Democrats need to win the presidency and the Senate to have a chance of enacting any of the ambitious health-care plans they’ve proposed in the presidential primary so far, including Medicare for All. But if tonight’s debate made anything clear, it’s that they first have to get Republicans out of their head—and out of their fight.
Ten of the party’s White House contenders spent the initial chunk of their matchup in Detroit engaged in a spirited and surprisingly substantive debate on health care. They sparred over the merits of Medicare for All versus a public option, over the question of costs and taxes, and over the fraught issue of whether to do away with private insurance plans. But the crux of the debate came down to one question: How much do Democrats need to fear Republicans, and the inevitable attacks they’ll make on any far-reaching liberal policy proposals?
“It is time to stop worrying about what the Republicans will say,” South Bend, Indiana, Mayor Pete Buttigieg declared toward the end of the exchange, after candidates including former Representative John Delaney of Maryland and the author Marianne Williamson voiced concerns that Democrats were risking electoral suicide by touching what has become yet another third rail of American politics.
“It’s true that if we embrace a far-left agenda, they are gonna say we’re a bunch of crazy socialists,” Buttigieg said. “If we embrace a conservative agenda, you know what they’re gonna do? They’re going to say we’re a bunch of crazy socialists. So let’s just stand up for the right policy, go out there, and defend it.”
The mayor is not running from the party’s left flank, but his reminder, an echo of arguments former President Barack Obama used to make, seemed to crystallize the progressive end of the bold-versus-pragmatic debate Democrats are having. During the debate’s opening statements, one moderate hopeful after another introduced him- or herself to viewers as the more palatable, more realistic, more electable alternative to the two top contenders on the stage, Senator Elizabeth Warren of Massachusetts and Senator Bernie Sanders of Vermont.
“Tonight, I will offer solutions that are bold, that are realistic, and that are a clean break from the past,” Representative Tim Ryan of Ohio pledged. “I have bold ideas, but they are grounded in reality,” Senator Amy Klobuchar of Minnesota assured the audience. Former Colorado Governor John Hickenlooper said he was progressive but “a little more pragmatic.”
They tried to couch their pitches as more appealing to voters in the middle, as offering more choice and less disruption to the health-care system than their rivals. But to Buttigieg, Warren, and Sanders, the obstacle to reshaping a broken system is not opposition from voters themselves, but the fear of political reprisal. Indeed, Republicans—and, as Sanders pointed out, the insurance industry—have been framing the debate over health care in U.S. politics for a generation or more, ever since the famous “Harry and Louise” ads torpedoed the plan designed by then–first lady Hillary Clinton. When Obama finally achieved a major overhaul of the system, he sold the Affordable Care Act as legislation modeled on a law signed in Massachusetts by a Republican, Mitt Romney.
Warren and Sanders want desperately for Democrats to change the conversation, to stop fearing the big bad Republican wolf. They each begged their fellow Democrats to keep the GOP and its spectral presence out of the party’s internal debate over health care. “Let’s be clear about this: We are the Democrats. We are not about trying to take away health care from anyone. That’s what the Republicans are trying to do,” Warren said early on, in one of the night’s first big applause lines. “And we should stop using Republican talking points in order to talk with each other about how to best provide that health care.”
The debate over health care is tied up in the party’s broader argument over electability in the 2020 primary. In her opening statement, Warren warned Democrats against going for “small ideas and spinelessness.” What she really wants, however, is for the party to not get bogged down in the same fight that’s long been dictated by its opponents.