Democrats Search for the Holy Grail of Health Care

The 2020 contenders disagree on whether the health-care system needs a major overhaul or incremental fixes.

Aaron Bernstein / Reuters

The 2020 Democratic hopefuls can agree on one thing: All Americans should have access to health care. But what that means in practice could look dramatically different depending on which candidate, if any, wins the presidential election.

Four of the 10 candidates who participated in the first Democratic presidential debate tonight are on the record as supporting Medicare for All—a government-run insurance plan for all Americans. The rest seem to support a hybrid way forward, in which Americans who have private insurance would get to keep their plan, but those who are underinsured would be able to sign up for an (ideally inexpensive) public plan.

During the debate, Senator Amy Klobuchar of Minnesota supported this more incremental approach. “It’s something Barack Obama wanted to do, which is a public option,” she said, referring to the early debates over the Affordable Care Act. “I’m concerned about kicking half of America off their health insurance.” Beto O’Rourke, the former U.S. representative from Texas, said something similar, noting that he would “preserve choice” by not erasing private insurance plans.

Several others, though, want to go further, putting all Americans on a Medicare-style plan. “I spent a big chunk of my life studying why families go broke. One of the No. 1 reasons is the cost of health care and medical bills,” said Senator Elizabeth Warren of Massachusetts. “Medicare for All solves that problem.” Congresswoman Tulsi Gabbard of Hawaii and Senator Cory Booker of New Jersey also seemed to support a single-payer, Medicare for All approach.

The candidates supporting single-payer might face challenges ahead because most Americans are happy with their own health coverage, and the idea of single-payer health care will likely raise the specter of “socialized medicine”—and unpleasant associations with struggling socialist countries such as Venezuela. That’s before taking into account the hospital closures that might occur if private-insurance payments to hospitals are sliced to Medicare levels, as John Delaney, the businessman and former U.S. representative from Maryland, pointed out during the debate. Then again, supporters of Medicare for All say that doctors and hospitals would save money and time if they no longer had to tangle with insurance companies to get their services covered.

Warren focused on insurance companies as the cause of high health-care costs in the current system, suggesting that their goal is to bring in high premiums and pay out as little as possible for health services. But it’s not clear that health insurers are the true—or at least the sole—culprits when it comes to the mind-boggling prices Americans pay for medical care. In fact, many health experts have converged around the idea that American doctors, hospitals, and other providers simply charge too much for their services. Finding a way to rein in those costs, without shuttering hospitals and while still offering all Americans affordable, comprehensive coverage, remains the holy grail of health care—regardless of whether the end result is private insurance or a government plan.

No matter which Democrat’s vision for health care prevails, the devil will be in the details of how to accomplish just that. Of course, a 60-second debate answer is rarely enough time for details.