Democrats grapple with Medicare for All

MASON CITY, Iowa -- A half-dozen presidential candidates back "Medicare for All," a proposal to put the government in charge of most health benefits. But some of the Democrats they're courting aren't sure the nation's health care system should be overhauled so dramatically.

After watching Massachusetts Sen. Elizabeth Warren, a Medicare for All supporter, speak in a packed northeast Iowa tavern, 67-year-old Connie Suby said she backed the ambitious proposal as an ultimate goal. But she cautioned "we're not ready for that as a country," urging "baby steps" keeping private health insurance in place.

"Give people the option," she said.

Suby is among the Democratic voters concerned such a major remodeling of America's health care infrastructure might be too big of a leap for their party's next president. While polls suggest Democrats like the idea of Medicare for All, it's not clear they're sold on an abrupt shift away from private insurance. In more than two dozen interviews across three early-voting states, most Democratic voters said they're open to a more incremental approach toward single-payer health care starting with making government-run insurance available to more people -- such as a publicly funded health plan Americans could choose as an alternative to their employer-sponsored plan.

That explains the complicated dance Warren and others, including Sens. Kamala Harris of California, Cory Booker of New Jersey and Kirsten Gillibrand, are performing as they balance their support for single-payer with rhetorical room for private insurance companies to still play a role in the system. Warren told a voter at a Virginia town hall Thursday it's not "inconsistent" to pursue Medicare for All as well as smaller steps to get there, such as lowering the age for Medicare eligibility.

Other candidates have simply spurned Medicare for All. Former Vice President Joe Biden has called for the expansion of Medicare as an option for Americans of all ages to buy into "whether you're covered through your employer or on your own or not." Former Texas Rep. Beto O'Rourke touts "Medicare for America," which would automatically provide government-run insurance to those who don't get it through their jobs.

Only Bernie Sanders, the author of the Senate's Medicare for All bill, is solely focused on single-payer as a way to "fully solve the health care crisis," an approach his team thinks adds to his progressive bona fides.

The Vermont senator's legislation would set up a four-year transition to government-run care for almost all health treatments, free of premiums or deductibles, with private insurance available as a supplement. Warren, Harris, Booker and Gillibrand have been less clear on how they would treat private insurers under a Medicare for All system, and each has supported more incremental steps to increase access to care.

Despite enthusiasm from many progressives for Medicare for All, it's unclear whether Democratic primary voters will choose a nominee based on a single-minded commitment to ending private health insurance. Chris Jeffrey, a 55-year-old grocery manager from Clive, Iowa, praised Sanders for having "pushed the debate" toward the most far-reaching health care vision. But even though Jeffrey caucused for Sanders in 2016, he said he's open to Biden or Warren as well. While health care is a top issue for him, he doesn't favor one candidate's approach over another's.

President Donald Trump and the GOP have used Medicare for All as a cudgel in their battle to paint the Democratic agenda as too extreme for most voters. The White House blasted Sanders' bill last month in a statement predicting it would "cripple our economy and future generations with unprecedented debt."