democratic socialist.”
But the debate over health care may be unique in its potency. It mirrors a larger struggle among Democrats over how daring their message ought to be, and whether promising to rapidly expand social-welfare programs is the best way to defeat President Trump.
Polls show that Democratic ideas for expanding government health care are popular, but the key details of a single-payer system can make many voters uneasy.
Jared Bernstein, a liberal economist who served in the Obama administration, said the distinctions between Democratic candidates had less to do with where they want to take the country than with how — and how quickly — they aim to get there. Their core priorities were largely identical, Mr. Bernstein said.
“The candidates who are trying to carve out more moderate positions are essentially saying, ‘I think we get from where we are to where we need to go through incremental steps.’ The others are saying, ‘No, we’re into giant steps,’”
That Mr. Sanders would be a champion of giant steps is no surprise. His insurgent campaign in 2016 exploded the bounds of traditional debate in Democratic politics and thrust once-remote ideas — like European-style health care and free tuition at public colleges — to the center of debate on the left. He has shown every sign so far of approaching 2020 in a similar spirit, and describes other proposed policy solutions as inadequate half measures. He cast all impediments as the products of a corrupt political system that could be overcome through a mass mobilization of the popular will.
[Read about Bernie Sanders’s entrance into the 2020 race, and where he stands on the issues.]
Invoking the watchword of his 2016 candidacy, Mr. Sanders said it was time to “complete that revolution” by enacting his health care and education policies. To him and his supporters, it is an article of faith that Democrats lost the 2016 election partly because Hillary Clinton failed to offer a vision of economic justice that might have captured some of the indignant energy of Mr. Trump’s campaign.
While throngs of Democrats have endorsed “Medicare for all” as a campaign slogan, Mr. Sanders has been nearly alone among the presidential candidates in demanding an immediate-term, full-blown version of the idea. Most of his leading rivals, like Ms. Warren and Senator Cory Booker, have backed the concept as an eventual goal as they pursue more pragmatic alternatives in the near term. (Ms. Harris endorsed eliminating private health insurance in a CNN town hall, but has also stressed her support for more modest ways of expanding government-backed care.)Mr. Brown and Ms. Klobuchar stand out for their willingness to say “no.”
Both have long been skeptics of single-payer health care, viewing it as impractical and disruptive. They are both closely attuned to the sensibilities of the moderate Midwest, a region that delivered the presidency to Mr. Trump and that Democrats are determined to recapture in 2020.
Mr. Brown, who has been visiting early primary states but has not decided whether to run for president, kicked off the long-distance debate over the weekend, arguing on CNN that pushing for single-payer would be a mistake.
“I want to help people now, and helping people now is building on the Affordable Care Act,” said Mr. Brown, a liberal populist whose diagnosis of the country’s economic problems resembles Mr. Sanders’s in important ways.
Even before Mr. Sanders entered the race, other candidates drew unsubtle lines separating themselves from his brand of politics: Ms. Warren has branded herself a proud capitalist, and Ms. Harris said emphatically on Monday, “I am not a democratic socialist.”
But the debate over health care may be unique in its potency. It mirrors a larger struggle among Democrats over how daring their message ought to be, and whether promising to rapidly expand social-welfare programs is the best way to defeat President Trump.
Polls show that Democratic ideas for expanding government health care are popular, but the key details of a single-payer system can make many voters uneasy.
Jared Bernstein, a liberal economist who served in the Obama administration, said the distinctions between Democratic candidates had less to do with where they want to take the country than with how — and how quickly — they aim to get there. Their core priorities were largely identical, Mr. Bernstein said.
“The candidates who are trying to carve out more moderate positions are essentially saying, ‘I think we get from where we are to where we need to go through incremental steps.’ The others are saying, ‘No, we’re into giant steps,’”
That Mr. Sanders would be a champion of giant steps is no surprise. His insurgent campaign in 2016 exploded the bounds of traditional debate in Democratic politics and thrust once-remote ideas — like European-style health care and free tuition at public colleges — to the center of debate on the left. He has shown every sign so far of approaching 2020 in a similar spirit, and describes other proposed policy solutions as inadequate half measures. He cast all impediments as the products of a corrupt political system that could be overcome through a mass mobilization of the popular will.
[Read about Bernie Sanders’s entrance into the 2020 race, and where he stands on the issues.]
Invoking the watchword of his 2016 candidacy, Mr. Sanders said it was time to “complete that revolution” by enacting his health care and education policies. To him and his supporters, it is an article of faith that Democrats lost the 2016 election partly because Hillary Clinton failed to offer a vision of economic justice that might have captured some of the indignant energy of Mr. Trump’s campaign.
While throngs of Democrats have endorsed “Medicare for all” as a campaign slogan, Mr. Sanders has been nearly alone among the presidential candidates in demanding an immediate-term, full-blown version of the idea. Most of his leading rivals, like Ms. Warren and Senator Cory Booker, have backed the concept as an eventual goal as they pursue more pragmatic alternatives in the near term. (Ms. Harris endorsed eliminating private health insurance in a CNN town hall, but has also stressed her support for more modest ways of expanding government-backed care.)Mr. Brown and Ms. Klobuchar stand out for their willingness to say “no.”
Both have long been skeptics of single-payer health care, viewing it as impractical and disruptive. They are both closely attuned to the sensibilities of the moderate Midwest, a region that delivered the presidency to Mr. Trump and that Democrats are determined to recapture in 2020.
Mr. Brown, who has been visiting early primary states but has not decided whether to run for president, kicked off the long-distance debate over the weekend, arguing on CNN that pushing for single-payer would be a mistake.“I want to help people now, and helping people now is building on the Affordable Care Act,” said Mr. Brown, a liberal populist whose diagnosis of the country’s economic problems resembles Mr. Sanders’s in important ways.